20000260.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OF NA;�5ME 0 SS
MAILING ADDRESS
CITY ZIP
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PERMIT EXPIRES
us' PERMIT
ZO E
NUMBER
JOB
ADDRESS 2-
PLAT NAMEISUBDIVISION NO.
LOT NO,
LID NO.
"D FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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EXISTING — PROPOSED.
L.. P ".0 E
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REQUIRED DEDICATION� FT
METER SIZE
LINE IjF7.
01 FIXTURES
PRV REQUIRED
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Yes 0 No 13
REMARKS
MNPRICONTAACTOR RESPONSIBLE FOR EROSION CONTROIJORAINAGE
NAME
oll�
ENGINEERING REV15WEDIDATE
ADDRESS J
I
Fit E REVIEWEDBY DATE
CITY ZIP
TELEPHONE
STATE LICENSE NUMBER EXPIRATION
VARIANCE OR OU
SHORELINE OR ADS#
IN
C
C3 YES NO
SERA REVIEW
COMPLETE EXEMPT
EXP I
SIGN AREA
ALLOWED I PROPOSED
HEIGHT
ALLOWED PROPOSED
I
IROPERTY TAX ACCO NT PARCEL NO.
z1_3 4/6
rl NEW if RESIDENTIAL Cl PLUMBING/MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT UPSIDE REAR
0 ADDITION f-I COMMERCIAL o COMPLIANCE OR
CHANGE OF USE
PARKING
LOT AREA
PLANNING REVIEWED BY DATE
0 REMODEL C] APARTMENT SIGN
PEO'D I PROVIDED
I
F NOE
REPAIR C] GRADING CYDS n I X FTI
REMARKS
n DEMOLISH C] TANK 0 OTHER
P CARP.;EIT F%U,;A,:E�'NG WALL 0 RENEWAL
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JYP!;��ESSOR TIVITY) EXPLAIN: —
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'yP UCTION
OCCUPANT
GROUP
NUMBER
OF
STORIES
NlllElOF
OW NG
UN3TLSLI
r CRITICAL
AREAS R
NUMBE
SPECIALEIDNISPECTOR
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[REMARKS
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DESCRIBE WORK TO
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VALUATION I FEE
PLAN CHECK FEE
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HEAT SOURCE GLAZING % LOT SLOPE I
BUILDING
Lm
PLAN CHECK NO: rESTED DATE
U.-'N.
LGRADiNGIFILL
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- C.A�K`AL
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIV E PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS , MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: 160 DAYS
PERMIT LIMIT.- I YEAR � PROVID D WORK 1. STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. INSPECTION FEE
;APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
N INTEREST, AGREES TO DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPIN
:NDEMNIFY.
2 EDMONDS. WASHINGTON. TS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
INSPECTION FEE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
FROM THE ISSUANCE OF T IS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
RECEIPT
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
0 NOR LIMIT IN ANYWAY THE CITYS ABILITY TO ENFORCE ANYORDINANCE PROVISION.*
RECEIPT
TOTAL AMOUNT DUE
62
I HEREBY ACKNOWLEDGE TH AVE READ THIS APPLICATION; THAT THE INFORMATION
AT! "M
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT A THE OWNER, OR THE DULY AUTHORIZED AGENT OF
CONSTRUC.
Thi, ppk,bo, �s b,t , pt Unt 111 Ild by thl
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING
NO PERSON WILL BE EMPLOYED
CALL
B,ildmg 011i I , lbi,lho, Doputy:',IiF,b� — obd. -b
TION, AND IN DOING THE WORK AUTHORIZED THEREBY,
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION ipl I. .�k..dg.d m �p Pd.b,
WORKMEN'S COMPENSATION INSURANCE AND POW 16.27,
0"llGN BJTE
SIGNATU 'I 106LWNII 1; DATE SIGNED
(425)
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e"l
771
-3
-0220
RELEASE D
ATTENTION
EXT 333
00
I
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-
� I"A YELLOW - INSPI!CTOR
CATE OF OCCUPANCY HAS BEEN GRANTED, USC SECTION 109
FAX
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PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ...........
FOUNDATION:
Footing ...........
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Wall.......................... .
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Pier/Potch .. ...............
Retainirig Wall ...........
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Slab Insulation ..........
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PLUM13ING:
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Underground .............
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Rough�ln ...................
Commercial Final
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HEATING:
0
1 p
Gas Test ....................
M
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Gas Piping .................
Equipment ..................
commercial Final
EXTERIOR SHEATHING
NAILING ..........................
M rn,
FRAMING — .....................
0 n
0 R
I r.,
FIRST FLOOR FRAMING
C
INSULATION ..........
Floor Insulation ..........
Wall Insulation ...........
Ceiling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
Z:
10
0.
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
g5
OCCUPANCY ..................
-7/
ERMIT EXPIRES
CITY OF EDMONDS
PERMIT
ZONE I
NUMBER ?��700Z&10'
CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS 7
2-Ll
OWNER NA��Ml 0��14EII
PEA
MAILINGADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 0
P—a a' a 0
CITY ZIP ITELEPHOIE
EdIVOnd.5 �102D
EXISTING— PROPOSED— In-d �a A".d 0
FlE.UIIIE.DE.I.ATI.N_ PT
FIXTURES PFW REQUIRED
NAME
ADDRESS
YES 0 No
REMARKS
OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
Hu
CITY ZIP TELEPHONE
STATE LICENSE NUMBER EXPIRATION— I CHECKEDBY
C3 NEW
RESIDENTIAL
0 P UMBING I MECH
0 ADDITION
0 COMMERCIAL
o C MPLIANCE OR
C14ANGS OF USE
0 REMODEL
0 APARTMENT
0 SIGN
-6f
GRADING
0
REPAIR
0 C,GE
IFENCI X FT)
0 DEM8LtSH
0 TANK
0 OTHER
GAA�"A.G�EIT
E)TA'l I IRN'G WA L L
0 RENEWAL
0 R
K
ITYPE � I.BUSINESSORA IVITY) EXPLAIN:
o U' CT
NUMBER
OF
CRITICAL
OF
STORIES
WELLIN
UNITS
AREAS
OEECRIEEWORIT..�'o2v
FIRE REVIEWED BY DATE
VARIANCE OR CU
SHO EUNEORAUSN
INSPECTION
z R EO'D
N
I PBO 0
OSTED
OYE S 0 NO
SEPA REVIEW
71GN AREA
HEIGHT
COMPLETE EXEMPT
AL—E. PROPOSED
ALLOWED PROPOSED
.XP I
I
I
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE REAR
PARKING
LOTAITIA
REVIEWED BY DATE
REO'D I PROVIDED I
11-NNIN
[ CHECKEDBY ITYP UCTION JM� CCU AN;,,
R.U'
SPECIAL INSPECTC*
R REQUIRED C] YES
E
REMARKS
P.
PROGRESS INSPECTIONS PER USC, 1081FINAL INSPECTION REO'D1 F4
—'CS AOL;_"
VALUATION
55E
PLAN CHECK FEE
_N CHECK
HEAT SOURCE LOT SLOPE %
7�E.
BUILDING
[MECHANICAL
PLAN CHECK NO: ED DATE
PLUMBING
li
THIS PERMIT AUTHO IZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING/FILL
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAY MARQUEES, ETC.) WILL REQUIRE
3 SEPARATE PERSWISSION.
STATE SURCHARGE
PERMIT APPUCATION; 180DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
fix,
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG, INSPECTION FEE
�A PLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES 1`0 INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON� ITS OFFICIALS, EMPLOYEES� AND AGENTS FROM ANY AND
71, DSCAPING
INSPECTION FEE
ALLCLAIMS FOR DAMAGESOF WHATEVER NATURE, ARISING DIRECTLY OR IND;RFCTI Y
m FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
RECEIPT
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REOUIREMENTOF ANY CITY ORDINANC
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANYORDINANCE PROVISION.-
ECEIPT
TOTAL AMOUNT DUE
JR
I HEREBY ACKNOWLEDGE HAVE READ THIS APPLICATION; THAT 7HE INFORMATION
APPLICATION APPROVAL
GIVEN I CORRECT. AND TTHAATT� AM THE OWNER. ON THE DULY UTHORIZED AGENT OF
Thl, pptiC,I,,,,, ba a p,,,it anal llglld by Ihl
7 E OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
and FIOS 11 P
8 IdaK Offi,ml 01 �klllhll D and. and
8
TION, AND IN DO NG THE WORK AUTHORIZED THERE YNO PERSON WILL BE EMPLOYEE)
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
dop,ty:
ma, oddjd,opalad.
WORKMEN*S COMPENSATION INSURANCE AND RCW 18.27.
OF CI kGN D E
SIGN ATU F!L(O WN R OAT SIGNE
(425)
CD
?SgR_�
2. 4
771 0220
OAT
RELEASE
ATTENTION
EXT 333
oo
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-
ORIGINAL - FILE - YELLOW - INSP CTOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
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