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I I I PERMIT EXPIRES
.. PER
CiTY OF EDMONDS ZONE NUMBER —2-&.D21
CONSTRUCTION PERMIT APPLICATION B ITEIAPT#
ADDRESS V sl- &I
PLAT NAMEISUDDIVISION NO. LOTIO, III NO,
UG EEE S
.AILING ADDRESS
Z/
PUBLIC RIGHT OF WAY PER OFFICIAI.
EXISTING — PROPOSED —
REQUIRED DEDICATION— FT
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METE. SIZE
I LINE SIZE .1 NO. OF FIXTURES
PAV RE OUIRED
YES 0 No 0
I
REMARKS
OWNERIC
kDDRESS
;ITY ZIP
NAME
ENGINEERING REVIEWIEEVDATE
AIDF;1��
FIRE REVIEWED By DATE
11,
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TIL11HO—
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VARIANCE OR CU
SHORELINE OR ADS' I
ISIECTI NO
RED .0 N
0 YES 0
I PRO
IDS
STATE LICENSE NUMBER ATE
CHECKED BY
f *1 i�ll_ vi v 4- cl, 0 rn k,
Lu
ROPERTY TAX ACCOUNT
PARCEL NO,
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LI
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..SIGENTIAL
PLUMBING / MECH
UGT,ON
COMMERCIAL
o
C MPLIANCE OR
CHANGE OF USE
C] REMODEL
C] APARTMENT
SIGN
REPAIR
RADING
CYDS
0
FENCE
_ � _ ITI
C] DEMOLISH
C] TANK
n
OTHER
AGE
0 RR.FT
R=,lNyG WALL
E]
RENEWAL
_ CA
CA
B
TIVITY) EXPIAIN:
--7s_PAqSVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED I P80POSED ALLOWED I PROPOSED
�Xp
LOT COVERAGE REGUIRED SETBACKS (FT) PROPOSED SETBACK$ (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UPSIDE REAR
DATE
PARKING BY
GO I PF.V
7R DE.T
CHECKEDBY ITYPE
R AL =jb_...
NUMBER N OF SPECI L INSPECTOR
UMBER. All, I CAL
T'
WELL N AREAS REQUIRED [] YES
OF I U =R
UM R
NITS N MEE
DESCRIBE WORK TO BE DONE
0 CUPANT
GROUP
UBC 108/FINAL INSPECTION
VALUATION I FEE
PLAN CHECK FEE
HEAT SOURCE
LOT SLOPE %
BUILDING
PLAN CHECK ND:
TT_ED DATE
PILMBIN,
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THEP BUD
uU
GRADNGIFiLL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES , ETC.) WILL RED IRE
SEPARATE PERMISSION.
S RCHARGE
P
PERM
-:::: ITAPPLICATI N; 18-VAYS
ER'
PERMIT LIMIT 1 YEAR. PROVIDED WORK IS STARTED WITHIN 180 DAYS
I YEA _'
ENG REVIEW FEES
SEEBAC KGF PINK PERMIT FOR MORE INFORM 10�
E BAD K OF '
ON BEHALF OF 'HIS DR HER SPOUSE� HEIRS. ASSIGNS AND SUCCESORS
ENG INSPECTION FEE
;APPLICANT.
N INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
INSPECTION FEE
ALLC�LATMS FOR DAMAGBSOFWHATEIEF,.ATURE, AR15ING DIRECTLY OR INDIRECTLY
AMA.- o
IEF.IT SHALL NOT BE
RECEIPT
T BSU THIS PERMIT. SSUANCE 01 THIS
CE
FROM THE ISSUANCE OF ANY ITYORDINANCE
D5 EYED TO MODIFY. WAIVE OR REDUCE ANY RECUIREMENT OF c
GFY WAIVE
PLAN CHECK DEPOSIT
NOR LIMIT IN ANY WAY THE CRY S ABILITY T. ENID RGE ANY OF DINANG� I R.VI SI
OR LIMIT I Y WAY T
RECEIPT
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AFPLICATION� THAT THENFORIVATION
ATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
t bI ll,od by 11.b
W
THE 0 NE R I ACRE E TO COMPLY WIT. CITY AND STATE LAWS REGUI_ATlLNrFCE0.NSLR,�EC�
CALL
T ZED THEFEBY� NO PERSON WIL
ION. AND IN DOING THE WORK AUTHOR'
OF WASHINGTON RELATING TO
FOR INSPECTION
IN VIC, ATION OF THE LABOR CODE 01 THE STATE
WOHKMEN SCOMPENSATI.N INSURANCE DRO-6.21,
OFFICIALS G LIFE L DATE)
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(425)
_j
771-0220
RE SEDBY DATE
—
EXT 333
A ENTION
TT
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL-FiLE YELLOW INSPECTOR
A FINAL
CATE OF OCCUPANCY HAS BEEN GRANTED. LEG SECTION 109
FAX
pINX.oWNER GOLD -ASSESSOR
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A
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall....... ..................
Pier/Porch
M
Retainlrig Wall ...........
Slab insulation ..........
x
am
PLUMBING:
Underground .............
C
Rpugh-In ...................
M,;
Commercial Final
HEATING:
GasTest ....................
Gas Piping .............. ..
MM
Equipment �7 ............
Final
rn
commercial
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ..............
FIRST FLOOR FRAMING
5
z
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Z.
0
Ceiling Insulation
M
SHEETROCK HAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR -.00
.................
OCCUPANCY
)Z402.-.73
CITY OF EDMONDS
JC
CONSTRUCTION PERMIT APPLICATION LAI
ER NAMEAIAME OF BUSINESS"
ADDRESS
FIT'
NAME
ADDRESS
TELE
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STATE LICENSE NUMBER
CHECKE By
(_ _r k -) k A- c' o c;
TAX ACCOU.TPARCELNO.
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RESI.E.T"Al,
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A ,T,.N A
C MPLIANCE OR
o CHANGE OF USE
E] REMODEL Ej SIGN
F NCE
REPAIR GRADING CYDS 0 1 � X FT)
DEMOUSH TANK
OTHER
L o GARAGE E] RETAKINIRNYG WALL
J CARPORT
C Roo F
_j RENEWAL
ACTIVITY) EXPI-AIN:
NUMBER
NUM95R OF
DWELLING
I —
AREAS
OF
STORIES
UNITS I
NUMBE R
DESCRIBE WORK TO BE DONE
1,W,. I PERMIT EXPIRES
BE PERMIT
ONE NUMBER
B
DDRESS w
EIAPT�
"�5z
PLAT NAME/SUBDIVISION NO,
LO' N"
LID No
LID 'ti IS
AL:_7
PUBLIC RIGHT OF WAY PER OFFICI B REET.Al
AP —
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Pw P I'
P.- P�.
EXISTING — PROPOSED-
REOU IRED DEDICATION FT —
u
METER SIZE LINE SIZE NO, OF FIXTURES
IRV EOUIRID
I
YES 0 No 0
REMARKS
—PRICCNTRACTOR RESPONSIBLE FOR EROSION CONTROUDITAINAGE
FIRE REVIEWEDOV
DATE
VARIANCE OR CU
SHORELINE 01; ADB#
INSPECTIONO
REQ'D
I PEOND
OSIED
OYES 0 N
SEPA REVIEW
P—E EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
I
EXP I
I
LOT COVERAGE
REQUIRED SETBACKS IlT)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
I ... T SIDE REAR
FRONT UPSIDE REAR
PARKING
LOT AREA
I
PLANNING REVIEWED BY DATE
REGO I PROVIDED
PLAN CHECK FEE
HEAT SOURCE GLAZING I LOT SLOPE %
BUILDING
PLAN CHECK NO: �VESTEOIATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. rHIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
WAY IRE
DOMAIN (CURBS. SIDEWALKS, DRIVE S, MARQUEES, ETC.) WILL REQU
SEPARATE PERMISSION.
SURCHARGE
PERMIT APPLICATION: 110OAYS
I
PERMIT LIMIT. I YEAR 'PROVIDEDWORK SSTARTEDWITHIN 180DAYS
40. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT. ON BEHALF FHI OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
I I INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
N NTEREST AGREES T
LANDSCAPING
ITSOFFICIALS. EMPLOYEES, AND AGENTS FROM ANYAND
INSPECTION FEE
OFWHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
NOT BE
PERMIT SHALL
CITY ORDINANCE
PLAN CHECK DEPOSIT
OF ANY
PROVISION
ORDINANCE
TOTAL AMOUNT DUE
I HAVE READ THIS APPLICATION THAT THE INFORMATION
I HE RE BY ACKNOWLEDGE THAT NT OF
IS CORRECI AND THAT I AM THE OWNER� OTATHE OUSLYR-UTHOTRNZG
GIVEN COGE
THE OWNER. I AGRiE TO COMPLY WITH CITY AND S E LAW EGULA NSTRUC.
CALL
TION.ANDIND ING THE WORK AUTHORIZED THEREBY. No PERSON WILL BE LllPlYED
0 RE ATING TO
WASHINGTON
FOR INSPECTII
IN VIOLATI ON OF THE LABOR CODE OF THE STATE OF
WORKMEN S COMPENSATION INSURANCE AND RCVV 18.27
ATE SIGNED
(425)
771-0220
EXT 333
ATTENTION
I T IS UNLAWFUL. TO USE OR OCCUPY ABU ILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
S"'.
L- - . - - - - __ - __ - - - � __ -
_ .--- - __
APPLICATION APPROVAL
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ORIGINAL FILE - YELLOW INSPECTOR
PINIX-OVINER - ..LD-All.B-P