20000568.pdf:1.=
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
f
0 T
zip
ADDRESS
CITY ZIP
NAME
qoj�z ( Sc
ES
USE PERMIT
'ONE NUMBER 2005GS
JOB SUITEJAPTA
sw
PLAT NAMEISUBDiVISION NO, I LOT NO- LID NO,
LID FEE S
TESC
,USLIC FIGHT OF WAY PER OFFICIAL STREET MAP
--lull,
III d
EXIS ING — PROPOSED -
SWIl R.q.1-
REQUIRED DEDICATION— FT —
METER S FFIXTURES PFW REQUIRED
YES 0 No 0
F MARKS
lWN-CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP TELEPHONE
TTATE LICENSE NUMBER EXPIRATION DATE CHECKED By
JPX A
P)l iTIPAR E77T 0 0
FIRE REVIEWEDRY
-VARV*#e�-F CU '11-4 SHORELINE OR ADBN
-141
SERA REVIEW SIGN AREA
COMPLETE EXEMP ALLOWED PROPOSED
Ex
DATE
I PIOND
OSTEC
ALLOWED/ PROPOSED
LOT COVERAGE REOUIREOSETBACK (FT)
PROPOSED SETBACKS WTI
FRONT UPSIDE REAR
C] NEW RESIDENTIAL PLUMBING I VECH
CON.P.LIA CE OR
yo
ALLOWED PROPOSED FRONT 9;
_1�5_ yEj�
IWno ch-Aner
[3 ADDITION COMMERCIA, L X CHA E OF USE
_1�(:,IENIOIDEL 0 APARTMENT C] SIGN
k
',5 1 -7 M�c
FENCE
GRADING CYDs C3 X FT)
0 REPAIR
Ilz
L
THER
• DEMOLISH TANK xO —
• GAIAGET RMLN"G WALL RENEWAL
'ARF.R C] a RY C]
(TYPE OF USE, BUSINESS lqnw
IMF-:
T
C DBY -KPjMS;q �T TI N,,I;, C
�T*'
9_9�A
OCCUPANX3
ROLF
F IS L
NUMBER Go CR A
NUMBER
OF DWELLIN AN
STORIES NU BER
6T.'� fR
SPEC IN�PECTCS
aU ED
RE 'R
--
OCCUPAN
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REG
Law
"qw"
1
�: 0- -(-: 2 - �c r �1� �Q -
VALUATION FEE
-3"
PLAN CHECK FEE
HEAlSOURCE GLAZING % LOT SLOPE
BUILDING
0
'On—a-
ILAN CHECK NO' VESTEDOATE
MECHANICAL
N)
THIS PERMIT AUTHORIZES NLY THE WORK NOTED. TH S PERMIT COVERS WORK 1.
PUBLIC
30.@'Me�
BE UDINE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS' MARQUEES, ETC.) WILL REQUIRE
E-ATE SURCHARGE
5
SEPARATE PERMISSION.
PERMIT APPLI.ATI N: - DAYS
PERMIT LIMIT. 1 AR. PROVIDE. WORK IS STARTED WITHIN 18D DAYS
ENG REVIEW FEES
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
1S.RS
OF HIS OR HER SPOUSE, IKEIRS. ASSKINS AN. SIC
CITY OF
LANDSCAPING
INSPECTION FEE
;A!"PLIECIAEN�T�CAN.BEHALl
" R
T F EET.,..EMNIIY 'FEND AND HOLD 'A
EMPLOYEES AN 'NEES THE
N C �.IE. SFR.M ANIAND
'LDLM,�o,',D�SiW,oA'�".'A.A'.'.�'.F�.'A'T'EVER �AT�RE.A�l�IN.�'��CTIORINDI�ECTI
A "T TP-F
PERMIT NOT BE
PLAN CHECK DEPOSIT
FECEIPT/5:� 7-1
ISSUANCE OF THIS
FROM THEISSUA IS.
DEEMED ToMODINCE OF THIS PERMIT. ANY REGUIREM�NT DFANY C TYALL
IY,V�AIVE OR REDUCE ORD ORDINANCE
ANY INANCE
REGEIP
NOR LIMIT INANYWAY THE CITY'S A81LITY TOENFORCE
TOTAL AMOUNT DUE
THAT THE Nl.RNATION
T"IRS AIPLICIATI�OLNY
APPLICAT ION APPROVAL
Y ACKNOWLEDGE THAT I I-AVE Ri WINE CRT C AUTHORIZED AGENT 05
IHEREB E�Ap
AND THAT' AM
T �PFIII-t-0 iI by the
GIVEN E CORRECT
THEC
THE OWNER. I AGREE TO COMPLY " H ITY AND STATE LAWS REGULATING CONSTRUC
CALL
.,d F - P.4
TION.ANDINDOIN THEW RK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYE.
WASHINGTON RELATING TO
FOR INSPECTION
.,pk,,.w9 spaceprovidod.
F
IN VIOLATION 0 THE LA E 0 THE STATE OF
�O-, EN S SAT[ INS ANCE AND RCW IB.27
_
OFFICIALS SI NATURE D E
DATE Sit NED
EN
_00
(425)
-I 1�4� c
771-0220
EXT 333
RELEASE ATE'
OTENT16N
%
IT IS UNL- ICCLIPY A BUILDING OR STRUCTURE UNTIL
771-n221
FILL TO USE OR
A FINAL IN PECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILE YELLOW INSPECTOR I
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR
5196
z
0
0
:=n
m
rn a
0
80
mm
z
10-4
ca
0 -n
n
m M
C3 Fn
0
0 Fn
c- cn
c ca
rn 0
z
z
0
z
0
0
m
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Fouling ......................
Wall ..........................
Z,
0
Pier/Porch ............
d
C)
RetainIng Wall ...........
M
Slab Insulation
--I -n
PLUMBING:
a In
C
Underground ...........
18 T
M
0
(Y\S
Rough -In ...................
C
commercial Final
M
M
HEATING:
C
>
Gas Test ....................
Gas Piping .................
Equipment . ................
ITI,
Commercial Anal
M
C)
EXTERIOR SHEATHING
M
NAILING ..........................
a43
M 0
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...................
z
Floor Insulation
Wall Insulation ...........
0)
Z
Ceiling Insulation
0
0
SHEETROCK NAILING
ITI
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
vq
OCCUPANCY ............
tw 0Q6Q%
<�� �600 101 PERMIT- EX�11`-_'S
'US PERMIT
CITY OF EDMONDS ZOENE 9 r NUMIER
APPLICATION 408 SUlTFJAK#
CONSTRUCTION PERMIT,.
5w
OWNE
L4- �7=s IX.4 &)L) L.
MAILINGADDRESS
:9T
CITY llp
;H.NE
75,
NAIVE
rADDRESS
A-RES—S::
CITY IP
CIT Y
TELEPHONE
NAME
ADDRESS
CITY TELEPHONE
7
,ST.NTELICENSE Nt-JMSER E.,�_".N DATE
....ED BY
Tr7rf 00
R:.E.Tl: PLUMBINGIMICH
MER. �XC.A.N.UA�CE OR
C, E OF USE
0 SIGN
PENCE
GRADING' CYGE
x FTn
X
x
jjS;Wl TANK
C3 i�g yA!qK'
-RETAINING
Z cleAFIOE" NO WALL RENEVVA�L�
CARPORT
0
(TYPE OF USE, BUSINESS OR Pl_AIN:.
NUMBER 12,
OF
o STORIES
NUMBER 0 F
DWELLIN
UNITS
RESCRIBEWORK TOSE Dql�p
ftpAl
-
SLOPE %
.... ........ m-,bog:)
THIS PERMIT AUTHO IZES ONLY THE WORK NOTED.�THIS PERMIT COVERUWQHK
SEDONEONPRIR EPROPERTYOKLY. ANY CONSTRUCTION ON THE PUBLIC
a DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATIO i 180 DAYS
PERMIT UMIl I YEAR - PROVIDED WORN 15 STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
p F HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESDI
;A PLICANT. ON BEHALF 0
FEND AND HOLD HARMLESS THE CITY I
N INTEREST, AGREES TO INDEMNIFY. DE MPLOYEES. AND AGENTS FROM ANY Al
2 EDMONDS. WASHINGTON, ITS OFFICIALS, E
a LLCLAIMSFORDAMAGESOFWHATEVER NATURE
A - ARISING DIRECTLYORINDIRECI
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT
DEEMED To MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINAN
ITINANYWAYTH ENFORCE ANY ORDINANCE P slo
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO,
I
LID FEE
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
D
EXISTING — PROPOSED—
0
C3
REQUIRED DEDICATION —FT
METER SIZE
LINE SIZE
NO.011IXTUFtES
IFIV REQUIRED
Es E3 No C3
-REMARKS
OWNER/CONTRAO IOR RE SPONbISLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWEDIDATF
FIRE REVIEWED BY DATE
r
.��R CU
ArsHO SUNS OR A.
I NYSEP.EOC
BOND
POSTED
P
AT)"
RE
SERA REVIEW
SIGN AREA
HEIGHT
CO
AL
AULOWED/, PROPOSED
LOT COVERAGE REQUIRED SETBACKS 11.1 PROPOSED SETBACKS K.)
ALLOWED PROPOSED FRONT FROM ISIDE REAR,
�n
5; a hA
]?2Z
By DIE
PARKING 4NING FIEVIEW7
'P
C
P N
PA.
GROU
CI)riNSPECTOR I AR
A ODCUIRAN T
LOA D
IRED8,Eb
REMARKS D,
PROGRESS INSPECTIONS PER U BC 108/FINAL INSPECTION REO'
5
jlllljp�
VALUATION
FEE
PLAN CHECK FEE
MECHANICA L
D;
STATE SURCHARGE
ENG. REVIEW FEES
VJA77ail
E.S-ffl9Pe0TN""TE
F LANDSCAPING
D INSPECTION FEE
Y
E CHECK DEPOSIT
RECEIPT/_5;r Z,
PLAN
E
NOR LIM
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMAT ON
GIVEN IS CORRECT: AND THAT I AM THE OWNER. OR THE DuLy AUTH ORIZED AGENT
OF
THE OWNEK I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CCINSTRUC-
CALL
L=K, T Ey6`NoP"R o. LL.EE.lLGYED
TION, AND IN D5, TEHIE AuT--o-,l�TE.DET- -FE - - WIN ELAT,N.
IN VI oLATIG�;. E E AT WASHIN.TO R
To
FOR INSPECTIC
WOR�MEN'S ATjCflbl�rp�NCE AND RCW 18.27
(425)DATE
SIGNED
771-0220
:,'AftENTION
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A B41LOING OR STRUCTURE UNTIL
771-0221
HAS BEEN MADE 41ND APPROVAL OR A
A FINAL INSPECTION CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
FAX
-L
APPLICATION APPROVAL
TH. ppli-I.— t . plt uAil.,p.d �l 11.
S�'Nimo Offii.! , hi._ C.gly. ..d F., .1. P.id. -d
_.'PI., ._�,.do.d 1� p ... F."d.d.
DATE
ORIGINAL - FILE YELLOW - INSPECTOR I
PINK - OWNER GOLD - ASSESSOR
IIING
z
0
m
c M
M
0
80
c
M Z
10-4
o -n
-n
-4
m m
a
0,
ro
co
'o
z
z
m