20000602.pdfCITY OF EDMONDi_�
CONSTRUCTION PERMIT APPLICATION
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!I` I - Fp_ERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB S TIT�IAITI
ADDRESS fn W A qJO24
FLAT NAMEISUBDIVISION NO� LOT NO, LtC)NC(.
LI. FEE
0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP C3
F.'1% 1%� d 0
EXISTING — PROPOSE. 0
0
REQUIRED DEDICATION— FT
V RlQlIRlD
YE�S 0 NO El
�RE�ARKSTT FOR EROSION CONTROUDRAINAGE--1
FIRE REVIEWED By DATE
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(:)YES (:]NO
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HEIGHT
RoPERTY TAX ACCOUNT PARCEL NO.
EXEMPT
COMPLETE EXEMPT
COMPLETE
ALLOWED PROPOSE.
ALLOW ED , PROPOSED
nn
Exp
EXP I
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LO COVERAGE F;-E—oUIRED SETBACKS PROPOSED ETBACKS (FT,)
T COVERAGE
0 NEW 9_�ESIDENTIAL
La-PLUMBINGIMECH
ALLOWED PROPOSED FRONT SIDE FUR FRONT UPSIDE REAR
L' G F.
k
El ADDITION E] COMMERCIAL
I
o C MPLIANCE OR
CHANGE OF USE
PARKING L DATE
REMODEL APARTMENT
SIGN
RECID I PROVIDED
0 rAADINr CYDE
C3 FEN E
C] DEMOLISH 0 TANK
OTHER
oGARAGE C] RETAINING WALL
CARPORR
RENEWAL
USE BUSIN&VSlffA�GTIVlTY) V—XUIN—:
�A
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7ee �&l J� _e n
STr� I OF
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CHECKED By _0F 11) oC...u7L?,
NUMBER NUMBER
CRITICAL
AR
PANT
SPECIAL IDNSPECTOR
LOAD
OF DWELLING
STOR ES UNITS
,UEAS
mBEA
JARIA
REQU IRE Cj- YES
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REMARKS
PROGRESS INSPECTIONS PER UBIC 1=11NUAL INSPECTION REQ
Q_
k4- I
PLAN CHECK FEE
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HEAT SG_UAGE I �NG �-1
LOT SLOPE
BUILDING
PLUMBING
PLAN CHECK,�!�
�IlTll DATE
EC.A.ICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTtD. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON,TH E PUBLIC
DDMAIN (CURBS. SIDEWALKS. DRIVEWAYS, MAROUEES. ETC) W LL REQUIRE
BE SDEW' SEPARATE PERMISSION.
GRADINGiFILL
STATE SURCHARGE
P A 11 APPLICATION: 180 DAYS
E M T
PER'
PR RK,S STARTED WITHIN 16DOAYS
PERMIT LIMIT. I YEAR " oV'DED W
A
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
OF
ENG. REVIEW FEES
-AP PL -AN N EHALF OF AND, U ES F5
N P INTEREST. AGREES TO INDEMNI S HAR ESS HE ITY F
;A PLICANT, ON BEHALF OF HIS OR HE El �ASSI NIL
N I R - FY. E
E 'EDMONDS, WASHINGTON ITSOFFIClA E L YEE A DA ENT FF. ANYA
F I E TLY I IRE TLY
ALLCLAWS FOR DAMAGEiOFWHATEV T E RI I
H S. CE THIS PERMIT, I N E F T IS F5 IT $ ALL N T BE
FROM THE ISSUANCE OF
DEoSMEDT. MODIFY.WAIVE �O REDUCEANY E IRE ENT F N ITYPIRDINAN
NOR LIMIT I Y W Y T. AN E R IS'
NOR LIMIT olN ANYWAY THE CITYS A81LI YT E F EANY I
LANDscAP G
INSPECTIO FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
D LoYED
TION:ANDIN ONG THE WORK AUTHORIZED THEREBY. NO PERS NWILLBEEmp T
I VIC I " o
N LAT ON OF THE LABOR CODE OF THE STATE OF WASHINGTON RE ATING 0
WORKMEN S COMPENSATPW�EURANCE AND RCW I B 27,
CALL
FOI q INSPECTI
71 _ Q 23!�;_
sIGNATUR(JOW I DATE S16NEO
k=l !L2L_ I -
(cm 16
l2ftom
ATTENTION I EXT 333
IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX
51se
VALUATION I FEE
APPLICATION APPROVAL
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OR10INAL - FILE - YELLOW - INSPECTOR
PINK - OWNER - GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
M
Retaining Wall ...........
Slab Insulation ..........
M.
PLUMBING:
IT1 0
Underground .............
C)
Rough ..........
-in
IT
M
Commercial Final
-4
HEATING:
Gas Test ......................
Gas Piping
................. ------------
Equipment .................
ITI M
0
Commercial Final
0 un
EXTERIOR SHEATHING
NAILING ...................
Mo.
FRAMING........................
;13
FIRST FLOOR FRAMING
INSULATION ...................
Z
Floor Insulation
rA
Wall Insulation ...........
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Ceiling insulation
C.)
M
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
DATE RECEIVE
PERMIT EXPIRES
US'
us'
PERMIT
SZo
CITY OF EDMONDS
ZON
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB
SUITFIAPTN
ADDRESS 1�4
OWNER NAMENAME OF BUSINESS
FLAT NAMEISUBDIVISION NO.
LOT NO,
LID 16.
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m
MAILING ADDRESS I
LID FEE S
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ol \-I KA
PUBLIC RIGHT OF
WAY PER OFFICIAL STREET MAP
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CITY
EXISTING —
PROPOSED
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ITELEPH?N19E
41S - ]4�'
REQUIRED DEDICATION— FT
SIZE
LINE SIZE NO I FI.T FES
'FR V REQUIRED
NAME
::�A[MeTEH
YES 0 NO 0
ADDRESS
MARKS
A REMASKS
1-FRI-NITRACTOR RE11-18LE FOR EROSION CONTROUDRAINAGE
W_r
AND
ICITY ZIP
ITELEPHOIE
NAME
v ENGINEERING VItUE
WIVI rLt8l
ADDRESS
'9 0 FIRE REVIEWED BY DATE
�j CITY
...... . VARIANCE OR CU SHORELINE OR ADBa INSP EC ION
STAYE LICENSE NUMBER EXPIRATIONDATE CTKEDB, RE 'D. POSTED
OYES ONO
V-) \-A ej c 0 SEPAREVIEW SIGN AREA _. � HEIGHT
PROPERTYTAX AC OUNTRAR F. NO. OMPLITE I EXEMPT ALLOWED PROPOSED
D1 K) 7- EXP
q
0
0
LOT COVE KS PROPOSED SETBACKS (FT)
RAGE REQUIREDSET C
NEW RESIDENTIAL [3-FLUMBING / MECH ALLOWED PROPOSED FRONT SIDBA PEAR FRONT URSIDE REAR
..i RCIAL cl C
0 ADDITION COMME COMPL ANCE OR
0 HANGE OF USE j
PARKING LOT ARIA VIED By DATE
E] REMODEL APARTMENT SIGN REDD I PROVIDE Cl I ILANIIOG RIEVIE
X
M z
JO --i
REPAIR GRADING Y.. FENCE X FT) REMARKS
Ca��
E] DEMOLISH C] TANK OTHER
2
CD
ROO EV WALL 0
C] GARAGRET E] RETAKIN RENEWAL
CARPO
CHECKED 11 0, CO .H Occu
J 0 _e ' -1)" 1 C87 71
NUMBER NUMIIRO' SPECIAL INSPE I AREA
DW 5 1 J Ar [:]CTOR OCCUPANT
OF JELLING LOAD
UNTS NUMBER REQUIRED YES
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0- ' REMARKS
ZEIIIE W BEOO
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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0
n'E5TED TPLUMBING
VALUATION
FEE
PIN CHECK FEE
PLAIN . HECK FEE
LOT SLOPE I BUILDING
EAT Sq.ULC_. I . — BUILDING
m
DATE ILL.. G
P LAN CHECK
r
MECHANICAL
I
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
PERTY ONLY. ANY CONSTRUCTION ON THE IUBLIC
BE DONE ON PRIVATE PA GRADINGIFILL
OMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
S E SURCHARGE
P'RMITAPPLICATI N; 181) DAYS
PERMIT LIMIT,, I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS ENG. REVIEW FEES
P
SEE BACK OF INK PERMIT FOR MORE INFORMATION
SUCCESORS
;APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS
N INTEREST. AGREE TO DEFEND AND HOLD HARMLESS THE CITY OF
G
:NDEMNIlY.
E EDMONDS. WASHINGTON TS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
=0 FEE
j VE ATURE. ARISING DIRECTLY OR INDIRECTLY
ALLCLAIMS FOR DAMAGE OFWHATE R N
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
IN ANY WAYTHE CITY'S ABILITY TO NFORCE ANY ORDINANCE PROVISION.
ILA. ..E�K DEPOSIT
IECEIP
NOR LIMIT
C I
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN CORRECT. AND THAT I AM THE OWNER OR THE DULY AUTHORIZED AGENT OF
IS
IAGREETOCOMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
T a nat , p,am,I 1,da 11pld ty lal
THEOWNER.
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
RELATING TO
FOR INSP CTIO
E�.' dng Oth-I ., hillhol D,pay: and F - p,,d. ad
n.-p- a-I.1,.d,a p... pl-d-d.
IN VIOLATION OF THE LABOR CODE Or THE STATE OF WASHINGTON
S COMPENSATION INSURANCE AND RCW 18.27.
.-
816NATUO DATE
WORKMEN
_Sj%�ATUR� �Tl
D 9 SIGNED
164
J�CIALS
nOWNER OR AGE
yu
TZ�
FELEASEDBY OTE f
ATTENTION
EXT 333
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL 0 R A CERTIFI-
ORIGINAL - FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER - GOLD ASSESSOR
519.