20000290.pdfPERMIT EXPIRES
p T
ZONE
CITY OF EDMONDS
NEURMMBER
CONSTRUCTION PERMIT APPLICATION 'AOBRESS
PY SUITEIAPTN
OWNNERN M61NAME
FLAT NAMEISUBDIVISION NO LOT No.
LID 10,
-S+-o-
LID FEE $
.�OFBUIINESS
U ES
A NGAERE
AILING ADDRESS
P BLIC RIGHT OF WAY PER OFFICIAL STREET MAP
U
_-d
TEllP Ap"', 0
IIW P.,
0
EXISTING — PROPOSED -
I U" P% 1. 1"' 1 0
q -do
P.q.- C3
..1-d El
YA
�p
r---A .A.A, 1, La. tia A
0:7 1
RIQUIREIDEDICATION— IT
-
_d _'_ 0
"' "u", 0
—
METER SIZE
LINE
EQUIRED
W R U,. D
NAME
I
YEPRV
SO No 0
REMARKS
OR HESPOt�!SIIILE FOR EROSION CONTROUDRAINAGE
L ADDRESS
A IA.
ZIP T
�q:p
J71 0:2_71
NAME
Ism -t- m 4
ENGINEERING AEVIEWEDI�ATE
ADORES? a
FIRE REVIEWED BY DATE
CITY ZIP
"L
LJA-. A
3a
VARIANCE OR CU
SHORELINE OR AUS.
IMSPE
RE
0 YES
STATE LICENSE N BER EXP I N DATE
CHECKEDBY
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED , PROPOSED
I�C�O T
JI PlllEllY( RCEL NO.
I
an
EXP I
LOT COVERAGE
REQUIRED SETBACKS (1)
PROPOSED ET.A.KS (1)
NEW RESIDENTIAL I E.H
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE REAR
ADDITION 0 COMMERCIAL o C MPUANCE OR
CHANGEOFUSE
I
LOTAREA
DATE
E3 REMODEL APARTMENT El SIGN
PARKIM3
REG'
I PROVIDED
1PLANNINGREVIEWEDBY
REPAIR GRADING CYDS 0 FENCE X FT))
13 I — —
R
—
DEMOLISH TANK
I/A pk� Ad've
Sk-
G A AGE RETAKIWI�NG WALL RENEWAL
ARPORT
C BIG,
_fi� /� 9Z
r (TYPE OF USE. BUSINESS OR ACTIVITY) EXPILAIN:
ED 8;FE[7
OF RPION
OCCUPAN;e
Q CUP
7ECK
-
NUMBER
NUMBEROF
CRITICAL
CIAL 1�
6CCUPANT
OF
'0 STORIES
DW LLING
UN.�-
AR EAS
NUMBER
.'Eau,FE. 0 YES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'
VALUATION FEE
PLAN CHECK FEE
HEAT IT SLOPE %
�TRCE 1 :5 )
BUILDING
_
PLAN CHECK 4 NO:
PLUMBING
II
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK To
BE oANE,oH P.R.IV.AT.1 PROPERTY ONLY. ANY =NSTRUCTI.N ON THE PUBLIC
GRADING/FILL
B.M N UR S EWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
PERM 180 DAYS
APPLICATI N:,,
PERMIT LIMIT: I YEAR � PIT
STA TED WITHIN 180-AYS
RoVID'D WORK R
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
PLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESDRS
END, INSPECTION FEE
;A
NPINTEREST. AGREES To INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAP No
5 G 0 ITSOF ICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
E EDMONDS.WA HIN T N F
INSPECTION FEE
ALLCLAIMSFO RDAOAGE OFWHATEVER NATUR E. ARISING OIRECIL,
ISSU NCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
FROM THE ISSUANCE OF T'
DEEMED TO MODIFY. WAIVE GRIPE.`U(ITT ANY REQUIREMENT OF ANY lY ORDINANCE
�"Jy-�JID
NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
TOTALAMOUNT DUE
REC
1 HEREBY ACKNOW EDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION
APPLICATION APPRUVAL
R TH LY AUTHORIZED AGENT OF
iE DU
GIVEN IS CORRECT, AND THAT I A. THE OWNENR6 oTATE
THEO NER, I AGREE TO COMPLY WTHCITYA S LAWS REGULATING CONSTRUC-
o
CALL
Buil-Gol"P.I.--,
EMPLOYE
TION. AWND ED THEREBY. NO PERSON WILL BE L
DOING THE WORK AUTHORIZ RE ATING To
WASHINGTON
d P
FOR INSPECTION
IN VI IIN
OLAT ON OF THE LABOR CODE OF THE STATE OF
WORKMEN S COMPENSATION INSURANCE AND RCW 1827,
OFFICI L SIGNATUR DATE
SIGNATURE (OWNER OR AGE
-74SI NED
(425)
a__
-
771-0220
::Z, � ) -/0
ELEASE
ATTENTION
EXT 333
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-
ORIOINAI.-FILE - YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK OWNER - GOLD -ASSESSOR
5�8
z
0
vi -4
0 X , i .
r— M
0
rn
0 -n
.m
3: M
m
0
C) Fn
C:
c 43
M 0
Z
z
z
0
m
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ...............
wall..........................
Pler/Porch .................
Rst.iop Wall ...........
M
Slab Insulation ..........
PLUMBING:
M
C
0
1
Underground
M 0
-inRough .............
-4 0
Commercial Final
M
ITI Z�
HEATING:
r
p Gas Test ....................
X
Gas Piping . ............... -
0 -n,
n 20
Equipment .................
MITI
Commercial Final
EXTERIOR SHEATHING
0 M
NAILING ..........................
C cq�
E 0)
mo�
FRAMING ..................
FIRST FLOOR FRAMING —
INSULATION ...................
Z
Floor Insulation
-4
Wall Insulation ...........
Ceiling Insulation
SHESTROCK NAILING
M
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..............
0,
ATE PIECE 0
PERMIT EXP RE =0/, I'
10, PERM
IT
&ITY OF EDMONDS NUMBER
SUITEIAITI
CONSTRUCTION PERMIT APPLICATION JA006DRESS
OWNER NAMENAME OF BU INESS
PLAT NAME/SUBDIVISION NO. I LOT 10,
I'D 0.
MAILING ADDRESS
LID FEE $
T S-4pl-d 0
Y01-
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RE
W 00
CITY
EXISTING - PROPOSED-
0
0
F1011FEDOIDIC-ION- FT -
W11IN
METER SIZE
LINE I'll
NO, OF FIXTURES
PRI REQUIRED
NAME
I I
Yes 13 No
r
ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY "0
Amin to
NAMESTV
uu iff"L616w
NUUI)JA
4 tl yy), A)
ENGINEERING REVIEWEDIDATE
ADDRES?.
DATE
FIRE REVIEWED By
z
CITY zip
TELEPHOI
J
BOND
0
NIATE
OHICKE BY
VARIANCE OR CU
SHORELINE OR ADB�
INSPECTION
POSTED
m
STATE LICENSE NUM �I]
REO'D
C]YES ON.
j1I
r- v g C Ll
SERA REVIEW
SIGN AREA
HEIGHT
IIIPERTYrl,,AICI TPARI LNO.
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP I
A
LOT COVERAGE
REQUIRED SETBACKS -)
PROPOS ED SETBACKS
Cc:
0 NEW
RESIDENTIAL
PLUMBING MECH
ALLOWED PROPOSED
FRONT SIDE REAWR
FRONT UP SIDE REAR
0
0 ADDITION
C] COMMERCIAL
o C PLIANCE OR
CHAN E OF USE
0
c:
PARKING LOT ARIA PLANNING REVIEWED BY DATE
m
0 REMODEL
APARTMENT
1:1
C3 SIGN
PRO
REQ'O ORD
m z
FENCE
REPAIR GRADING CYDS X FT)
REMARKS
C3 DEMOLISH C] TANK
hfv (A ck� I
1
"se "
r
0)
RAG'
0 GA C] FQTAXININB WALL RENEWAL
CARPORT F C ER
0 —9`7
..
0 -n
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
I III
CHECKED BY
TYPEOF 0 S11aICN
GROUP
Con 1
O"Up";e
, -4
M NUMBER
N ME
FI-ALINSPECTOR
OCACIUPANT
m rn
0
OF
STORIES
0
D ELI
UNITS
JAREA
WIRED C] YES
Lo
0
0 Fn
DESCRIBE WORK TO BE DONE
M
REMARKS
p ROGRESS INSPECTIONS PER UBC 108fFINAL INSPECTION REO'D
5
M
0
z
A-
AAAfl-Lirn
VALUATION
FIF
55 c
PLAN CHECK FEE
HEAT�TRCE ING I
SLOPE I
81110ING
Q
0
m
PLAN CHECK NO'.
DATE
PLUMBING
IVESTE1
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: B DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CURBS, SIDEWALKS, DRIVE S, MARQUEES, ETC.) WILL REQUIRE
2 WAY
:3
L SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATIOK:1 180 DAYS
PERMIT LIMIT'. I YEAR, PROVID D WOR S STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-
ENO, INSPECTION FEE
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
IN NIEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS '"' "" "
LANDSCAPING
I ED"ONDS*WAS"I"GTON* ITIOFFICIALS, EMPLOYEES, AND AGENTS FROM ANYAND
INSPECTIONFEE
A LCUIMSFORDAMAGESOFW ATEVER NATURE, ARISING DI RECTIOR INDIRECTLY
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
-3
DEEMED TO MODIFY. WAIVE A REDUCE ANY REQUIREMENTOF ANY CITIORDINANCE
NOR LIMIT IN ANYWAY THE CITY S ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
RECEIPT
C)
TOTAL AMOUNT DUE
;7
I HERE Y ACKNOWLEDGE THAT I HAVE I�A. THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
Y
T E OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
BE
CALL r,: B,p,ty'a.d F-1 .1. i,.t1d.
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL LEMPLOYTED
THE LABOR CODE Or THE STATE OF WASHINGTON RE ATING
FOR INSPECTION -1,pi I, aI1dgqd � -0 PI-d.d.
IN VIOLATION OF
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27
OFF, SIGNATURE
SIGNATURE(OW CROR AGENT) 'TDAT
SIGNED
(425) / /h T/v
I - I o Do
Li�
�
771-0220 KELEASE 0 TE
ATTENTION
EXT 333 Olt)
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 21 I
771-02
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -PILE YELLOW INSPECTO R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX PINK - OWNER GOLD - ASSESSOR