20000614.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
;EF�M��OF+BUSI&,
0
.ING ADDRESS
-7vs i-VL.-
ZIP TELEPHONE
(ke-"7f) 11 -7 4 - -14 Ll -ey�
NAME
PERMIT EXPIRES 14:7A
USE PERMIT -ZW64A
ZO E
N NUMBER
JOB lU IT
ADDRESS 2!L
U
PLAT NAMEISUBDIWSION NO, LOT NO_
LID IN
LI. FEE I
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
T .... P '-.' '
RW P"P2Z`R.�I
EXISTING - PROPOSED-
SW11p, Od
REQUIRED DEDICATION- PT -
U-91-d
WTER SIZE
LINE SIZE
NO, 01 IIITUFE�
PRV REQUIRED
I
I
Y�S 0 NO 0
L
REMARKS
IWNFRICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP
TELEPHONE
NAME
blop- Eksme 6v-s
S-e-cy,"c JL
ENGINEERING RFVIEWEDIDATE
ADORES
-rL
11,75LA6 teo AV -CAI-
FIRE REVIEWED By DATE
12 CITY ZIP
TELEPHONE
0
2,5-q -9 377-1
OR ADB# INSPEC!101
VARIANCE OR CU SHORELINE
I PION
HE . D S"D.
CHEC(�Y
OYES [3NO
HEIGHT
e)t_LQ7GlQtoQ
14 -3
SIGN AREA
PROPOSED
ACCOUNT PARCEL NO.
pl;
OMPLETE EXEMPT ALL NED PROPOSED ALLOWED ,
C OWED I
�ERTY jX
nn
EXP
LOT COVERAGE R LIMED SETBACKS (FT.) PROPOSED ETBACKS (FF.)
ED U
NEW RESIDENTIA
PLUMBING I MECH
ALLOWED PROPOSED FF DINT SIDE HEAR FRONT UPSIDE HEAR
0 ADDITION 0 COMMERCIAL
COMPLIA CE R
CHANGE OF USE
LOT AREA PLANNING REVIEWED BY DATE
C] REMODEL C] APARTMENT
C] SIGN
REOD I PROVIDED
0 REPAIR GRADING CYDS
o FENCE
X
X FT))
EMARKS
[3 DEMOLISH TANK
C3 OTHER
_E
An ' 0 RENEWAL
0 GCARPA.FT RETAININ I G WALL
I QI :
E 15:
H '
8;PECTOR
C
ryPEOFC NS UCTION E IIGGH U
-
4-)
NUMBER MEER OF
OF DWELLING
STORIES
OF ITICAL
AR
N=S'
IF
REQUIRED C] YES
AREA OCCUPANT
LOAD
DE CRIS,.WORK TO S� D HE
REMARKS
INSPECTIONS PER UBC 108/FINAL INSPECTION REQ
FLLrm,
PROGRESS
w,
14"loky vlecJtr 473
5a:�t
A ECT)c
J20 -
V� At
- - -
I VALUATION FEE
PLAN CHECK FEE
GLA21NG % LOT SLOPE %
NGI
B ILDING
PLAN CHECK NO: ESTED 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
GRADMG11ILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YEAR , PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
E
;APPLICANT,
N INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY 01
LANDSC PI
EDMONDS WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AN.
INSPECTION EE
ALL CLAIMS FOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
SHALL NOT BE
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. 15SUANCE OF THIS PERMIT
DEEMEDT MODIFY.WAI VEOR REDUCE ANY RFOUIRE.EIXT OF ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
I N 'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
OR LIMIT IN ANY WAY THE CITY
TOTAL AMOUNI
HE E
LICATIONT"AT.IHl Fo M I N
ANTT o
THAT I HAVE READ THIS APRP,.E '� R
�DUF
APPLICATION A
I HEREBY ACKNOWLEDGE E
UL ALT
GIVEN IS CORRECT AND THAT I AM THE OWNER C H D A. OF
TN. P.,
THEOVINER I AGREE TO COMPLY WITH CITY AND S.TA.TyE LoAWS RE.GNULAT1�.-ECOXFUC
CAL L
-.,.,P?
ou,�, .P.Ll P.
TION. AND IN DOING THE WORK AUTHORIZED THEIR N PER WIL EMPLOYED
RELATING TO
E:T ,� 11.dl.� "I P. c'
FOR INSP ON
IN VIOLATION OF THE LABQJLCOD5 OF THE STATE OF WASHINGTON
DAT
VIORKMEN'S COMPENSAI�ON INSU�ANCE AND RCWf 16,21.
(425)
OFFIC _SSIG ATURE
F.T7—
SI..EO
�6A_
771-0220
LEASED By
EXT 333
A17ENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING 08 STRUCTURE UNT11 771-0221
FINAL NSPECTON HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE - YELLOW INSPECTOR
ASSESSOR
A
CATE OFIOCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD -
5me
z
9 _'
0
0 m
0
0 0
c:
m m
c: 2
o -n
n
m M
05
o 'm
C co
r. c.
0
7-1
z
z
0
m
7,
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
S BACKS .....................
ET
0
FOUNDATI N:
Footing ......................
z
I
Wall .................
PlertPorch .................
M
Retainlrig Wall ...........
I -n
Stab Insulation ..........
M
C
PLUMBING:
M
0
C.)
Oc
t,
Underground . .............
Sough -In
M
rn :4
...................
Commercial Final
HEATING:
Gas Test ....................
00
0 n
Gas Piping ................. is-
3:
M M
Equipment .................
0 5:
Commercial Final
U)
EXTERIOR SHEATHING
M 0
NAILING ..........................
z
FRAMING ........................
FRAMING
FIRST FLOOR
INSULATION ...................
Floor Insulation
z
Wall Insulation ...........
10
0
Calling Insulation
IT!
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
-7/-2--71 0 PERMIT EXPIRES 4
I USE PERMIT
CITY OF EDMONDS ZONE UMBER
CONSTRUCTION PERMIT APPLICATION IOB "� U ) C SU'T7'
ADDRESS
A
IER
�;M��O��Sla � + PI -AT NAME/SUBDIVISION NO, LOT No LID
0 LID FEE S
JNG ADDRESS 11
" PUBLIC RIGHT OF WAY kR OFFICIAL STREET MAP _l,.ppd
P.- It—
EXISTING - PROPOSED
-
CITY ZIP I 1111-El
ONE
-24 q -66 5b--
REQUIRED DEDICATION- FT -
... Id
WII
NAME
METER SIZE
LINE SIZE
11.01FIITURE5
CP IV 11OUIRED
SF0 NO 0
ADDRESS
R MARKS
CITY
PHONE
NAME
f.
NGINEERiNG
it WEDIDATE
ADDRESS
Ar--
FIRE REVIEWED By DATE
CITY ZIP TELEPHONE
- I i �'l - 2 -1-7 '7
0 tj 7
I
: I
_5
STATE LICENSE NUMBER EXPIHAIIUNUR"
11111G.,
z
I
04�-6NO
I'
SIGN AREA
HEIGHT
COMPLETE ElEMPT ALLOWED
PROPOSED
ALLOWED PROPOSED
P AOCOINTIAR EL NO.
0
of 2, ( 0
E� P
LOT COVERAG REQUIRED
SETBACKS (M.
PROPOSED SETBACKS (Fl)
FRONT URSIDE REAR
0 NEW
RESIDENTIAL
PLUMBING ECH
ALLOWED PROPOSED
FRONT SIDE REAR
0
E] ADDITION
COMMERCIAL
o COMPLIANCE OR
CHANGE OF USE
rn
c:
LOT AREA PLANNING REVIEWED by
PARKING DATE
IT,
0
0 FEM60EL
APARTMENT
SIGN
R5QD
PROVIDED
I
0
c
FENCE
FTI
x FMT)
C] REPAIR GRADING CYDS FT)
ARKS
c
off)
OTHER
E] DEMOLISH TANK C]
10
E
GARA 13ETAINING WALL RENEWAL
>
CARPGRT ROCKCRY
0
(TYPE BE. BUSINESS CTIVITY�IaXPFM:
O�z Cc rv, i �
CIRE!C��E�YPE
lI 11 1
OF C V]I�C I
0 C P'k�_ z
GRDU
NUMBER
OF
BER OF
D ELLIN
CRITICAL
A EAS
,
V� �p
CIALINSPECTOR JAREA
_ 'I __
-A -II
0,
-n
-i
STORIES
UNITS
NUMBER
CE
QUIRED M YES
3: 9
DESCRIBE WORK TO BE DONE
REMARKS
Im
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REOTI
5�
o
0
c
yq n
9 rn
A
z 0
VALUATION
FEE
z
A. Irc, 0( -DC) A�u
PLAN CHECK FEE
3:
I
LAZING %
LOT SLOPE I
BUILDING
U5
z
PLAN CHECK NO:
ED DATE
PLUMBING
MECHANICAL
77 D
rn
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE..D.oNl,oNP.RlVATEPR.lER Y ONLY. ANY CONSTRUCT*- ON THE PUBLIC
T
GRADINGIFILL
N CUR . SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGS
PERMIT APPLICATION: 180DAYS
PERMIT LiMITl AR - PROVIDED WORK IS STARTED WITHIN IRD DAYS
Ye
ENG. REVIEW FEES
SEC BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
EE
;APPLICANT,
N INT REST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
"
L�NDSCAPII
E MONDE, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
IS 0 IRE
ALL CLAIMS FOR DAMAGES OF WHAT EVER NATURE. ARISING DIRECTLY OR I NO CTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS FERMI r SHALL NOT BEE
PLAN CHECK DEPOSIT
DEEMED TO MODIFY. WAIVE DR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANC
PROVISION.' '
BE E
0 NOR LIMIT IN ANY WAY THE CITY'S ABIUTY TO ENFORCE ANY ORDINANCE
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN I S CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZ5D AGENT OF
Thi. .1pl-11- I-" -'I P'I �,m
THE OWNE , I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONST..C-
R EMPLOYED
CALL
E.,I dII,9 01111 , hi,Ml, DlPlIY: -d F.I. - PlId. ld
TION� AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING 0
FOR INSPECTION
. ..... pt l.mI.d9.d I. �plll pl.vldld
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27.
C
OFFI ALSSIGNATURE DAI
DATE SIGNED
(425)
-7
SIGNATURE (OWNER OR AGENT)
-7 __J_7 t*sn
-o mnn
I I
I ..
.
ELEASED By ATE
ATTENTION
EXT333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
OR A CERI
771-022-V
OR(GHAL-FILE YELLOW- INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL
CATE OF OCCUPANCY HAS BEEN GRANTED. LED SECTION 109
FAX C3 R/;,K OWNER GOLD, ASSESSOR