20041091.pdfDATE RECEIVED
17,1 L-Cl FPERMIT EXPIRESLe // VI�L� 5
I
CITY OF EDMONDS PkRMIT
CONSTRUCTION PERMIT NUMBER Ll
APPLICATION JOB
OWN ADDREss2 SIITEIAIT,
ER NAMEINAME OF BUSINESS
IN 'A ss PLAT NAME/SUBDIVISION NO LOT NO LID NO
W DDR
z
0 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApprovod 13
CITY RW Permit Rtnjuifed 0
ZIP TELEPHONE EXISTING PROPOSED Street Use Permit Required 11
0 ell inspection ReqUiled E3
CC) REQUIRED DEDICATION SidijAalk Required C3
NAML FT Underground 13
Wmno rpourad C3
I 11::117F777��URES
METER SIZE PRV REQUIRED
U
Lu
ADD SS NOD z
i Ix
U REMARKS Uj
Ir OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDIRAINAGE Lu
z
3
�i I T z
Lu
NAME
CBL#
It-
ZA Oil
........... ) �ESSi
M ADD ENGIaftg�t -
o DATE
U
`- � -3
9 D,
z 2,11iY IP T,EP111E FIRE REVIEWED By
DATE w
L) 63
0 DK&f-
STATE LICENSE NUMBER ION DATE BY VARIANCE OR CU SHORELINE OR ADS# INSPECTION ;7A
Q.D
REO'D
Jr, L �14 QjS;;, If_(bqL1j_ 13YES 13NO COMPLETE EXEMPT
PROPERTY TAX ACCOUNT PARCEL NO, CA# I I
IF ZONE SIGN AREA HEIGHT
Uj WAIVERD
S' G'
ALLOWED PROPOSED ALLOVVED , PROPOSED
_j 70 :3n 0 t-1 STUDY
NEW RESIDENTIAL PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
to
ADDITION COMMERCIAL COMPLIANCE OR ALLOWED PROPOSED FRONT SIDE REAR FRONT LJRSIDE REAR
MIXED USE 0 CHANGE OF USE z
REMODEL PARKING TLOTAREA PLANNING REVIEWED BY z
MULTIFAMILY D SIGN DATE
REPAIR GRADING CYDS' m FENCE REO'D I PROVIDED (L
X _ FT.) REMARKS
DEMOLISH TANK OTHER
z GARAGE RETAINING WALL FIRE SPRINKLER
0 CARPORT ROCKERY FIRE ALARM
P: (TYPE OF USE. BUSINESS OI)ACTIVIT�� E7_,VLA1h
F.
TYPE T ON
U OCCUPANT
aj NUMBER Ef2 GROUP
a OF NUMBER OF ?C1
M I DWELLING
0 STORIES SPECIAL INSPECTIdN
UNITS CONSULTANT OCCUPANT
LO
DESCRIBE WORK TO BE DONE REQUIRED 13YES AD
REMARKS
C
z
Wk,
C04
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY;
VALUATION
............. $
Description FEE Description FEE
HEAT SOt LOTSLOPE% VESTED DATE Plan Check State Surcharge
PLAN CHECK NO: Building Permit City Surcharge
Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical
1= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
IE DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
M Grading
SEPARATE PERMISSION.
Engr. Review
dw PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19-00-005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
in
U) *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
ul Fire Review Plan Chk. Deposit
_1 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE 171TY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM Ai. Y AND Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY Receipt #
3: FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
C11
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp.
0 'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
3: NOR LIMIT IN ANY WAY THE CITY Total Amt. Due
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION L
/GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE OULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC This application is not a pennit until signed by the
TION: A IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL EEMPLOYED CALL Building Offical or his1her Deputy and Fetus are pad.and
IN V11 �5 13
WOIW�NTN 0 TH E LA"R CODE OF THE STATE OF WASHINGTON RELATING TO receipt is acknowledged in space provided
E COJPENSqlOrSUFPNC AND RCr 18:27. FOR INSPECTION
OFFICIAL SIGN TURE D
S NATURE (:ER 0 EN .
IN!
1, d D4TE SIOED
101 /,,)-jen (425)
ATTEN_hON A/ 771-02:20 RELEASED BY /DATE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL EXT. 1333
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. ORIGINAL -FILE - YELLOW -INSPECTOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES PINK -OWNER - GOLD - ASSESSOR
z
0
1
0
M
--i -n
j
X
M
M 0
0
40
0 C
M
M Z
C) --I
C
x
W
q -n
n
M M
065
0 r-
0 M
Q
Z
z
-1
X
0)
z
0
M
1%
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall...........................
z
Pier/Porch .................
0
--I
Retaining Wall ...........
0
M
Slab Insulation ..........
PLUMBING:
—j
Underground .............
M
C
M
0
Rough -In ...................
0
0
Commercial Final ......
C
M
M Z
HEATING:
z
Gas Test ....................
Gas Piping .................
0 -n
Equipment .................
n
Commercial Final .......
M M
0)
EXTERIOR SHEATHING
0 r—
NAILING ..........................
0 M
C: CD
FRAMING ........................
Q 0
Z
FIRST FLOOR FRAMING ...
;a
INSULATION ...................
Floor Insulation .........
z
Wall Insulation ...........
Ceiling Insulation .......
z
0
SHEETROCK NAILING ...
M
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
4 ?A0 1/- /0 4?/ 00000,