20041085.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAM NAME OF BUSINESS
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE CHISCKED IBI
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PROPERTY TAX ACCOUNT PARCEL 190.
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NEW
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RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
oGARAGE
RETAINING WALL
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CARPORT
ROCKERY
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CrYP"F USE, BUSINESS OR ACTIVITY
,) EXPLAIN:
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NUMBER
NUMBER OF
OF
DWELLING
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STORIES
UNITS
FO BE DONE
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PLUMBING / MECH
COMPLIANCE OR
OF
CHANGE USE
SIGN
FENCE
( X Fr)
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
JRCE �,,)ILAZING % LOT SLOPE %
OLAN CHXK NO:,,. VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE 014 PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Lu PERMIT APPLICATION: 180DAYS
IL PERMIT LiMITI YEAR - PROVIDED WORK IS STARTED WITHIN 1130 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
LO
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED 10 MODIFY WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGEN1 OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TIqN; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN YIOLATION OF THE LABOP CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATIOq_�INSURANCE AND RCW 18.27,
SIGNATURE (OWNER 0 G V DAT� SIGN�ED
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PERMIT EXPIRES v -17
USE
ZONE
PERMIT
NUMBER
JOB
ADDRESS CD '
Q-1.1
SUITE/APT#
PLAT NAME/SUBDIVISION NO, LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
iESCP Approved
13W Permit Required
C3
13
Street Use Permit Roq'd
C3
EXISTING —
PROPOSED
Inspection Required
Sidewalk Hequirod
13
13
REQUIRED DEDICATION— FT
Underground
Wiring required
13
METER SIZE
LINE
SIZE
NO. OF FIXTURES
PRV REQUIRED
YES E3 NO 0
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REMARKS
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OWNER/CONTRACTOR
RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE W
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IIANCE OR CU
SHORELINE OR ADB#
INSPECTION
BOND
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POSTED
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OYES
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S
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP
LOT COVERAGE
REQUIRED SETBACKS (FT:)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDVEAR
FRONT L/R SIDE REAR
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PARKING
LOT AREA
PLANNING REVIEWED BY PATE.�,
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REO'D PROVIDED
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CHE�KED BY I TYPE OF CONSTRUCTION
CODE OCCUPAN�
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] q5 44-7
YES lf4 LOAD
REMARKS
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11PIROGRESS INSPECTIONS PER UBC 108/IBC109/IRClD9 FINAL INSPECTION RECI'D 5.
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
i
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
I
(425)
771-0220 R
Plan Chk. Deposit JI/ Y
Receipt #
Total Amt. Due _09_jrz.
Receipt#
APPLICATION APNROVAI
I his application is not a permit until signed by the
Building official or his/tier Deputy: and Fees ate paid, and
receipt is acknowledged in space provided.
_ ICI IS SIGNA(VRE DATE
,C",
ATTENTION Off 1333
IT IS UNLAWFULTO OSL OR OCCUPYA BUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPEOft
PINK - OWNER GOLD - ASSESSOR
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LOT COVERAGE, WORK SCOPE:
LOT SIZE- +1-�OMt SU. F T. TO CONSTRUCT A WOOD
EXISTING HOUSE4fta--lffllSQ, FT, FRAMED
NEW ADDITION- 1� SO, FVNWW�,fj� ADDITION OVER EXISTING
TOTAL- 'L71 (�5 SO. FT. GARAGE
104-81'
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PLANNING
RECEIVED
. . . . . . . . . . . . . .
. . . . . . . . . . . . . . . ...
. . . . . . . . . . DEC - 6 2004
....... . . . . . . . . . . . .
....... . .......
. ...... ... ..
...... . . . . . . . ....
. ... ......
. . . .......
......... . . . . . . . . . . . . . . . .
..... ....... .. SITE PLAN PERMIT COUNTER
...........
. . ... . .... .. .. . . . . . ...
.. ...........
. . . . . . . . . . . . ........
V1
. . . . . . ..... . . . . . . . . . . .
SCALE: 1 101.0
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.. ..........
. . . . . . . . . . . . . . . . . . . . . . . . . .
NORTH CITY, COPY
LEGAL DESCRIPTION KS (o qo46
SEE ATTACHED �M Jt ftkWOe $Lc� 016 t) � Cc - r-- ll'z� tzT t'� ��q'
(/mm"v co, +'�t - �01 - $00, (jt�
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
z
0
__4
Retaining Wall ...........
M
Slab Insulation ..........
PLUMBING:
Underground ............. M
C
Rough -In ................... 7- M
0
--I
0
0
Commercial Final ...... C
--I K
rn
HEATING: ITI Z
Gas Test .................... 10 C
>
Gas Piping ................. -3
Equipment ................. 0 -n
Commercial Final .......
M M
EXTERIOR SHEATHING
0
NAILING ..........................
0 M
C= cl)
FRAMING ........................
9 Cn
Q C)
FIRST FLOOR FRAMING... Z
INSULATION ................... IV\% ;U
3:
Floor Insulation ......... >
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Wall Insulation ...........
Ceiling Insulation ....... Cn
z
0
SHEETROCK NAILING ...
0
SPECIAL INSPECTION ... M
p
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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The fnitials MT are Milton
Thompson, a temporary contract
inspector for the CitY.