20000019.pdfDATE RECEIVED
5D
PERMIT EXPIRES 7�0 _�,-
PER M T E X P'RES
US E
us
P E R M T
PERMIT zat) OL"?
CITY OF EDMONDS
ZO N
ZONE NUMBER
N U M B E R
CONSTRUCTION PERMIT APPLICATION
IT EUlTEJAlT*
'A'DORESS Lo
C)
C)
.FL.E Lo
OWNERgi.AME OF-W
PLAT NAME/SUSDIVISION NO.
LOT NO.
NO.
W'AO.
LID FEE S
MAIL121ADOnESS
PUBLIC SIGHT OF WAY PER ElliCIlL STREET MAP
TElCP 4P--d 0
SW ,u, 13
-w .. 0
O'p
EXISTING — PROPOSED
REQUIRED DEDICATION� FT —
0
u
u-
=.Z.-
4'. — 2-
Y
CITY
'Y
FNAME
5 5111
NO. OF FIXTURES
PRV REQUIRED
YES El No C3
I
--so
REMARKS
-P.-MLE
FOR EROSION --NTROtJDFAlNA.E
R E RESIGN
CITY ZIP
ENGINEERING
ADDRESS
.-Ja)o
FIRE REVIEWED BY
DATE
CITY
N D
A.AT.
STATE LICENSE NUMBER IA. b 1—
VARIANCE OR DO
SHORELINE OR ADEN
INSPECTI
a
FIE 'D
C3YES nNO
JPEO
OSTED
w#4614IC-E.,
f
D6
SERA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL No* C) 09
6
EXP
LOT COVERAGE
REOUIRED SETBACKS I")
FEAR
SED SETBACKS (FT.)
FRONT R SIDE REAR
""'
C] NEW WRE.I..TIAL
PLUMBING I...
ILUMMING I MEC-
ALLOWED PROPOSED
F NIT I E�'
FRONT SIDE
RO S"
ADDITION C] COMMERCIAL
COMPLIANCE OR
Cl CHANGE OF USE
�T
PARKING
A
AREAP-N
I 3T ARE
ING REVI-E.
PLANNING REVIEWED
By DATE
By
REMODEL 0 APARTMENT
C] SIGN
REGO I PROVIDED
REPAIR
FENCE
I X FT)
MARKS
DEMOLISH C] TANK
ci OTHER
CARA. E RETAINING WALL
C' 6
T
CAR AOE T I'90ERY
L
0 RENEWAL
0 7 __-L
.
(TYPE OF
- USE. BUEIN.S 'aCTIVIT:S
ST UPANT
..ECKED.Y TYP.O,FC.oV-.lj.TK)N CODE
GROUP
0
- ' NUMBER
NUM ER OF
CRITICAL
--- ----------
OCCUPANT
0 OF
DWELLING
AS E��
LOA D
STORIES
N
DESCRIBE WORK TO BE DONE
=RKS
QQ ImPoPeTIONS
PER U BC 1081FINAL INSPECTION REO
PLAN CHECK FEE
HEAT SOURCE Gl_AZM LOT SLOPE I
BUILDING
PIL N CHECK NO: IIESTED DATE
PLUMBING
MEC ANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ON- ANY CONSTRUCTION ON THE PUSUC
IRE
GRADING/51ILL
DOMAIN (CURDS. SIDEWALKS. DRIVEWAYS . MARQUEES. ETC I WILL RED
m SEPARATE PERMISSION.
STATE SURCHARGE
2 PERMIT APPLICATI N: 100 DAYS
0
I
PERMIT LIMIT. I YEAR PROVIDED WORK S STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
'AN U�I�A SEE 'ALFTOF HIS 01 HER 11111E "El"LASSIGNS AND SUCCESORS
P' CITY OF
ENG. INSPECTION FEE
T 'Ti.A. R ES IN, EVINFY, DEFEND XN. .0 HARMLESS THE
IN ES ?OFFICIALS. FROM ANYAND
LANDSCAPING
FEE
EMPLOYEES. AND AGENTS
T�
I EOMONDLWAS""'TN� I ECTLYOR INDIRECTLY
INSPECTION
I ALLCLAI- 1011-A-A-E . W.ATEIEFIIATIIFE.ARI SING GIR
OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE
ME
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REOUIRE NT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY 'S ABILITY TO ENFORCE ANYORDINANCE PROVISION.-
TOTAL AMOUNT DUE
I 11REBY I HAVE READ THIS APPLICAIION� THAT THE INFORMATION
DUSLY AUTHORIZED AGENT OF
=L!EADN'�EIT."ATT
E,VE,, I AM T�EGWNER 0TATNS
N "TYAN6S LAW REGULATING CONSTRUC-
CALL
THEOWNE .
T R, I AGREE TO COMPLY 5 0 PERSON WILL BE EMPLOYED
I.N. AND N DOING THE WORK AU:H.FilEC THERE YN
__R
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FO INSPECTII
WORKMEN S COMPENSATI
-D
DATE Sit,[
(425)
, rl"_, I
LGNATI.iFE I.AYNER :jj!:r
IL" 1 0
771-0220
i"
EXT 333
ATTEf9tION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
FAX
5198
VALUATION FEE
PT j 4 b (
APPLICATION APPROVAL
This pplic"o, is , p,,,It rtol 119.0d by thl
auitdimg Offi,i,l or hmirrI,, DlPutY: nd FaIrr 111 PlId. 1-d
,jpj is ack,,ml.dg,rd m w p—d.d.
FF:ZSIGNATURE
90a
EL9ASED EN
ORIGINAL FILE - YELLOW - INSPECTOR
PINK - OWNER - GOLD - ASSESSOR
z
0
M
m
co
m 0
80
a
ni
m
z
g -n
m M
065 1 1
0
c Q Fn
rn o
z f-
z
(j)
z
9
0
m
OF INSPECTIONS
RECORD
INSPECTOR DATE APPROVED
SETBACKS .....................
F OUNDATION:
Footing ..........
wall: ............
Pier/Porch .................
Retalnirig Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
M,
M
Rough -in ...........
�O O-C
Commercial Final
HEATING:
Gas Test ..............
Gas Piping .................
0 -n
Equipment .................
'n
Commercial Final
m rn
EXTERIOR SHEATHING
NAILING ..........................
C
FRAMING ........................
0
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
z
Wall Insulation ...........
Ceiling Insuiation
i
z
SHEETROCK NAILING
0
�u
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
.7.
US
us PERMIT
IdNDS
CIT)7F EDMONDS
Zo
ZONE NUMBER
PPL, CATION
CONSTRUCTION PERMIT APPLICATION
i . ZTEIAITI
0
ADDRESS
AD
OWNER
tjf��OF-r
PI -AT NAMEISUBDIVISION NO. LOT 10* LID NO.
10 FEE S
MAILING AOD�ESS
... A—.1-0
-b rtL
FU BLIC RIGHT OF WAY PER 0 FlICtAL STREET MAP A. U
a".=
CITY ZIP 7 EXISTING — P OPOSED-
-15 -7 RIE.I.I....E.CATIO.— FT
PRV REQUIRED
NAME
YES 0 NO 0
ADDRESS
ARKE
OWNERCONTRACTOR RESPONSIBLE FOR EROSION CONTR
C
�ffugggzngl
ADDRESS
COMPLETE
wxwmm
_f�Z
C. _10—rhorro"
4,vj cL��
FIRE REVIEWED BY
CITY zip
T�.LIPHOII
-
STATE LICENSE NUMBER
wA�_z,f4W,So-lq0_;',
EXFIIIAATION�DA�TE OAHE E By
Li(DO
VARIANCE OR CU
REVIEW
EXEMPT
SHORELINE 08 ADBN INSPECTION D
RED 'D OSTED
[31ES -N- 1p,o,
IGN AREA HEIGHT
ALLOWED PROPOSED ALLOWED PROPOSED
IROFERTYTAX ACCOUNTPARCEIN
15-14-a C)c I o c--.)9
o c)
EXP
0 NEW kVF..l ... TAIL
PLUM.1-D I ECII
LOTCOVERAGE
AL—E. FR.F..E.
REQUIRED SETBACKS (F7.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT UP SIDE REAR
C3 ADDITION E] COMMERCIAL
o C MPLIANCEOR
0 1
CHANGE OF USE
PINNING REV;—E DAT11-
PARKING LIAREA P NNINGREVIE�WEOUY
REMODEL 0 APARTMENT
0 SIGN
REO' PROVIDED
. I
I
I
)OREPAIR
0 FENCE
( — X _ IT)
- rAKS
R A KS
DEMOLISH TANK
o OTHER
oGARAGE RETAINIttG WALL
CARPORT
0 RENEWAL
ROCKE
(TYPE OF USE. BUSINESS OR ACTIVIT C"ECKEOBY JTYIEOI CONSTRUCTION
COD 0 CUPANT
—NU.7.R TICAL SPECIAL INSPECTOR GROUP
PEOURED E] YES JAREA LOAD
STORIES U OCCUPAN . T
DESCRIBE WORK TO BE DONE REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPEC:rl
VALUATION
PLAIN CHECK FEE
SOURCE GLAZING % LOT SLOPE I
BUILDING
JHX
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS. SIDEWALKS, DRIVE S, MA QUEES, ETC.) WILL REQUIRE
S EPA RAT E WP EAYR M I S S I Ro N.
MECHANICAL
GRADINGfFILL
STATE SURCHARGE
F.
PERMIT APPLICATION: IBD DAYS
PERMIT LIMIT. I YE AR - PROVIDED WORK IS STARTED WITHIN 160DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT ON BEHAL HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREE S F OF
TO �NDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, TS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALLGLAIMSFOR DAMAGESOF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
I FROM THE ISSUANCE OF TH S PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BEE
DEEMEDTOMODIFY� WAIVE OR REDUCEANY REGUIREMENTOF ANYCITYORDINANC
0 NORUMITIN ANY WAYTHE CITY'SAeILITYTO ENFORCE ANYOROINANCE PROVISION.'
ENG. REVIEW FEES
ENG. INSPECTION PEE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
RECEIPT
RECEIPT
I HEREBY ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THEOWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTFUC
TION, AND IN DOING THE WORK AU HORIZEO THEREBY. NO PERSON WILL BE EMPLOYE.
DE OF THE STATE OF WASHINGTON RELATING TO
IN VIOLATION OF THE LABOR CoT
WORKMEN'S CDMPENSATIo�_JASURANCE AN RCW 18.2
APPLICATION APPROVAL
TI,m ad, . pan.,, urtil.,,d by a.
CALL Binldmg Official 11 hi,lh,, DQpXy! ad F ,a paid. and
FOR INSPECTION r .... In i,,,k,..I.dged in space provided.
OFFICIAL SIGNATURE DATE
DATE SIrED
SIGNATURE (OWNER OR 0
C�K CA,-" C)b
(425)
771-0220
111 ASED`13Y DATE
A17ENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
INSPECTION HAS BEEN MADE AND APP ROVAL OR A CERTIFI-
EXT 333
771-0221
ORIGINAL FILE - YELLOW - INSPECTOR
A FINAL
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
5me
z
o m
a
m
0
80
m IT!
10
cp
0 _111
-4
:f
m M
0
o Fn
C 0)
m co)
M 0
z
ri
z
cl)
z
9
0
Ill