20000143.pdfr. 7
01
co, O-P-SXI
CITY OF EDMONDS
SE ERMrr
E 2oo.L,48
NUMBER
CONSTRUCTION PERMIT APPLICATION
SUITEIA1
ADDRESS
=
OWNER NAME/NAME 01 EeH
U'l hAM S W A
E AL DESCRIPTION CHECKI
SUBDIVISION NO
ID NO
MAILING ADDRESS
Go
SIFIElil MAP
TRW
CITY . jAA
-_ - E1U"81R
PUBLIC RIGHT OF WAY PER 0111cIAL
SKISTING — REOUIRED DEDICATION —
P1I.It'FN`q.`11d 0
SNmtU,,P,N-IRrxid 0
F R.q.-d
PROPOSED
S-1.1K R.q.-d
AME
N NA.
i �:T:
PRV PEOUIRED
YES- ..-
NUMBER
tlo:
0 =C0
IT I Z5Z 3 0
.1 N.
E) NEW
ElADDITION
L!�'RESIDENTIAIL
COMMERCIAL
PLUMBiNWECH
OR
BE OF USE
[VR'R'. DEL
APT.BLDG.
SIGN
REPAIR
CVOS
E] FENCE
L_.
E] DEMOLISH
WO.DSTOVE
INSERT
SWIM POOL
GARAGE
CARPORT
RETAINING WALU
ROCKERY
[,e0ENrUEA:PA
R SW
(—TYPEOFUSE, USI �ESSOR ACTIVITY)' EX -PLAIN
I AI
NUMBER MBER OF
irt
S1 N AREA
1OWED I PROPOSED
FRONT.'UP SIDE f
/0 &
9
0 YES
EMARKS
PROGRESS INSPECTIONS PER UBC 108
wh-w
FINAL INSPECTION REQUIRED
VALUATION
PLAN CHECK FEE
BUILDING
HER OURCE:
GLAZING
PLUMBING
Plan Check N 0.
MECHANICAL
-Th—jT�Pamit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the pub IT (p.ur.L,� sidewelks,
� p mission.
STATE SURCHARGE
driveways, marquees. BIG.) wIlIll=i a
Permil Application: 180 Days
STORM DRAINAGE FEE
Permit Limit: 1 Year - Proirlded Work is Started Within 180 Days
"Applicant, o n behalf of his or her spouse, heir " " sign s and
hold
ENG. INSPECTION FEE
successors in interest, gross to indem I, Id
ShIlty., de an and
harmless the City of Was Ing on ite officials,
6.001
fEdmonde,
t a i gas of
employees, and agen a rom ny and
SSU
6 Ce
whatever nature, arising directly or indlIrleceltaly1miromorther"a an
on'yh.,D�U;;rm'f nor be deemed o
PLAN GHECK DEPOSIT
,,all
of this permit. 11 Bsdunc:
to am IT I any cir oruln—c.
modify, waive ol o f any ordinance
's
DUE
o ability to an orce
nor limit 1� any way the Cit
TOTAL AMOUNT
provision.
I hereby ackno a ge at I ave read this 8pplication; that the
ATTENTION
I
'AT'ON APPROVAL
AP:!
1 r as to comply , or y
IV s cc ct; nd that I am the owner in,, dul
informal on Ith city and
,
THIS PERMIT
Ths M-11-n is not a permit,until
a thoriz a nt of I a 0
: So -Dinagnrd in doing the Work aothoriz-
AUTHORIZES
ad b he Buildinq official or IT s/her
sign y I -paid.
to a to Latin
r y. o pers will im�loyed in violation of the Labor
ONLY THE
WORK NOTED
Deputy. and lees are and receipt is
Ed
Cc I rate I ashIn ton elating to Workmen's Compensa.
ckn_l.d'ed in space provided.
tio I S Eu. 27,
GENT
IT
INSPECTION
DEPARTMENT
51
CITY OF
EDMONDS
CALL FOR
A N 10 1
INSPECTION
R
UL �O 7U UILDING OR STRUCTUO
IT! "N R OCCUPY A -
E
UNTIL A FINAL I N HAS SEE. IADE AND APPROVAL
N.,E
R 771 -0220
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
PINK GOLD — A�,DSSDr
SECTION 109
1024,
z
0
0
M
M
0
0
M M
CE
0 -n
M M
0 55
0
0 1; 1!
C (a
C (j) I ,
M 0
Z
z
X
z
ITI
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
lj,
SETBACKS ...................
FOUNDATION:
Footing ....................
wall .......................
0z
Pler/Porch ................
0
RetainingWall ..... I .......
Slab Insulation ............
N
PLUMBING:
C3 A
M IR
Underground .............
0
Rough -In ...............
A
��i
Commercial Final ....
p
HEATING:
GasTest ...... ; ...........
0 -n
Gas Piping ........ .......
Equipment ................
M M
C3 DI,
Commercial Final .........
EXTERIOR SHEATHI NG
C
0
NAILING ....................
ITT 0
vv�
FRAMING ....................
;13
INSULATION:
FloorInsulation ...........
Wall Insulation ...........
CellingInsulstion .........
z
SHEETROCK NAILING ......
M
SPECIAL INSPECTION ......
MISCELLANEOUS
FINAL APPROVAL
4L
FOROCCUPANCY ..........
A
us'
PIER;;�
CITY OF EDMONDS
ZONE
NUMBER'
0 ICATION
CONSTRUCTI N PERMIT APPIL
N AMEOFBUS11 ESS
0 ER NAMEfN
W
I A �l A -7
LEG.,
Su.D,YIS,.N .
A�
"Q��S
a I - PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP I TISCI A 11 ,1 11
4:a;, \ . - 11 R11d 13
CIT TELEPHONE NUMBER RW P.11P
EXISTING —REQUIRED DEDICATION — S11.1 U1. P-11 R" d 0
PROPOSED 1. —11- RIU. _ o
Si'd-11, R"1111d
METER SIZE I LINE SIZE I N..OFF.XTURES I 1AVRE UIRED
J As YES o No o
DATE
\kA_'_ -I - I I —
NEW
[�AEISIDENTIAL
LJ PLUMIIINGVMECH
ADDITION
COMMERCIAL
COMPLIANCEOR
CHANGE OF USE
�REMDDEI
APT. L...
SIGN
m,/-'
GRADING
FENCE
E] CYDS.
L_X_F
�51EPAIR
DEMOLISH
OODSTOVE
INSERT
SWIMPOOL
UBSPA
GARAGE
CARPORT
RETAINING ALL/
ROCKERY
jZ`NEWA
SEDONE
VARIANCE OR CU
ADS I
SE R VIE
COMPLETE EmPT
Ex
ION AREA
=POSED
HEIGHT
LOT COVERAGE
ALLOWED I PROPOSED
REQUIREDS—ACKS(FT)
FRONT SIDE REAR
;rz,/4, A,
PROPOSED SETBACKS (PT.)
FRONT UA SIDE REAR
MW
6
ECkEDIIY TYPE OF CONSTRUCTIo
nr AgODE
W 1�7
6,
occuPA_
OR
SPECIAL INSPECTOn
0 E: JAREK
REQUIRED
Ica
LOAD
EMARKS
PROGRESS INSPECTIONS PER LIBC 108
FINAL INSPECTION REOUIRED
(a iial kooAr-
0 PLAIN CHECK FEE
HEAT SOURCE:
—
_f t _1 "C',
4 d,-
PLUMBING
ASWC-heck No.
MECHANICAL
This Permit covers work to be done on privat property ONLY.
GRADINGIFILL
Any construction on th..pu%ic domain (curbs, sidewalks.
driveways, marquees, etc I wit require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
STORM DRAINAGE FEE
Permit Limit: 1 Year � Provided Work Is Started Within 180 Days
"Applicant. on behalf of his or her p*us, and
END, INSPECTION FEE
GCeSSOrS in interest, agrees to I W hold
S. ndEmn f�ld no
d its fticl.lej
18sh
W harmless City of Edmon a .11 cInglol,
T the
employees, and agents from any �ndl aims for damages
from the issuance
a
5 oo
whatever nature, arising directly or Indirectly
deemed to
PLAN CHECK DEPOSIT
of this permit. Issuance of this permit Shall not be
modify, waive or reduce any requIrement of any city ordinance
nor limit in any way the City's ab illy to enforce any ordinance
TOTAL AMOUNT DUE
m9l
provision."
I hereby ackrinhadge I at I pave reaa ims pplication; that the
ATTENTION
APPLICATION APPROVAL
Information gIW3P IB corr 1: d that I am the ow ner, or the duly
a ageot f the WIT r_.1n�gnr.enf. Omp.y�w.trh city and
rtze a 0,
THIS
This application Is not a permit until
Sim kauthorIz.
.late Is a d coin Ih
f
OPERMIST
AUTH RIZE
THE
signed by the Building official or his/her
In, person In b employed In Violation of the Labor
f
ONLY
WORK NOTED
Deputy; and fees are paid, and race,, Of is
h late a ashin Compensa
W 1,.?ton relating to Workmen's
acknowledged in space provided.
r, I e aria
ER 0. ENTI I I
INSPECTION
DEPARTMENT
IGNAT RE DATE
JOATI
[N�
CITY OF
I
.
E MONDS
D
CALLFOR
P(TF-FICIALS
F L
D V, ATE
N
I INISPECTION
2/z-,, Lm
S N OCCUPY A BUILDING OR STRUCTURE
'TT
3AL
j
IN.PEkl. DIE AND APPROVAL OR
A� HAS SEEN MA
LINT,j F
HAS BEEN GRANTED. UBC
171-0220
F,11 Y' ILL
GINAL ELLC� In
I. L
. U
A CERTIFICATE OF 0 UPANCY
SECTION 109
PINK - OwrIer GOLD Assessor
z
0
IT
0 M
M I:= a , .
0
80
C:
ITI
M
F --I
� 1
0)
0 _11
M M
0
0 'M
C co
C V) ,
M C)
7 -1
Z
z
z
171