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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER �;:�N14F 7�7 Q4 I JEA-
MAILING ADDRESS
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ICENSE NUMBER ' E
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02'�RESIDENTIAL
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COMMERCIAL
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cl COHANGE OF USE
MODEL
APARTMENT
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SPAR GRADING GyCS
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EMOLISH TANK
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NU"IE
OF 7-- 1
STORIES UNITS
DESCRIBE WORK TO BE DONE
PERM�IT �EXPIRES��
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USE PERMIT �Z&0-2-9 I
ZONE NUMBE
SUITVAPTN
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PI -AT NAMEISUSCIVISION NO. Ll NO.
LOT _1.0 FEE I
TES—Ppl—
PU BLIC RIGHT OF WAY PER OFFICIAL STREET MAP - I.-
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EXISTING — PFOPOSED�
REQUIRED DEDICATION— FT �
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--- �ETER �NG
OF X,�URES PFV REQUIRED
YES 13 NO 0
R MARKS
—FAZONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
FIRE REVIEWED By
DATE
VARIANCE OR CU
SHORELINE 08 ADD.
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED I PROPOSED
ALLOWED I PROPOSED
EXP I
LOT COVERAGE
REGUIRED SETBACKS (FT)
PROPOS D SETBACK$ (FT,)
ALLOWED PROPOSED
PRO- SIDE REAR
FRONT UP SIDE FEAR
PARKING
LOT AREA
PLANNING REVIEWED
By DATE
REOD I PROVIDED
SPECIAL INSPECTOR JAREA OGACDPANT
REQUIRED C3 YES Lo
REMARKS
DRMr.Rrqq INSPECTIONS PER USC 108/FINAL INSPECTION REO'D 11
VALUATION I FEE
PLAN CHECK FEE
HEAT SOURCE LOT SLOPE
BUILDING
5Z ..
PLAN VHECK NO: VESTIO DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS. SIDEWALKS. DRIVEWAYS , MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSiO
GRADINGiFILL
1� URCHARGE
PERMIT APPLICATION:, 180 DAYS
PERMIT LIMIT.- I YEAR - PROVIDED WORK S STARTED WITHIN IBD DAYS
SEE BAG K OF PINK PERMIT FOR MDRE INFORMATION
C
A 'CANT ON BE. OF HIS OR HER SPOUSE IRS. ASSIGNS AND SUCCE oRs
AL' oF'
p�LT'E'�AE'�T�.'AN.'.E�".'�L'TO INCE.Mll DEFEND XHE Yo D
�NAP,I E F
To
N NO HOLD HARMLESS TH CITY AN
EGMoNDS,,F.ASHDlNGllN "OFFICIALS. EMPLOYEE. E.TSY Ro AN
CLAIM - OR AM . CTL o IR G'LY
ALLGLA'. P A.E,G -S ANDIAGRE FIND E
A F D A EDC FWHATEVER NATURE. ARI�ING
L
r FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL HOT BE
'SSU C. o
�Fy AIVE REIDUCEAN FE.LIFE.ENT .1 ANY CITY ORDINANCE
To M.-I Y
DEEMED TO MODIFY. WAIVE OR
NOR LIMIT IN ANY WAY THE CITY S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
Y W Y THE,
ENG, REVIEW FEES
ENG. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
CEIPT
REG
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFDAMAIION
GIVEN IS CORRECT: AND THAT t AM THE O—ER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER iAGREETOCO PLY WITH CITY AID STATENI.AWS REGULATING '-NST7L%
IN Do NO THE WORK AUTHORIZED T.SFEGY. PERSON WILL BE EMPLOYE
TION. AND E STATE OF WAS.,.. TIN. TO
IN VIOLATION O'F THE LABOR CODE OF TH , TON FELA
_�ORK. N'S COMPENSATION IN URANCE AND RCW 18.21,
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TION
OFFICI SIGNAT Y/;E/O
(425)
771-0220 ELEASED By DATE
A-F FENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTiFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
EXT 333
771-0221
FAX
ORIGINAL FILE - YELLOW - INSPECTOR
PINK - OWNER - GOLD - ASSESSOR
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RECORD OF INSPE&IONS
INSPECTOR
DATE APPROVED
SETBACKS ................
FOUNDATION:
Footlng .....................
wall .................
P[er/Porch
R.6Inlrfg Wall .... .......
siiOns6lation
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PLUMBING:
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undirgiound, ..........
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Commerclat Final
HEAT,,
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Gas Test ............
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Gag Piping ............
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Equipment .................
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donirnerda'l Final
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NAILING ...................
FRAMING .............
FIRST FLOOR FRAMING
INSULATION ..............
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Floor Insulation
Wall Insulation
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Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION,
MISCELLANEOUS ..........
FINAL APPROVAL FOR.
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RECEIVED
� .1) ERMIT EiPIRES,
CITY OF EDMONDS
U S E
E PERMIT
USNE
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P" z NUMBER 2MO-2_91
CONSTRUCTION PERMIT APPLICATION
JOB SUITOAPT4 4
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ADDRESS
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OWNER �IA4F BV;T Q4 � -f
BID NNO
PI -AT NAMEISUBDIVISION NO.
FLAT NAM"SUDV
LOT NO.
U.N..
LID FEE S
MAILING A. BESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
PUBLIC RIGHT OF WAY PER 0
EXISTING — PROPOSED
EXISTING — P POP,
REIOUREOOEDICATION� FT
RE.UI RED -E-'CAI�.N _
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REGUIRED
CITY ZIP JT1111" IE
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MET I ER SIZE
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LINE SIZE
LINE E'Z
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YES 0 No 0
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REMARKS
REMARKS
—P-SIBLE FOR EROSION CONTROUDRAIN-
-_.E-'C-NTRA.TOR FEEPC
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STATE LICENSE NUMBER EXPIRATION 011
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COMPLETE EXEMPT
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SIGN AREA
ALLOWED I PROPOSED ALLOWED
_�EQUJReD
HEIGHT
, PROPOSED
RCEI q
PROPERTY TAX PtZ I
C] NEW M/IRESIDENTIAL C;,lfflM6lNG MECH
LO COVERAGE
ALLOWED PROPOSED
SETBACKS (FT.) PROPOSED
FRONT SIDE REAR FRONT
US ETBACKS(FT.)
R SIDE REAR
[DXDDITION C] COMMERCIAL cl COMPL ANCE OR
CHANGE OF USE
[a,R5MODEL C] APARTMENT C] SIGN
0 REPAIR ..A.ING CY.. C] FENCE
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C3 DEMOLISH TANK o OTHER
GARAGE r-1 RETAININ
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ROCKE Y C3 RENEWAL
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PARKING LOT AREA PLANNING REVIEWED By DATE
REGO PROVIDED
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CHECKED By
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NUMBER NUMBER
OF DWELUNO'
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STORIES
CRITICAL
AREAS
UMBER
SPECIAILEIDNSPgCTOR JAR9A
REQUIR 1:1 YES I
OCUUPANI
LOAD
D,B,F,BE WORK To BE ONE
REMARKS
PROG EBB INSPECTIO NS PER UBC 108/FINAL INSPECTION REO'D
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VALUATION
FEE
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PLAN CHECK FEE
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LOT SLOPE %
HE�l BUILDING
PLAN CHECK NO: IVESTEDDATE PLUMBING
OCHAN;CAI_
THIS PERMIT AUTHORIZES ONLY THE W FIX NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY OOLY. AN CONSTRUCTION ON THE PUBLIC
Y GRADING/FILL
DOMAIN (CURBS. SIDEWALKS, VEWAYS ARQUEE% ETC.) WILL REQUIRE
SEPARATE PERWISSION.
URCHARG8
"ITAIII-IIAT! "I 11"Ayl
PERNUTLIMIll YEAR- PROVIDED WORK IS STARTED WITHIN IBODAYS ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFO
ENG. INSPECTION FEE
;APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
N INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING
III EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
A CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY ORIN ECTLY
FLLOM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMiT,SHALL NOT BE PLAN CHECK DEPOSIT
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY C TV ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINA FECI
TOTAL AMOUNT DUE
S IC
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPL CATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AD ENT OF
RUC. Thl I PPftntI.n 11 10t I pennit In III igned by tho
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONST CALL uny: nd F .1. P.W. nd
TION: AND IN DOING TH E WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYE D 6,,ild,lg 011i . ci,l o, hnll,e� Dep In p p-ded.
IN VIOLATION OF TH g LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION I k ..09,Id
WORK!I� COM N TION INSURANCE AND RCW 18.27, OFFICI _//ATE
RAG I I)AqSlr�ED (425)
T/ — 1 -,9,)
A 11Z "�2j' 771-0220 LEASED BY D.E
ATTENTION EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDI NG OR STRUCTURE UNTIL
A FINAL NSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 771-0221 -.,,DNA, -FIL YELLO INSPECTOR
CATE OFIOCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX P,N,. OWN: COLD ASSESSOR
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ............
Wall_ ........... ............
Pier/po'cl . ........ ........
Retaining Wall ..... .....
Slab insulation ..........
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PLUMBING:
0,
Underground .............
Rough -In ................... .........
--I �n
. ...........
commercial Final
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HEATING:
-1 0!
GasTest ............
0 0,�
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Gas Piping ..... ........
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Equipment 7
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commercial Final
3:
EXTERIOR SHEATHING
NAILING..........................
FRAMING
MT
0
INSULATION .......... ........
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Floor Insulation
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wall Insulation
7-11
§HEETROCK NAILING :57 P -1.:�
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SPECIAL INSPECTION
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MISCELLANEOUS . ..... .
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FINAL APPROVAL FOR
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OCCUPANCY ..................
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