20051063.pdfDATE RECEIVED
�05 PERMIT EXPIRES
PERMIT 6
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITEiAPTI,
ADDHESS
�> 7. V
R NAMEINAME OF BUSINESS
411 j A .1-14 t,* n j, PLAT NAME,1SUBDIVISION NO. LOT NO LID NO.
I
i
I
LU
M
z
LID FEE S
MAILING ADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
I LSCP Appro,ed 13
0
RW 1,01M.1 Req,ored 0
Street use Permt Rp.qjaecl 13
EXISTING PROPOSED
Inspect.on Recti,ted
CITY ZIP
TELEPHONE
S,aeA41% Requ-ted
REQUIRED DEDICATIO14
FT
underground
V C3
NAME
METER SIZE
LINE SIZE
NO, OF FIX`rURES
PRV REQUIRED
YES13 NOO
U
I=
ADDRESS
REMARKS
z
x
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/cRAINAGE
U
W
z
CITY ZIP TELEPHONE
0
rM 1AX -b qiii 1. Mcent
connectors re uired
q
z
NAME CBL#
8L�kMINa_f1ErJI`LW�D BY
liances passing DATE
L_ 16,
on fd&-bi&Bi1t9 APP � 2
803.2
V
spaccle IMC
M
0
L)
ADDRESS
1d8t A/e-' -I!>-
lL.Ied
----------
<-
c;�-&
CITY ZIP TELEPHONE
PUBLIC WORKS REVIEWED BY DATE
0
4/ 6
lel&-i ",6 ""ID3 00
z�S-Sj
STATE LICENSE NUMBER EXPIRATION DATE K 6
FIRE REVIEWED BY
DATE
IN
VARIANCE OR CU
SHORELINEORADBq
INSPE.C�ION
SEPA
PROPERTY TAX ACCOUNT PARCEL NO.
RE D
COMPLETED EXEVP]
IS
LU
4704 3116 04401) L4�0 _b
13YEr NOI
I
-
CA#
ZONE
SIGN AREA
HEIG HT
NEW 0;0AESIDENTIAL PLUMBING I MECH
OVVAIVER
0
ALLOWED , PROPOSED
ALLOWED PROPOSED
__*t]COMMERCIAL iiX,
COMPLIANCE OR
ADDITION
STUDY
PROPOSED SETBACKS
El MIXED USE CHANGE OF USE
LOTCOVERAGE
REQUIRED SETBACKS (FT.)
(FT)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIR SIDE REAR
REMODEL MULTIFAMILY SIGN
Ej
M
z
E
GRADING FENCE
4REPAIR El cycls x FT.)
z
PARKING
LOTAREA
PLANNING REVIEWED BY DATE
cc
j
REO'D PROVIDED
OTHER
DEMOLISH El TANK
I
GARAGE RETAINING WALL FIRE SPRINKLER
ED
REMARKS
z CARPORT ROCKERY FIREALARM
0
r- (TYPE OF USE, ACTIVITY) EXPLAIN:
9L
U
(n
NUMBER NUMBER OF
TYPE O)j=
OCCUPAJ(
*—,7
OF DWELLING
STORIES UNITS
GROUP
DESCRIBE WORK TO BE DONE
U
SPECIAL INSPECTION
CONSULTANT
OCCUPANT
LOAD
REQUIRED 13YES
REMARKS
z
GEOTECH REPORT
M
BY-
STRUCTURAL DESIGN
BY'
I/C �i-KIIVA
VALUATION
$
Description
FEE
Description
FEE
q
66Ga ?I e�a,
-
HEAT SOURCE LOT SL6PE% VESTED DATE
Ul
Plan Check
State Surcharge
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
-
Engr. Review
Recording Fee
2-
PERMIT APPLICATION: SEE ECDC I 9.00.005(A)(5)
UJI
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
Engr. Inspection
Plan Chk. Deposit
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
W 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Receipt #
W� IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Fire Review
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
M CTLY OR INDIRECTLY
< ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRE
Fire Inspection
Total Amt. Due
x 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
_j
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Landscapeinsp.
Receipt
APPLICATION APPROVAL
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AD� �IER, OR THE DULY AUTHORIZED AGENT OF
CALL
Ttus application is not a permit until signed by ine
OMP 'A�
THE OWNER. I AGREE TO C , I1THH CITY AND STATE LAWS REGULATING CONSTRUC-
FOR INSPECTIQN
Building Official or hiSther Deputy and Fees are paid. and
TION; AND IN DOING THE WO)KAUTHORIZO THEREBY, NO PERSON WILL BE EMPLOYED
rece " acknowlelged in space provi,.ed
0 CODE OF HIE STATE OF WASHINGTON RELATING TO
IN VIOLATIC:N,0F 0 FRI!
CI
WORKMEN'S PENS 0 t� RANFAND RCW 18:27.
JRE
DATI
DATE SIGNED
(425)
0
SIG;76E (0:=
771-0220
RELEAkpn
lv�
DATE
EXT. 1333
I
OR OCCUPY A BUILDING OR STRUCTURE UNTIL
I -
A AS BEEN MADE AND APPROVAL OR A CERTI ORIGINAL -FILE YELLOW -INSPECTOR
F HAS BEEN GRANTED. UBC109/ IBC110/ IRC110. PINK -OVJNER GOLD - ASSESSOR
6 . PRESS HARD - YOU ARE MAKING 4 COPIES
z
0
11
0
M
11 -n
F) -4
3:
0 M
C
M0
0
40
0 C
--i r,
3: M
M z
g) 4
C
o
-n
M
M
0
0
0
C
M
M
0
Z
X
z
--I
3:
0)
z
0
1
0
M
a
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall. ....... ....................
Pier/Porch ..... ............
z
Retaining Wall ...........
0
Slab Insulation ..........
PLUMBING:
=i 5i
Underground .... * .........
IT!
Rough -in ...................
M
0.
Commercial Final ......
0
0 C
HEATING:;
3: M
M z
Gad -rest ....................
C
> z
Gas Piping .................
3:
Equipment ..................
0 -n
Final .......
n�Commercial
EXTERIOR SHEATHING
MITI
..NAILING ..........................
0
0 r
FRAMING ........................
0 M
C C/)
FIRST FLOOR FRAMING...
M 0
Z
INSULATION ...................
;U
Floor Insulation ..........
3:
>
Wall Insulation ...........
z
si
Ceiling Insulation .......
3:
C/)
SHEETROCK NAILING ...
z
0
SPECIAL INSPECTION ...
0
IT!
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................