20050282.pdfCEIVED
b PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPTH
OWNER NAME/NAME OF BUSINI�SS ADDRESS tZ
IM1111--b-I I 't I /j ),_� 7LAT NAMEISUBDIVISION.40. LOT NO. LID NO,
MAILING ADDRESS LID FEE S
W I
z PU13LIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved E3
RW Permit R u
Street Use P1=11tZlequired
CITY ZIP TELEPHONE EXISTING PROPOSED Inspection Requirod E3
...... E3
REQUIRTI"LCARN"IL 0�1-eUtR?011JUeCtM I
PRV REOU RED
NAME METE �IIJWU e)[1)
fffruel 1) ffifgaftpIi1MiRrLfqXfhK,§ht9
L) fhroij�hunheatelsrmces. INCR9.2 tO13 ez,
Lu W
t= ADDRESS REMAR,6%..� Lu
x OWNERICONTRACTOR RESP014SIBLE FOR EROSION CONTROUDRAINAGE
U
CITY TELEPHONE
NAME CBL#
ENGINEERING REVIEWED BY DATE
0: ADDRESS
0 1 4 GAS PIPE TESI' MUST BE
t;
FIRE REVIEWED tu
ZIP 13OBSERVED BY CITY INSPEOTOR ix
z TELEPHONE
0
U AEEInAvITS i i mnT
VARIANCE OR CU SHOREgf TION SEPA
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY ORM 'D
L
u*
Ipm 13 NOI COMPLETED I EXEMPT
L.,vAj'q t ��s q -3 13 YES
PROPERTY W ACCOUNT PARCEL NO CA# ZONE SIGN AREA HEIGHT
WAIVER ALLOWED I PROP015ED I ALLOWED PROPOSED
o6z 6 STUDY 13
1-le,&S 66
F1 NEW RESIDENTIAL PLUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
K A ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR C3
ADDITION COMMERCIAL COMPLIANCE OR I z
M CHANGE OF USE X 605.2 2
MIXED USE z
PARKING PfflWW&SHMFFDATE
E] REMODEL L-0 MULTIFAMILY SIGN REQ'D PROVIDED �;HALL B INSTALLED ON THE
GRADING FENCE DING
REPAIR CYDS X FT.) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
0
P: (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: )CCUPAKIT-
_,�q 4STR TION CODE C
Tvrof 'V3
(.31
in _rNU F
uj NUMBER Me
C
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
L -LOAD
STORIES UNITS
DESCRIBE WORK 10 BE DONE REQUIRED [3 YES
REMARKS z
0
ifn siddifian to �,.%e required
GEOTECH REP RT surelreU
BY: pr k. vxilveq an approved M
STRUCTURAILD .7-Eivii tank shall be
BY: Med expv,
on aij aiot wamr talliks
YO I Am VALUATION I instair
$ UPC pul;
09 m rz-
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOTSLOPE% VESTED DATE Building Permit City Surcharge
Q A"&, , J I �.
PLAN 9HECK NO: Base Fee -21,N
Plumbing D 00
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
j SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
06 PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Plan Chk. Deposit
OAPPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review
U) IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
_j
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
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE 0
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE LandscapeInsp. TiDtal Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,
Recording Fee
LReceipt
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 permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or hisdhor Deputy: and Fees are paid, and
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING To FOR INSPECTION
WORKMEN'S COMPENSA;jlj�ITRANCE AND RCW 18:27. OFFICIALS SI DATE
DATE S ED (425)
SIGN E (OWNER JA E04
REL
0 7711-0220 BY) DATE
&TE�NTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY 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 / IBC110 / IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
z
0
4
0
M
-4 -n
0 M
a 0
IT! 0
--1 0
0 C:
M
M Z
_z
X
o -n
n
M M
0
0
0 M
C II
C C0
Q 0
Z r-
IV
z
C/)
z
.0
IT11
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall .................. .......
Pier/Porch .................
Retaining Wall ....
Slab Insulation .......... .
PLUMBING:
Underg�ound ..............
Cl)
0
M
Rough -in ...... ............
M
Commercial Final ......
0 0
C
HEATING:.
M
M z
Gas Test ....................
C z
Gas Piping .................
0)
Equipment ..................
0-n
Commercial Final .......
M
EXTERIOR SHEATHING
M
NAILING ........... ..............
0
0 M
FRAMING ........................
CO),
0)
FIRST FLOOR FRAMING...
M 0
Z r
7
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Z
Ceiling Insulation .......
3:
SHEETROCK NAILING
z
0
A
SPECIAL INSPECTION
0
M
MISCELLANEOUS ..........
FINAL, APPROVAL FOR
OCCUPANCY ..................
wwo v000�'