20000283.pdfPERMIT EXPIRES
US' PERMIT 2-011
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CITY OF EDMOND 111 2- NUMBER
CONSTRUCTION PERMIT APPLICATION JOB S ITEJAPT#
ADDRESS r , - T I
l NnAM�GF BUS
79 LID FEE S
PLAT NAMEISUBDIVISION NO N LID NO�
GADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP P-11 R.41- I
S,,- U., P-1 RWd I
71,EP E EXIII JNG-PROPOSED� "db
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ARKS
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COMPLETE EXEMPT ALLOWE P OPOSED
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ALLOWED PROPOSED..
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PROPOSED FRONT SIDE R
'o ADDITION
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AN.
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0 DEMOLISH 0 TANK o OTHER
A AGE 0 A INGWALL RENEWAL
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r (TYPE OF USE BUS OR ACTIVITY) EXPLAW:
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NUMBER
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DESCRIBE WORK TO BE DON
REMARKS
J ViI
-CTION REQ
PROGRESS INSPECTIONS PER USC 10811FINAL INSPE
VALUATION FEE
PLAN CHECK FEE
EAT SOURCE
BU LDING
PLAN CHECK NO:
Pl. MOING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WOLRYK NNo'yED ;mISUpERMITCoTVHRS WORK TO
PROPERTY ON C�. TR CTIO N E PUBLIC
GRAGINGIFILL
DONE ON PRIVATE �A
BE S' MARQUEES, ETC.) WILL REQUIRE
DOMAIN (CURBS, SIDEWALKS, DRIVEWAY
SEPARATE PERMISSION.
SI SURCHARGE
5 PERMIT APPLICATION: ISO DAYS
S
PERMIT LIMIT'. I YEAR * PROVIDED WORK I STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
, OR HER Ep.UEE EIIS�ASSK31,1� AND CCES.RE
EHALF 0, HIS
.. END �N H. . HARMLESS THE CITY OF
N.S G
ENS, INSPECTION FEE
LANDSCAPING
;,APPL'CANT
E INDEMNIFY
INTERE i'A R SE TO
NGTO NjIoTgOF�FTC�IALB AGENTS FRO. ANY AND
I FEE
EIITI�LGYIIS�jAND
EDMON DSI
ALL.". 'OR.A.A. E A VE 'A EAR ING GIRECTLYOR INDIRECTLY
RECEIPT
--- AN E OF THISPERMIT ISSUANCEOFTHIS ERMITSHALLNOTSE
2" THE ISE U C
F OF ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
F WAIVEORREDUCE ANY REOUIRSMENT
D 0 DI Y
CEMEOTOM
RCE ANY ORDINANCE PROVISION
R EIPT
T -!>
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0 NOR LIMIT IN ANYWAY E TYSASILITYTOENFO
T
TOTAL AMOUNT DUE
THA HAVTE�RE.A�o,,.",.,,ApPLI.CEATI.�; T14AT THE INFORMATION
APPLICATION APPROVAL
I HEREBY ACKNOWLEDGE
GIVEN I RECT. AND THA �T� AM E E OFT GULY AUTHORIZED AGENT OF
S COR
Thil 1001-11- 111 P-'t `IOi1F,i9-d by th,
THE OWNER. AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING C.NETFUC-
T.ERep NO RE TISCH WILL BE EMPLOYED
C EU'jdI19 Offl-I 01 "I"'bor D.pulys.I, ...... T.Id. -d
ALL
b�k-Kdpd I, -c- P-0-
TION, AND IN 0 THE AUTHORIZED
" ING L=COGS RELATING TO
THE OF THE STATE OF WASHINGTON
FOR INSPECTION
I
IN VIOLAT ON F
WORKMEN'S COMPENSATION NSURANCE AND HOW 18.27�
DATE
DATE I INII
(425)
)VINES 06bDE T) )
7 -0220 REAEASEDBY
71
EXT 333
A17ENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL 08 A CERTIFI,
ORIGINAL-FiLE , YELLOW. INSPECTOR
- GOLD � ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
FAX PINK - OWNER
5198
R ECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ...............
wall ...................
Pier/Porch .................
z
Retaining Wall ...........
Slab Insulation ..........
PLUMBINGi
-4
Underground .............
Rough -in ............ M
M
Commercial Final . ......
—40
0 C,
HEATING:
S
In
Gas Test .................... rn -YA
Gas Piping ...............
Equipment ............... w -i
0 -n
Commercial Final
EXTERIOR SHEATHING
In In
NAILING .......................
%j VY
0 1
FRAMING ................. 0 rM. P.
C C*
FIRST FLOOR FRAMING_ 9 0);
Q 0:
INSULATION ..........
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
N�
SHEETROCK NAILING
SPECIAL INSPECTION
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...............
ATE RECEIVED q
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER N�AA'ME OF
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LMAILING ADD ESS
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USE PERMIT
ZONE NUMBER
JOB SUITEIAPTIO
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PI -AT NAMEISUBDIVISION NO. L NO. LID' NO.
LID FEE S
u— �P' o
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP P'
EXISTING — PROPOSED— oc
REOUIRED DEDICATION— "T
METE;`EI_ZE --- 7__LlNE_S'ZE__F No _oFFlXTURES PRI REOUMED
YES 0 NO
RE A
M
NEFIIONIRACTOR RESPONSIBLE FOR EROSION CONTFIOUI)RA,NAGE
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ENGINEERING vvivil immwv,r
FIRE REV19WED BY DATE
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STATE LICENSE NUMBER
.Y. NO
SEPAEREVI
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ALLOWED I 4
�j PRQPERT��A ACCOUNT PARCEL NO.
xl
EXP
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181DINT"
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REMARKS
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0 GI;AAFPG.FT 1:1
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ITypE OF U ACTIVITY) EXPLAIN:
CH K ED By
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LOAD
DWELL N
T.
F IP,
tEOUI IED t07YES
E C.UN
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EAT SOURCE LOT SLOPE I
PLAN CHECK NO:
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCT40N ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS. DRIVE AYS, MARQUEES, ETC.1 WILL REQUIRE
z SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT, I YE , PROVIO D WORK IS STARTED WIT MIN 180 DAYS
AR E
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
p E�, LIT OF HIS OR HER SPOUSE, HEIRS, A.I.ND AND SUCCESORS
THE CITY OF
;�A P
NT G E. INDEMNIFY, DEFEND AND HOLD HARMLESS
�,�A�,;�.,AN.G
'DM'o'llD%WAl'HINOTO' ITS FIICIAIS� EMPLOYEES, AND AGENTS FROM ANY AND
A DA.A..iOF WHATEVER NATURE.ARISING DiRECTLYOR INDIRECTLY
LL '. PC BE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT
9 DEEMEOTOMODIFY.WAIVEOR REDUCE ANY MEOUIREMENT OF ANYCITY ORDINANCE
PROVISION. -
5 NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANYORDMANCE
HAVE READ THIS APPLICATION; THAT THE INFORMATION
'CM'REBY ..... T:
,,,,N =LEAN.T.AT A. THE OWNER, OR THE DULY AUTHORIZED AGENT OF
TING CONSTRUC-
THEOWNER I AGREE To COMPLY WIT. CITY AllI IETA�T,5 LoAWME.N" BE EMPLOYED
TION,ANIIIND ING THE WORK AUTHORIZED Ti ER , N PER WILL
0 RELATING TO
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN'S COMPENSATION INSURANCE AND RCW 18�2T
77ATU.E IOWNER '*.�.N�Tl
DIE lItINDED
. Cl
q
VALUATION I FEE
PLAN CHECK FEE
BUILDING
PLUMBING
ECHANICAL
GRADINGIFILL
SURCHARGE
ENG. REVIEW FEES
ENE. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
RECEIPT
PLAN CHECK DEPOSIT
APPLICATION APPROVAL
Th" -PPlIcall0m i� P""' U"' b'ft
,d
BI,ildl.g 01116-1 �' G-1,1.' F .. dd
TION a.d p,d.d.
OFFICIAL Gt TURE TE
(425
771-0 0
RULtA ED BY
ATTENTION r-A 1
OR STRUCTURE UNTIL
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING 771-0221 ORGINAL - FILE YELLOW - INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- PINK � OWNER GOLD - ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX
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