20050262.pdfDATE RECEIVED -7
PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB
OWNER NAMEiNAME OF B PINESS ADDRESS IV Ave
04 f [,1 1,00. V7 L-1412", IPLAT NAMEISUBDIVISION NO.
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MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
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STATE LICENSE NUMBER
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`7 1619
PROPERTY TAX ACCOUNT PARCEL NO.
NEW
[�/RIESIDENTIAL
ADDITION
COMMERCIAL
MIXED USE
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
EGARAGE
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RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUS] ORACTIVIT )EXPLAI -
BY
PERMIT EXPIRES
TEIAPT#
LOT NO,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
REQUIRE[
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REMARKS1 +tvi-nist-th isithiiiiiatditi Citiflif"049-
ENGINEERIN11
FIRE REVIEWI
VARIANCE
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STUDYTE�
on to the
LID NO
LID FEE S
TESCPApprovea
RW Permit Required
Street Use Pernrid Requited
Inspection Required
Sidewalk Required
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,f yttlRyeg Fan appo
tonk shall be
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SHORELINE- OR ADEIP If4SPECTION SEPA
REO'D COMPLETED I EXEMPT
C1 YES 13NOI
SIGN AREA HEIGH
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PROPOSED TBACKS (FT.)
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COMPLIANCE OR
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CHANGE OF USE
PARKIN�,
LOTAREA
PLANNING REVIEWED BY DATE
01%3N 'jPUIRSUA 4T TO UPC 608
FENCE IzvAmr,
( — X FT.) REMARKS AlWSSUREPEGUENM
OTHER 9H*EA1BF3 INSUL"n NFAR
FIRE SPRINKLER
FIREALARM
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0 OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
at UNITS LOAD
0 STORIES
DESCRIBE WORK TO BE DONE REQUIRED 13 YES
REMARKS
qA f 41 4�� f GEOTECH REPORT pUlt9`13701 TO'Uf)e 665-2Z�-
BY: W=g sMICE SHUrOFF
STRUCTURAL DESIGN 8&a BE IKSWALLED ON THE
BY:
VALUATION L
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I Description FEE Description FEE
Klil�, /G(etc, Y Plan Check State Surcharge
I If VESTED DATE
HEAT SOUFt Building Permit City Surcharge
PLAN., Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
It- BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.)'WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC i9.00.005(A)(5)
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PERMIT LIMIT., SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
in
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
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 Landscapolnsp. Total Amt. Due
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01 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Recording ee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application is not a pernia until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
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rHORIZED AGENT 0 F
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Wl LL MP OY CALL Building Official or his/her Doputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
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IN VIOLATION OF THE LABQR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
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WORKMEN'S COMPENiAXIN41 URANCEANDRCW18:27.
OFFIPAkS SIGNATU DAT
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LSIGNA�OIE Z(OWNEZRA t T)- DATE SIGNED (425)
16j 771-0220 RELEASED
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR /CCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL. FILE YELLOW INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 It IBC1i0 If IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .....................
Wall ..........................
Pier/Porch .................
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FletAining�Wall
0
Slab Insulation ..........
0
PLUMBING:
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Underground ...................
0) -4
0
M
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Rough -In ...................
M .
0
Commercial Final ....
00
C
HEATING:
3: M
Gas Test ....................
M z
Gas Piping ...............
0)
Equipment .................
0 .-n
Commercial Final .......
7n
EXTERIOR SHEATHING
M M
NAILING ..........................
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0 0)*
0
FRAMING . ..... ...................
0 M
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FIRST FLOOR FRAMING...
M 0
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-INSULATION'ra.'......, ...........
Floor Insulation .........
Wall Insulation ...........
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Ceiling Insulation .......
SHEETROCK NAILING ...
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0
SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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