20050983.pdfDATE RECEIVED'
[PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
JOB SUITE/A #
CONSTRUCTION PERMIT APPLICATION ADDRESS <z Iqo. LL t-11 is�� sin
OWNER NAME/NAME OF BUSINESS
e "o- KA PLAT NAME/SUBDIVISION NO. IOT NO. LID NO.
ui MAILING ADDRESS LID FEE S
TIESCIR Ariproved CI
tgi;i-0 P?-7-rwS'_r 'SLA.) PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AIN Perinit Acquired CI
0 Street Use Permit Roq'd E3
CITY ZIP TELEPHONE EXISTING — PROPOSED Inspection Required CI
Sidewalk Required 13
REQUIRED DEDICATION� FT Underground
V7 0 ta_t S 7 Wiringtoquirad C3
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES13 NO 13 3
T
ADDRESS REMARKS z
z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
All
CITY ZIP TELEPHONE
NAME BLN i, 44 3
6
ENGINEERINdI13I5V?VWE0`AY` VkI"E
ADDRESS
0 140T
FIRE REVIEWED BY P-1-.5,; L; t 1) DATE lu
CITY ZIP TELEPHONE M
0 M
_�ruv-A) 1 I -A 9t It& C�49__ —I 4LO6 VARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE ctiny REQ'O POSTED
1 1 jo SEPA REVIEW SIGN AREA OYES ONO S HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. \T COMPLETE I EXEMPT ALLOWED , PROPOSED ALLOWED I PROPOSED
(2>0 5`7 t `7 0 6 C�,
30 0 EXP
1:1 NEW RESIDENTIAL PLUMBING/ MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR Q
COMPLIANCE OR z
1:1 ADDITION COMMERCIAL z
CHANGE OF USE z
PARKING I LOT AREA [PLANNING REVIEWED BY DATE
1:1 REMODEL MULTIFAMILY SIGN ROVIDED
GRADING FENCE
1:1 REPAIR CYDS X FT) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY TYPE F POPASTRUCTION DE OCCUPAN�
COI
NUMBER MA GRO
NUMBER OF CRITICAL 0
OF DWELLING AREAS SPECIAL INSPECTION AREA OCCUPANT
0 STORIES UNITS NUMBER REQUIRED [:] YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 106/ IBC109/IRC109 FINAL INSPECTION REO'D
9
V r--ar:;� VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge < oc
PLAN CHECK NO: VESTED DATE Plumbing C>tU ('X) Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
III= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
a Grading
=I DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
It= SEPARATE PERMISSION.
2 Engr. Review
ul PERMIT APPLICATION: 180DAYS
EL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
NAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
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 Landscapelnsp. Total Amt. Due. /W,
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE FIIWVI.1�11. %�F
X_ Recording Fee Receipt # /114
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION I
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 pennit 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 VIOLATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged In space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
.e�� OFFICIALS SIGNATURE DATE
NT)
SIGtjAQRf (OWNER OR I GE DATE SIGNED (425)
�'1-n QSrint 9 771-0220 LE Y DAT
ATTENtION EXT 1333 7J01 n5
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADEAND APPROVALOR A CERTIFICATE OF OCCU-
IAL - FILA ELLOW - I SPECIR
R
PANCY HAS BEEN GRANTED. UBC1 09 / IBC1 10 / IRC1 10. Y"', 'IN R GOLD-ASSESSO
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
z
0
1
0
M
CD
M
C
M 0
0
__10
0
M
M Z
C) --I
C
0 _T11
x
M M
0 6)
0 r-
0 M
C Cn
9 0
M 0
Z r-
z
z
0
0
M
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ....... ...............
Wall..........................
Pier/Porch .................
z
Retaining Wall ...........
Slab Insulation ..........
0
PLUMBING:
Underground .............
OM
Rough -In ...................
M
-10
Commercial Final ......
0
C
HEATING:
M
Gas Test ...... ...............
M Z
z
Gas Piping .................
Equipment .................
Commercial Final ......
EXTERIOR SHEATHING
M M
NAILING..........................
r
FRAMING ........................
0 ITI
C 0)
Cn
FIRST FLOOR FRAMING...
Q 0
Z r
INSULATION ...............
Floor Insulation . .........
>
Wall Insulation ...........
z
3:
Ceiling Insulation .......
SHEETROCK NAILING ...
z
SPECIAL INSPECTION ...
0
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
Nr-7-
OCCUPANCY ..................
Ile WAr Woe