20050156.pdfDATE RECEIVED k-
PERMIT EXPIRES
USE PERMIT
ZONE
NUMBER, -
CITY OF EDMONDS
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADORES!,.
ER E/NAME OF BUSIN SS
RE E E 01 PLAT NAME/SUBDIVISION NO, LOT NO. LID NO�
R
.4L*
cc M I I Do 11 LID FEE $
W M I ING ADD fitS
z TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Rnquired E3
0 street Use Permit Heq'd 13
C11 inspection Required r3
ZIP ITELEPHONE EXISTING — PROPOSED Sidewalk Required 13
C) Z *2 REQUIRED DEDICATION— FT Undeiground
�)T wiring itiquilud
L _V40 * � I
z 4. —
NAME 'l, METER SIZE LI�E NO. OF FIXTURES PRV REQUIRED
N YES 0 NO
z
ADDRETS_ t/ REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
z
W
ZIP TELEPHONE
16 � 1 0
NAME CBL4
Z) I ENGINEERING REVIEWED BY DATE
M ADDRESS
0
FIRE REVIEWED BY DATE W
cc
CITY ZIP TELEPHONE M
0
VARIANCE OR CU SHORELINE OR ADEN INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY REO'D POSTED
111YES ONO S
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
W rl—oc,
EXP
N If LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
NEW RESIDENTIAL Er %� /4�H
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL z
CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED
GRADING FENCE
REPAIR CYDS ( X Fr) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY
FIRE ALARM
0
�VP OF U" 1jS,INEqS OR ACTIT EXPI&AIN: F C NS rkLICTION CODE OCCUPANT
CHECKED BY TYPEf
GROUP
ul ed, Amw ir, - 7 97
w NUMBER NUMBERbF CRITICAL 77
13 OF DWELLING AREAS SPECIAL INSPECTION JAREA UL;L;UPAN I
to UNITS NUMBER REQUIRED LOAD
0 STORIES A11A
DESCRIBE WORK TO BE DONE YES
REMARKS z
ROGRESS INSPECTIONS PER UBC 108/IBC109/IRCID9 FINALINSPECTION REQ'D F3
j
LA ti. d at
Z&j CC- -
VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
HECK NO- VESTED DATE Plumbing Base Fee
_44 //_0
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
:3 SEPARATE PERMISSION.
Engr. Review
cc PERMIT APPLICATION: 180 DAYS
W
IL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Cn 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Clik. Deposit
M IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp- Total Amt. Due
a DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY THE CITYS A131LITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt #
1 HER��NOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
I N IS OKI ECTI. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
I jE�F WNER I GREE AT PLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by the
1 4 V
10 ANDI� ING Tf OR UTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
I OVIOLATIO F THE OR CIE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged it) space provided.
U J
ORKMTV� MPE I:r
�;J U ANCE AND RCW 18.27.
0 MFICIXI. IGNATU E DATE
Sl N U WN 0 DATE Sl �ED (425) )` A/)
771-0220 —RE�F,)SED By 14ATE/__
ATttNTION EXT 1333
20 /:�j
ITIS UNLAWFULTO USE OR OCCUPYABUILDiNG OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - 14NSPE On
t'S
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK - OWNER GOLD - ASSE OR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
z
0
i
0
M
—i -n
Fn
M
C
M 0
0
--I (-)
0 C:
M
M Z
3:
(n
o -n
n
--i
3:9
M M
0 5)
0 r_
0 M
C Cn
F, Cn
M 0
Z
7-1
3:
z
co
z
0
1
0
M
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
GasTest ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
,lees
z
0
1
0
M
--I -n
M
C
ITI 0
0
0 C
—4 K . ,
M M
M Z
C
co
o -n
n
MITI
0
0
0 M
C C/)
r. Cn
M C)
Z
>
z
0)
z
0
M