20051037.pdfDATE RECEIVED
PERMIT EXPIRES
USE PERMIT
ZONE
I
CITY OF EDMONDS
NUMBER
CONSTRUCTION PERMIT APPLICATION
J013 SUITE/APT#
ADDRESS2
OWPER NAME/NAME OF BUSINESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO,
cr
W
40:
MAILING ADDRES s
LID FEE $
PUBLIC RIG14T OF WAY PER OFFICIAL STREET MAP
JESCP Approved
BW Permit Roquirod
E
C
Strom Use Permit Roq'd
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CITY ZIP TELEPHONE
C0MONO-5 01�02Z 142_S-17S- 39N'
EXISTING — PROPOSED
REQUIRED DEDICAT10N FT
inspection Required
Sidewalk Required
Underground
C
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
NAME
YES13 NO
13
ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
CITY ZIP TELEPHONE
NAME CBL 0
ENGINEERING REVIEWED BY DATE
ADDRESS
11-100 KG 12.q+� Sf `3tq'�6 I i
FIRE REVIEWED BY DATE w
CITY ZIP ONE E:
q I TELEPH ._q�60
VARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND
STATE LICENSE NUMBER EXPIRZTIO REQ'D POSTED
I DATE 9MMNI) BY 13YES 13NO S
Oq9 LA 9 SEPA REVIEW SIGN AREA HEIGHT
4 PROPERTY TAX ACCOUI PARC3L NO. COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
13
ul
_j 005— 00 1 14Z, 00 EXP
NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR 0
COMPLIANCE OR z
ADDITION COMMERCIAL 2
CHANGE OF USE z
PARKING LOT AREA [7G REVIEWED BY DATE 5
REMODEL MULTIFAMILY E] SIGN' REO'D PROVIDED 0.
REPAIR GRADING FENCE.
CYDS El X FT) REMARKS
DEMOLISH El TANK E] OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKtRY FIRE ALARM
(TYfE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY TYR LICTION 7CO E
VET CONSTR OCCUPANT�
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GROUP
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
UNITS LOAD
0 STORIES NUMBER REQUIRED [] YES
DESCRIBE WORK TO BE DON4 I
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
t*J STA-LL
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IN ZziUa LE;r -tn (2 A) LijerAt,
VALUATION
N 5,—% 1; L L 8ke 60 FOR bur5i0C. AIR
!�og corte)LxTn,,.-�. ()WAMAJN FLC0e, Description FEE Description FEE
S�tle PjTr ac, 1+ 6 0 5PC<,S UQl Plan Check State Surcharge
HEAT SOURCE GLA2ING % LOT SLOPE % Building Permit City Surcharge
.Wyno
PLAN CHECK NO, VESTED DATE Plumbing
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
2 DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
APPLICANT, 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
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 I
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapeinsp. Total Amt. Due
DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR Limir IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
x
I Recording Fee Receipt N
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS 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 VIOLAT!ON OF THE CDE OF THE STATE OF WASHINGTON RELATRIG TO FOR INSPECTION receipt Is acknowledged in space provided.
WORKMEN S COMPENSA� �NIMNS
�ANCE AND RCW 18.27.
( 'OXIqFA)s SIGNATURE DATE
DATE SIGNED (425) .0
77 AM 0-5
_j 1-0220 RELTSED r BY DATE I
AtTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
.A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- IRIGINAL-FILE YELLOW-INSP&TO
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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RECORD OFINSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ........... I ...........
Wall...........................
Pier/Porch .................
Z
Retaining Wall ...........
0
M
Slab Insulation ..........
PLUMBING:
3:
Underground ..............
M
C
M
Rough -In ...................
0
Commercial Final ......
M
HEATING:
M z
Gas Test ........... ......
C
> z
r
Gas Piping .................
0 -n
Equipment .................
Commercial Final ...
M M
EXTERIOR SHEATHING
0)
NAILING ..........................
0 M
C 0)
FRAMING ........................
CO)
M 0
FIRST FLOOR FRAMING...
z
_q
INSULATION ...................
Floor Insulation ... I ......
z
Wall Insulation ...........
Ceiling Insulation .......
z
0
SHEETROCK NAILING ...
0
SPECIAL INSPECTION
M
MISCELLANEOUS ..........
FINAL APPROVAL P(W
JR-
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op. 111100�