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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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USE PERMIT F)
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ADDRESS 02IZ510 31-? 3 -4,01, W.
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REMARKS
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lROPjYTAX ACCOUNTPARC LNO.
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VARIANCE OR CU
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PEO'D
0
I BOND
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ON.
0 YES ONG
REVIEW
COMPLETE EXEMPT
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ALLOWED PROPOSED
±(�,)
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ALLOWED PROPOSED
I
_EXP I
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REOUMED SETBACKS
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ALLOWED PROPOSED
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PARKING
TT RE
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PLANNING REVIEWED By DATE
REGO I PROVIDED I
CHECKEDBY JT7,
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REQUIRED rl YES
PER
VALUATION I FEE
PLAN CHECK FEE
SOURCE GLAZING I
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BUILDING
LAN HECK NO: JVISTED
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PL
DATE
PLUMBING
HIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
T S RE R M IT A U T S
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
N IV TE P
E .. ED PR A
GRADINGIFILt
Do". 'c....'ZE
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEE% ETC.) WILL REQUIRE
ED "W"
SEPARATE PERMISSION-
STATE SURCHARGE
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT. I YEAR , PROVIDED WORK IS STARTED ITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT. ON BEHALF Or HIS OR HER SPOUSE SSIGNS AND SUCCESORS
F
ENE. INSPECTION FEE
'ffEHEAT
N INTEREST. AGREES TO INDEMNIFY. " FEND XNHcE'HRLA� HARMLESS THE CITY OF
I I I T ES A' R EES To IN )E
NDSCAPING
. CIA Y AND
5 EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FR AN
E .. N WASHINGTON � IT
.S
I SPECTION FEE
LCLAIMS FOR DAMAGES01 WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
UL C" US 0 , G
AL NOT BE
RECEIP
s.ALL
FROM THE ISSUANCE Or THIS PERMIT, ISSUANCE OF THIS PERMIT, E
o ANY C Ty OROINANC
PLAN CHECK DEPOSIT
EENE T MODIFY WAIlEQR REDUCEANY REoUIREMENTOF
DE EDTOMODIFY.
'M
TO ENFORCE ANY ORDINANCE PROVISIOH.-
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OR LIMIT IN ANY WAYTHE CITY'S A LITY
N OF L� MIT, NY W Y T
PROVAL
I �ERE.YAC��.�L..�T.ATI�AIE�E�.T�lS�PPII�ATI.N;T�ATTHIINI��IEI
GIVEN 15 CORRECT. AND THAT I A. THE OWNER, OR THE DULY AUTHORIZED A. NT or
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING C.�STRUC-
CALL
6.11dl�g oll,1 Im-, D .�d F .1. P.ld
T,,ION,AND,lND ING THE WORK AUTHORIZED THEREBY, No FESS N WILL BE EMPLOYED
WASHINGTON RELATING TO
FOR INSPECTION
p—
I VIOLAT ON OF THE LABOR CODE OF THE STATE OF
Wor KMEN'S COMPENSATION INSURANCE AND ROW 1A.27.
OFFICI A G T DATE
-SIGN
(425)
URE (OWNER OF AGENT)
ATE SIINED
l7i� \"—
I � i, t go
771-0220
Ill. SED DATE
'��_ENTON
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
INSPECTOR
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE - YEULOW-
GOLD ASSESSOR
A FINAL
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER-
5198
I =
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .......... ...........
Wall..........................
Pier/Porch .................
z
0
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground
C:
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Rough -In ...................
0
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Gas Test .................... �12
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3: M,
rn Z
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p'�,
Gas Piping . .................
Equipment .................
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EXTERIOR SHEATHING
IT
ago 86,
0
NAILING ..........................
om�
0,
FRAMING ........................
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FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
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Wall Insulation ...........
Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
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MISCELLANEOUS ..........
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if
OCCUPANCY ................
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Ass,
DATE RECEIVED
M17TEXPI::.��
FPE7R _lRES -
USE PERMIT 200010
ZONE
CITY OF EDMONDS NUMBER
SU s
'CONSTRUCTION PERMIT APPLICATION AD'.FE.So?,� 510 3 A4 J61, LIV
OWNER NAMENAME OF BUSIN SS ---- LID EE S
r FLAT NAMEISUBDIVISION N67 LID NO.
mV MAILING ADDRES9
J_ PUBLIC RIGHT OFWAY PER OFFICIAL STREET MAP Tl� 11.11"pl""
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NAME
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ENGINEERING 101DATE
ADDRESS
Z
DATE
CITY zip
TELEPHONE
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0
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ALLOWE PROPOSED
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PROPERTY TAX ACCOUNT PARC�L No.
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REPAIR 0 llAlIll CYGS C] (PENCE
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as
as
NUMBER OF
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OF
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AR MBE
NU5AS R
JAH11
REQUIRED 11
lo
LOAD
STORIES
UWELL
NITS'
DESCRIBE WORK TO BE DONE
REMARKS
M 0
PROGRESS INSPECTIONS PER UBC lOa/FINAL INSPECTION REO'Dj
Z r-
(v
-+rAL
Crl)C /'5P _7
Z
0
VALUATION FEE
Z
PLAN CHECK FEE
0
HEAT SOURCE GLAZING %
LOT SLOPE I
BUILDING
IT!
PLAN HECK NO:
IVESTED DATE
PLUMBING
MECHANICAL
THIS PERMIT ALT .. IZES ONLY THE WORK NOTFIL THIS PERMIT COVERS WOR K TO
oNE ON ."ATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
m SEPARATE PERMISSION.
STATE SURCHARGS
A PER ITAPPLICATIO : IBODAYS
PERMIT LIMIT'. I YEAR MRDVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. RSVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. A-11 NE AN. SUCCES.F,
ENG. INSPECTION FEE
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
FROM ANY AND
LANDSCAPING
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS
ALLCLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
INSPECTION FEE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
, OEEMEDTO MODIFY, WAIVEOR FIEDUCEANY REQUIREMENT OF ANY CITY ORDINANCE
R
ENFORCE ANY ORDINANCE PROVISION.'
RECEIP�
r3,
0 NOR LIMIT IN ANY WAYTHECITY'S A81LITYTO
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE TH HAVE READ THIS APPLICATION, THAT THE INFORMATION
APPLICATION APPROVAL
I
GIVEN IS CORRECT. AND TH AM THE OWNER. OR THE DULY AUI HORIZED AGENT OF
AATT:
, �.y..,, by th,
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
g..,-
�II "'. _ ,%u.�dlIlF,ap0d
CALL as 11, pals.
Sui,
TfON; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
LABOR CODE OF THE STATE OF WASHINGTON RELATING To
FOR INSPECTION I.C.'Pusnia,' P
IN VIOLATION �t /
0 _j E
WORKMEN'S COMPENSATION INSURANCE AND RCW 18,27. OFFICI !G T
SIGN E OWNER OR AGE ATE SIGNED (425)
J 771-0220 REL ABED
ATTENTibN EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL -ulr r_ I —
A FINAL NSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFlk ORIGINAL 'ILE YELLOW - INSPECTOR
CATE OFIOCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK -OWNER GOLD ASSESSOR
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