20050015.pdf7DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
AfLN r) , L-L C,
MAILING ADDRESS I— _L
-3 1 4 c57
TELEPHONE
NAME
ADDRESS
CITY ZIP
ITELEPHONE
NAME
CBL it
_V-)'yvq Is
ADDRESS �-,j
a-6 1 -1 1 ']1
CITY
Gei 4Z 'P
k�'� 9 ZIW
TELEPHONE
DCX40'�� i 1 -.6 0001
I
STATE LICENSE NUMBER
EXPIRATION DATE
CHECKED BY
1119�fA
__�
PROPE TAX ACCO U�LXT PARCE
dNl
NEW RESIDENTIAL
PLUMBIN<ED
ADDITION COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
rill REMODEL MULTIFAMILY
SIGN
GRADING FENCE
REPAIR CYDS ( X FT)
DEMOLISH TANK
OTHER
oGARAGE RETAINING WALL FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN!
NUMBER
OF
1
NUMbEk OF
DWELLING
CRITICAL
"IT'(
FAR E A S
STORIES
UNITS 4;111
UMB
NUMBER
DESC�BE WOj3K TQ BE D!n
LnL�A' I k
ONO 0`619-3y)
r1\0 AS.*
wi� A u:i-m)�_eA
V
(2n -(LINS
L.0AA CA, � ic'u \4L
LL-:� ac� 6.-Is
HEAT SOURCE
I GLAZING %
III
LOT SLOPE %
PLAN CHECK NO:
, 61"/f*>C ?
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
It: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Lu PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 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 TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
x
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 AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF Tfffi LABqR CODE OF THE STATE OF WASHINGTON RELATING TO
WQMRMEN'Uf COf FtNOATIOV INFJRANCE ANWW 18 27,
DATE ]IGNED
P ) �?'
U )6
PERMIT EXPIRES —71 J I ()D
USE PERMIT
ZONE NUMBER
JOB SUITE/APT#
ADDRESS 3�)C)
+k Al
PLAT INAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
AW Permit Required
13
13
Street Use Permit Roq'd
13
EXISTING — PROPOSED
inspection Requited
E3
Sidewalk Required
E3
REQUIRED DEDICATION- FT
1 Underground
I wrong required
E3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
I
YES 13 NO
I
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU
-ft�
SEPA REVIEW
COMPLETE , EXEMPT
EXP P/—
LOT COVERAGE
ALLOWED PROPOSE()
PARKING
REO'D I PROVIDET
REMARKS
CHECKED BY ITYPE
SHORELINE OR ADBI I INSPECTION ' BOND
IIEQ POSTED
Vlqj�V APP []YES Ike's 10�
SIGN AREA HEIGHT
r ALI OWED . PROPOSED I ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT LIR SIDE REAR
LOT AREA I PLANNING REVIEWED BY
.� 4 oed ji I '_-V '�
SPECIAL INSPECTION JAREA
REQUIREDE
OCCUPANT
GROUP IK/A
OCCUPANT
LOAD
W
cc
M
a
z
2
z
REMARKS 0
z
PROGRESS INSPECTIONS PER UBC 108 / IBC1091 IRC109 FINAL INSPECTION REO'D
—_W� '_'rj J_ ) --e7 I i L::�_4_A AA A A
1�7444 rV
VALUATION
A 't-A-7,+Z4,_ gtt 7,--�ym s
$ 4", . 117
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
ATTENTION EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
FEE Descri p-tion
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due z_
Receipt 41
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFFICIALS SIGNATURE D
T
171 � c,
4LEASED BY -7 nAtF
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU-
ORIGII,
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
-7
YELLOW - INS'PECTOR
GOLD - ASSESSOR
z
0
i
0
M
=i:ii
X
M
C
M
0
—i (-)
0 C
M
M z
01
C —Z
W
0 71
n
M M
0 _W
0 r_
0 M
C (1)
9 Cf)
M 0
Z
z
cn
z
0
A
0
M
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
z
0
Pier/Porch .................
0
Retaining Wall ...........
M
Slab Insulation ..........
Cl)
PLUMBING:
0
M
C
Underground .............
M
0
0
Rough -in ...................
C
Commercial Final ......
M
M z
HEATING:
Gas Test ....................
Gas Piping
J
Cn
-n
.................
0
Equipment .................
M M
Commercial Final .......
0
0
EXTERIOR SHEATHING
0 M
C Cn
NAILING ..........................
Cn
Q 0
FRAMING ........................
Z r-
FIRST FLOOR FRAMING...
INSULATION ...................
z
Floor Insulation .........
Wall Insulation ...........
z
Ceiling Insulation .......
0
SHEETROCK NAILING ...
0
M
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
:3 -8) 6S
OCCUPANCY ..................
a