20000314.pdfDATE RECEIVED c-
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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7
MAILING ADDRESS
7207_
CITY
NAME
ADDRESS
CITY ZIP IT111PHON1
NAML 7-A-V
ADDRESS
CITY I TY_LEPHONJ
_'J.PERMITEX�PIRES t�90�
USE
PERMIT
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NUMBER
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IT PT.
F
ADDRESS
PILNTNALiEiSUBDIVISIONI�O.
LOT NO.
UDNO�
LID FEE $
P SLIC RIGHT OF WAY PER OFFICIAL STREET MA
IESCP N,�
R.1- o
EXISTING — PROPOSED
E UIREDD DICATION—
FT
F FIXTURES
PRV SQUIRED
tMI—TIRS11�E,
YES 0 NO 0 K.
_N_C. FACTOR RESPONSIBLE FOR EROSION CONTROIJORAWAGE
FIRE REVIEWED BY
DATE
1111/vfI
SERA REVIEW
11b., b.—
SIGN ASEA
ALLOWED PROPOSED
-1-1
ALLOWED PROPOSED
ROPESTY TlAFCE NO.
EXP I
,
TUL
RESIDENTIAL 0 PLUMBING I MECH
LOT COVERAGE REQUIRED SETS KS (FT, PROPOSED SETBACK$ (FT.)
ALLOWED PROPOSED FRONT SIDEACRFAR I FROST UR SIDE REAR
to
0 ADDITION COMMERCIAL ci COMPLIANCE OR
0 CHANGE OF USE
nAPARTMENT
AREA PLANNING REVIEWED By DATE
0 REMODEL rol cl SIGN
REar PROVIDED
I PROVIDED
C] FENCE
REPAIR El GRADING CYDS I — X
FT) REMARKS
DEMOLISH TANK c3 OTHER
GARAGE 0 RETAKIIIRINYG WALL 0 RENEWAL
CAR P., E
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DESCRIBE WORK T 0 BE DONE
REMARKS
i j - /
PROGRESS INSPECTIONS PE R USIC 1081FINAL INSPECTION REG'
VALUATION I FEE
PLAN CHECK FEE
I
HEAT IN LOT SLOPE
BUILDING
PLAN CHECK NOt ESTE� A7�_
PLUMBING
ME HANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINOfFILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. STATE SURCHARGE
PER IT APPLICATION: 100 DAYS
P.R.
W
6 PERMIT LIMIT: I YEAR - PROVIDED ORK IS STARTED WITHIN 100 DAYS
.'Y.AR - P
ENG� REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
OFF
'A PLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS A S ES
P
HARMLE T E I
ENG, INSPECTION FEE
IN INTEREST. AGREES TO INGEMNI DEFEND AND HOLD
A
INONDS, ITS OFFICF[YALS EMPLOYEES, AND AGENT
` LS, EMPLOYEES, AND AGENT
Il
EDM WASHINGTON,
2 BOM
LL CLAIMS 'ON . . RECT
A -A A �-F
ECEIPT
T.F _UANGE OF TH PERMIT $HALL NOT BE
PLAN CHECK DEPOSIT
F ANY CRYORDINANCE
FOINANCE PP.10.S.
TOTAL AMOUNT DUE
FE.
ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
I HEREBY
On THE DULY
GIVEN I CORRECT, AND THAT I AM THE OWNER, AD rHORtZED AGENT OF
S
T ii NplIc i nol pe,mi Ultil llpsd by IhQ
%��F...P.ldd
THE OWNER. I AGREE TO COM STATE LAWS REGULATING CONS TRUC-
PLY WITH CITY AND
CALL
1 $1 ., p
Y, NO PER$ N LL EMPLOYED
TION; AND IN DOING THE WORK AUTHORIZED THEREB 0 W1 BE L
RE ATING TO
ip, ii t, g , pac, p-dad.
FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
INSURANCE AND ROW 18. 27,
(425)
OFF) IG
771-0220
ffLE SED DATE
EXT 333
ATTENTION
IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
IT
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINALO FILE -. YELLOW - INSPECTO
ASSESSOR
A FINAL
CATE OF OCCUPANCY HAS BEEN GRANTED� UBC SECT ION 109
FAX
PINK. VVNE GOLD -
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E_ItSPECTED OUTSTANDING ISSUES -GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
INSPECTOR DATE
APPROVED
SETBACKS ..............
FOUNDATION:
Footing ............
Wall ......................
Pier/Porch .................
rl
�,b
Retaining Wall ...........
Z,
Slab Insulation ..........
PLUMBING:
=4 :fil
Underground .............
Rau gh-In .............
M
commercial Final
Pil 01
—I ol
HEATING:
M,
Gas Test ....................
Gas Piping ...........
10
Equipment.......... . .......
Commercial Final
fg
EXTERIOR SHEATHING
M M,
NAILING . ........ .................
FRAMING
0
0
FIRST FLOOR FRAMING
ITI C)
6
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling insulation
NAILING
W,
SHEETROCK
z
SPECIAL INSPECTION
M
%
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
0 PERMIT E�P�RES'
PERMIT
CITY OF EDMONDS NUMBER
1APT1
CONSTRUCTION PERMIT APPI. IC ION 'A'D'DRE I /z.,
LID .0.
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PUBLIC RIGHT OF WAY PER OFFICIAL SIF1111 A' W1111-vRe"".
P-1 A.b"
CITY EXISTING — PROPOSED
REGUIRED DEDICATION— FT
METER SIZE I PRV EQUIRED
NAME I YES 0 NO 0
;I F=�K
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TELEPHONE
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FIRE REVIEWED BY DATE
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POSTED
STATE LICENSE NUMBER
IRATII N DATE
C
Y
OTION
RE G
0YES r1NO
I
$EPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED SED
PROPO
ALLOWED PROPOSED
PROPERTY
�� T1111LIO,
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L9
Ex, I
VNEW
RESIDENTIAL
LUMERNG/MECH
LOT COVERAGE
ALLOWED PROPOSED
REOUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (I.)
FRONT URSIDE REAR
C] ADDITION
COM�ERCIAL
o COMPLIA CE R
CHANGE OF U E
I -
EVKEWED
By DATE
0 REMODEL
C] APARTMENT
C] SIGN
REOD
I PROVIDID
0 REPAIR
GRADING CYDS
I- X
FT) REMAH
C3 DEMOLISH
K
OTHER
ARAGE
OCAR PORT
RETAINING WALL
B., �Ry
0 RENEWAL
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKEDBY
ii�RUC
LYPEP�,N _
NUMBER
NUMBEROF
AL
I 'AN
SPECIAL INSPECTOR
U.
STOP SES
D ING
U
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NU BER
REQU, REDO YES
JARFA
11 A.
DESCRIBE WORK TO BE DONE
REMARKS
IOGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG
VALUATION I FEE
PLAN CHECK FEE
HEAT SOURCE GLAZIN T SLOPE %
PLAN CHECK NO: E
BUILD NO
PLUMBING
UTHORIZES ONLY THE WORK NOTED WORKTO
MECHANICAL
L
BE DONE ON PRIVATE PROPERTY ONLY. ANY C6N�6HTIFISUPCETFttOMNITOCNoTVHEER$PUaLtC
GRADINGIFILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAY" MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PER M IT APPLICATION: 180 DAYS
STATE SURCHARGE
P.
R BIN IBQ DAYS
PERMIT LIMIT: I YEAR PROVIDED o IS STARTED WIT
ENG. REVIEW FEES
PINK PERMIT MORE INFORMATION
SEE BACK ol� Fo�
ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
THE CITY OF
ENG. INSPECTION FEE
//c
;APPLICANT,
N INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS tAmost"A1
EMPLOYEES, AND AGENTS FROM ANY AND IN (fr
2
,MoNo,�WASHINGTON TFW.1FICIALS.
"'. .,GANNVGE,C ATEVER NATURE.ARISING DIRECTLYOR INDIRECTLY
A LLC
ECEIPT
FROM THESSUAoCE OF THIS p,R.11 ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
DEEMED To .."Y' WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
TO ENFORCE ANYOSDINANCL 1
OR LIMIT IN ANYWAY THE CITY'S ABILITY
N RLWITI.
7s,
L�D�G.l I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
I HEREBY
THAT
.,YEN 'S=T A AT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
G ILN C
AND 'RE ULAT
Thil Ipplicah- 'b 1 - P4 il 119med by
THE OWNER. I AGREE TO CO PLY WITH CITY STATE LAW -NE'A`%
G
No P EPSON WL .1 EMPLOY'
oil
ING THE ING K AUTHORIZED THEREBY
TION; AND IN DOING THE ING E STATE OF WASHM.T.N RELATING TO
TION
IN VIOLATIO OF THE L CODE OF TH
IN UR AND ROW 18.27.
oFFIcl ssio UBE E
WORKMEN'S COMPENSATION
GNED
(425)
V8110-ATERE IOW
771-0220
RE'E sp
4
EXT 333
ATTENTION
ITISUNLAWFULTOUSE OR OCCUPY A BUILDING 0 R STRUCTURE UNTIL
771-0221
BEEN MADE AND APPROVAL OR A CERTIFI-
ORO FILE YELLOW - INSPECTOR
ASSESSOR
A FINAL INSPECTION'HAS
HAS BEEN GRANTED. UBC SEC TION 109
FAX
P,;NAL
K WNEs GOLD
CATE OF OCCUPANCY
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