20050237.pdfDATE RECEIVED x
L L L12-br- C11 Z_ I I (.,d ERMIT EXPIRES
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USE PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB TIA T
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ADDRESS
LIWNER NAME/NAME OF BUSINESS
PLAT NAME/SUBDIVISION N LOT NO, LID NO,
4'e- !�c LN, P� ily
MAILING ADDRESS
Lu LID FEE $
I ESCP Approved 0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
0 RW Permit Hoquired E3
0 Street Use Permit Roq'd 0
CITY ZIP LEPHONE EXISTING — PROPOSED inspection Required 1:1
Sidewalk Sequirod 13
REQUIRED DEDICATION— FT Undergrotind
Wiring requited 0
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO
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ADDRESS REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE E5
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CITY ZIP TELEPHONE
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NAME CBL#
ENGINEERING REVIEWED BY DATE
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�.SHORELINE 0 AD INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE BY 13�> I REapr POSTED
DYES ANO S
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SEPA REVIEW SIGN 99EA HEIGHT
PROPERTY T ACCOUN COMPLETE , EXK ALLOWED PROPOSED ALLOWED PROPOSED
EXP
NEW RESIDENTIAL PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS ffr)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE,# REAR
COMPLIANCE OR 114
ADDITION COMMERCIAL C z
CHANGE OF USE /V/ /V/ z
PARKING LOT AREA Pliotii REVRVED113Y qAfE 5
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED (( V (L
GRADING FENCE
REPAIR 13 ( x Fr) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, 13USINESS OR ACTIVITY) EXPLAIN:
tr CHECKEDBY TYPE OF g4NSTRUCTION CODE OCCUPANT -
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NUMBER N BER OF ITICAL 5
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OF DWMELLING FAREAS SPECIAL INSPECTION AREA OCCUPANT
0 STORIES S N U MBER REQUIRED [] YES LOAD
DESCRIBE WORK TO BE DONE I - (,o
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/ IBC109/ IRC109 FINAL INSPECTION REO'D
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee C-z
_5 Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
9 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
j SEPARATE PERMISSION.
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2 Engr. Review
M PERMIT APPLICATION: 180DAYS
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PERMIT LIMIT., 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
tn Fire Review
tn 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS PlanChk.Deposit
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 #
cc ALL CLAIMS FOR DAMAGES OFWHA:rEVER NATURE, ARISING DIRECTLY OR INDIRECILY /41-A el -I-)
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE 41�---
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due
0 NOR LIMIT IN ANY WAY I HE CITYS ABILITY 70 ENFORCE ANY ORDINANCE PROVISION,'
Recording Fee Receipt # Z�—) q
I HEREBY ACKNOWLEDGE THAT I HAVE READ I HIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by the
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN V6LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S COMPENSA�,�IkfffiNCE AND RCW 16.27.
OFFICIALS SIGNATURE DATE
SIGNATURE (OWNE . RIO (425).
r_ r_ U RELEASED
771 -O'r
ATTENTION E)ff 1333
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/iRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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('-OWNER GOLD -ASSESSOR
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RECORD OF INSPECTIONS
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..........................
My&
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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