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PERMIT
200302
ZONE
CITY OF EDMONFDS
NUMrR
JOB
ON JOB
CONSTRUCTION PERMIT APPLICAT17P
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YES 0 NO 0
ADDRESS
REMARKS
OWNERICONTRACTOR RESPO NSIBLE FOR EROSION CONTROLJORAINAIE
CITY ZIP I-1,11HON1
NAME
ENGINEERING
REVIEWEDIDATE
ADDRESS
OE
FIRE REVIEWED BY
DATE
CITY
VARIANCE OR OU
SHORELINE OR ADBN
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STATE LICENSE NUMBER EXPIR AlE
ECKED By
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SEPA REVIEW
EXP
SIGN AREA
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HEIGHT
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PROPERTY TAX ACCOUNT PARCEL NO.
411442 &s -63100
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REMARKS
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VALUATION
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PLAN CHECK FEE
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BUILDING
PLAN CHECK NO:
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MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ONTHEPUBLIC
OMAIN (CURBS. SIDEWALKS. VEWAYS, MARQUEES. ETC.) WILL REQUIRE
D DRI
t: SEPARATE PERMISSION,
GRADINGIFILL
URCHARGE
PERMIT APPUCATION: 180DAYS
PERMIT LIMIT. I YEAR ' PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEEBACKO PINKPERM FOR MORE INFORMATION
ENG. REVIEW FEES
N BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIINS AND SUIIIESORS
;APPYCAN.T� CITY OF
N INTIERE ll.�MNIFY. DEFEND AND H.I. HARMLESS THE
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��NTS FROM ANY AND
EGMOND'BWA'H'NGTON� ITS OFFICIALS, EMPLOYEES, AN[) A'
ALLCLA'M F.R.AMAGE OF WHATEVER NATURE, ARISING DIRECTLYOR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
G"ME. TO .."Y' WAIVE OR REDUCE ANY REQUIREMENT OFANICITYOAIXNANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
SNG. INSPECTION FEE
LANDSCAPING
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
RECEIP
RECEIPT
KNOWL : HAVE READ THIS APPLICATION: THAT THE INFORMATION
I HERESY AC DGET"AT THOAIZED AGENT OF
, C. SCTE A. THE NEF, OR THE DULY AU
N AND THAT
To�"I'IAEFL I AGREE TO COMPLY WITH CITY AND STATE LAW REGULATING CONSTRUC
TION N IN 0 IN TH RK AUTHORIZED THEREBY. NO PERSON WILL BE E PLOYED
IN VI L I � N F TH LAS A CODE OF THE STATE OF WASHINGTON RELATING TO
WOR C PE SATIO INSURANCE AND ACW 18.27�
SIG F (0 RAG NT) DATE TAED
APPLICATION APPROVAL
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771-0220 E ........
N v EXT 333
ITISUNLA FULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 ORIGINAL -FILE YELLOW, INSPECTOR
A FINAL I SPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI�
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR
5198
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Feeling .;� ........... 11
Wall..........................
Pier/Porch .................
Retaining Wall ...........
0
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Slab Insulation ..........
PLUMBING:
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.
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M
0
EXTERIOR SHEATHING
0
0
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a
FRAMING ........................
rn 0;
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Coiling Insulation
Z,
SHEETROCK NAILING
M
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
v- -Ms
OCCUPANCY ..................
DATE RECEIVED�
USE,
PERMIT 20030?.
CITY OF EDMONDS ZONE
NUMPER 1/
JOB
CONSTRUCTION PERMIT APPLICATION ADDRESS
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REMARKS
NEFI/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY zip ITELEPHONE
NAME O&W
ENGINEERING REVIEWEDIDATE
M ADDRESS
0
FIRE REVIEWED By DATE
CITY ZIP
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SHORELINE 08 ADBY
INSPECTION
OYES [3NO
I BOND
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XPIR
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J pROWSTAX AD OUNTPARCGLNO�
6,S, 63/00
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0 CHANGE OF USE
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v
VALUATION
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HIAT/sore LOT SLOPE %
BUILDING
0
PLAN CHECK NO: 11) DATE
PLUMBIN
MECHANICAL
_T THIS PERMIT AUTHORIZES ONLY THE WOAKNoI THIS PERMIT COVERS WORK TO
1.1 SEMO ON P.R.IVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
GRAOING?FILL
.0 A17 .UB SIDEWALKS, DRIVEWAYS I MARQUEES, ETC.) WILL REQUIRE
:3 BE PARATE PEfQSSION-
UPICHARGE
PE MIT APPLICATION: ISO DAYS
A. PERMIT LIMIT. I PROVIDED WORK IS STARTED WITHIN 180 04YS
YEARR
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'AP PILICANT, ON BEHALFOF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCE SOPS
OF
ENG. INSPECTION FEE
1 M� 'E 5S THE CITY
N NTEREST, AGREES TO INDEMNIF y�Lo.EFN`L)oAy`E` H�OL.%HA
I" R' L
FROM ANY AND
LAIDSCA—G
FEE
EDMONDS. WASHINGTON, ITSWOFFITCEIV E., . A AGENTS
ALLCLAIMSFOR AMAGESOF HA ER NATURE, ARISING DIRECTLY OR INDI
NOT BE
INSPECTION
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL
OFANY ITY013DINANCE
C
PLAN CHECK DEPOSIT
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT
TO ENFORCE ANY ORDINANCE PROVISION.'
RECEIPT
NOR LIMIT IN ANY WAY THE CITY'S AIPUTY
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS A-PLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I A A THE DULY AUTHO RIZED AGENT OF
OWNER6 0
T I t pemit ddit s,glld by The
WTHE
THEOWNER. I AGREE TO COMPLYM IT" CITYAN STATE LAWS REGULATING CONSTRUC-
CALL
1,, 0 JI'di ,'hwh. 0 P.Y::i,dF....bl.Id I,
TION TH R"EDTHEREBY. No PERSON VALLSE EMPLOYED
N ONG THMIR�K.A.U.EoOl T OF WAIIIINBT.N RELATING TO
FOR INSPECTION
IN 116ALMAOTINOOF T.
i WORKMEN'S CO�&O� INSURANCE AND RCWATI�8.27-
0 S BIG AT A
(11 RAG
(425)
771-0220
ELEASEO By
EN ON v
EXT 333
FULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
ITISUNLA
INSPECTION HAS BEEN MADE AND APP ROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW - INSPECTOR
ASSESSOR
A FINAL
BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD -
i CATE OF OCCUPANCY HAS
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