20000630.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
MAILING AbDRESS
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ADDRESS f
CITY ZIP
NAME
PERMIT EXPIRES a 13 lo �
'NUNB'E'R
L—pi (_3 E APT
ADDRESS I C-l"?, F� -�_v
PI.AT NAMEISUBDIVISION NO� I LOT ND* LID 10,
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
P.- R 4d I
EXISTING _ PROPOSED —
REQUIRED DEDICAIION� FT
.ETTR "S.—E _1711.E SI. 0 .1 FIXTURES PRV REQUIRED
II YES 13 NO 0
�lEltARKIS-T-1— P.—NEIBLE FOR EROSION CO.TROUDRAINAGE
�FIRI IEVIEWEGBY ��=ATE
Y�MSATI
VARIANCE OR CU
SHORELINE OR AUSN
INSPECTION
....
REG D
(:)YES [3NO
I POST�.
PA REVIEW
IGN AREA
HEIGHT
GO I' STE EXEMPT
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ALLOWE 0 PROPOSED
ALLOWED PROPOSED
!nv TUCCOUIT�;CEI
NO,
EXF 1
1
,
C] NEW
RESIDENTIAL
6�PLUMBING I MECH
LOTCOVERAGE REQUIRED SETBACKS ('T)
ALLOWED PROPOSED FRONT SIDE REAR
PROPOSED SETBACKS (FTJ
FRONT UP SIDE FEAR
0 ADDITION
0 COMMERCIAL
c3 COMPLIANCE OR
CHANGE OF USE
I
PARKING REVIEWED By DATE
0 REMODEL
APARTMENT
[3 SIGN
REO'D I PROVIDED
QZ2SPAIR
FADI.G
CYD.
Ej FENCE
( — X FT)
REMARKS
DEMOLISH
0 TANK
o OTHER
c3GARAGE
CARPORT
RETAINING WALL
ROOKE ly
RENEWAL
ACTIVITY) EXPLAIN:
CHECKIDBY
tPEOFPON T�CTION
UP
CCUPAJ2�
NUMBER
. ..... AL
LL NO A PEAS
SPECIIA
LINSPECTOR
AREA
,,,PANT
LOAD
OF
STORIW-_�
OWE
UNITS
NUMBER
EQU R
C] YES
I WORK TO
REMARKS
--m— IMCOPP.TinNS PER U.0 10811INAL INSPECTION REO
-::r- n
VALUATION I FEE
PLAN CHECK FEE
LOT SLOPE I
BUILDING
PLAN'CHECK NO:
PLUMBING
MEC NICAl
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED� THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING,F
DOMAIN (CUR13% SIDEWALKS, DRIVEWAYS, MARQUEES. ETCJ WILL REQUIRE
- __
SEPARATE PERMISSION
STATE SURCHARGE
RMIT APPLICATION: 180 DAYS
PE M'
P�R
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED INITHIN 1 8D DAYS
Y E A
P'
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
AD K OF
BEHALF OF MIS OR HER SPOUSE. HEIRS. ASSIGNS AN. SUCCESORS
PIL 'E�AENSTjGN�SIEI�ll FT M
ENG. INSPECTION FEE
;AF, ,ON .1'
T R . I
IN INTERES REES TO I DEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
NT T AGREES TO'N�
LANDSCAP NO
EDMONDS, WASHINGTON, ITS OFPCIALS, EMPLOYEES. ANDIAGENTS 'ROM ANY AND
INDIRECTLY
INSPECTION FEE
ALLCLA,M' PC OFINHATEVER NATURE.ARISING RECTLYOR
LA I FOR 0 M OF BE
MS R A.AGES T SMALL NOT
0 E F S THIS PERMIT. ISSUANCE OF TMIS
AN E OF TH'
G
E CS,
PLAN CHECK D I T
RECEIPT
'PER.,
HE I SSUANCE
FG. T IS..
FROM T Y IT ORDINANCE
,E. B WAW�.FFE.U.EA.Y.E.., E.E.T. AN Y
G"Y W
ME TO ... Ily
D �E B To .
U IT. N, WAY THE." $ABIUTY TO ENFORCE ANY OPOINACCE PROVISION.'
NOR U MIT IN ANY WAY TH E CITY
OR
THAT I HAVE I THAT THE INIO ATIGN
APPLICATION APPROVAL
I HEREBY ACKNOWLEDGE
yo,�DT�,SppL,�CATI�oLNY.
GIVEN S CORRECT, AND THAT I AM TM NR OR G AUTHORIZED AGENT OF
T,pp,,.I,o. 01 Pg,,ld by Ih.
ER, I AGREE TO COMPLY WITH CITY AN6 STATE LAWS REGULATING CONSTRUC-
I HE OWN E EMPLOYED
offi-, p,ly.,.d F.—I. P.Id.
TION. AND IN DOING THE wORKAUTMORIZEDTHEFEBY.N PERSONVALL
WASHINGTON RELATING TO
TION
� �p
d ... 11.11d.d.
IN VIOLATION OF THE LABOR CODE OF THE ISCTWATE .
NI RANCE AND R 16-21
OrFCIALSSIGNAT R
WORKMENSCoMPENSATI
(425)
it
... RE (QIER 0' A NTI I
k-
771-0220
_M
RE EASED BY
EXT 333
ATTENTION
OCCUPY A BUILDING 08 STRUCTURE UNTIL
771-0221
—YELLOW
IT IS UNLAWFUL TO USE 08
APPROVAL OR A CERTIFI-
ORIGINAL - FILE 'N—SPECTop
A FINAL INSPECTION HAS BEEN MADE AND
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
FAX
PINK OWNER GOLD ASSESSOR
5198
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RECORD OF INSPECTIONS
t
INSPECTOR DATE APPROVED
SMACKS .....................
i
FOUNDATION:
Footing ......................
wall ............. ............
Z
0
Pier/Porch .................
—1 _�J
Retaining Wall ...........
M
Stab -Insulation ..........
PLUMBING:
i M
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Underground .............
0
171 0
0
0
R.0 gh-In ...................
C:
Commercial Final
M
HEATING:
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Gas Test ....................
Gas Piping .................
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Equipment .................
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Commercial Final
A
EXTERIOR SHEATHING
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NAILING ..........................
0.
FRAMING ........................
171
FIRST FLOOR FRAMING
INSULATION .. . ...............
Floor insulation
Wall Insulation ...........
CO
Ceiling Insulation
SHEETROCK NAILING
M
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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31
P�E�RMIT �EXPIRE�S
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�84 �'�/ PERMIT V
CITY OF EDMONDS — NUMBER
C014STRUCTION PERMIT APPLICATION 'AoDGRESS LZ�APT*.
efrnAMEN ME OF SU17S -lbk LID NO.
PILAT NAMEISUBDIVISION NO. Llb FE
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PUBLIC RIGHT OF WAY PE III, d 0
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0 EXISTING —, PROPOSED— -1-2�21U.V E03
ITY C d
TELEPHONE
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NO.OFFIXTURES WHY RED ED;
NAME YES C3 No C3
IS
REMARKS
ADDRESS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
T LPNG
ZIP TELEPHONE
BY
UNIT
not
co
C] NEW
I "I H
ADDITION
COMPLIAN
Cl CHANGE OC U`SE9
C] REMODEL
n SIGN
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0 GRADING - GYDs
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11 ( _ X FT)
DEMOLISH
TANK
c3 OTHER
GARAGE
CARPORT
C] RETAIN"tG WALL
ROCKS,
[3 RENEWAL
jyo� ACTIVITY� EXPLAIW
NUMBER
OF
E,GRIE6--'�
NUM5ERO
DWELLINq
UNITS
CRITICAL
AREAS
NUMBER
DESCRIBE WORK TO
fMDDMy- _ _1 I, /A
I
-= V-1
FIRE REVIEWED BY
DATE
ORELINE OR AD
VARIANCE OR CU SHORELINE OR AUHN
..........
.......
REO'D-
OYES bNO L
A R VIEW
SEPA REVIEW
SIGN AREA
HEIGHT
HEIGHT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXEMPT
E E
COMPLETE
PLE
Ro
ALLO POSED
WED P
-P I
P
LOT COVERAGE
REQUIRED SETBACKS (M.
PROPOSED SETBACKS (FT)
UR SIDE REAR
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT
P G
KING
PAR K�IN L
R)ft_ 1p 'EVI
XV
�TE
OAT
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BY
1
REQ'. I PROVIDED
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LOAD
REQUIRED[] YES
REMARKS
'D
REO'D
PROGRESS INSPECTIONS PER UBC 11018/FINAL
=�
INSPECTION
0
VALUATION
FEE
PLAN CHECK FEE
GLAIING I LOT SLOPE I
5UILOIIG
PLAN CHECK NO: IVESTED DATE
PLU.Bl-
MECHANICAL
.IS.PEG'MIT AUTPKROSIZES ONLY THE WORK NOT D. THIS PERMIT COVER WORK TO
N ON THEP BLIC
E ).E ON VATS PROPERTY ONLY. ANY CONSTRUCTIO
SIDEWALKS. DRIVEWAYS MAROUEES. ETC. I WILL REGUUIRE
GRADLNGIFILL
DOMAIN (CURBS, ,
:3 SEPARATE PERMISSION.
STATE SURCHARGE
I:
1 180 DAYS
PERMIT APPLICATION:
WITHIN 180 DAYS
_0
YE I
PERMIT LIMI� 1 AR ' PROVIDED WORK S STARTED
SEE SAC K OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
DEFEND AND HOLD HARMLESS THE CITY OF
ENG. INSPECTION FEE
LANDSCAPING
IN INTEREST, AGREES TO INDEMNIFY.
WASHINGTON, ITS OFFICIVES. EMUREyEESI�ANDIAGENTS FROM ANY AND
INSPECTION FEE
IE EDMONDS.
HATE R NAT IN RECTLY OR IND FECTLI
NOT BE
RECEIPT
PERMIT SHALL
)F ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
)RDINANCE PROVISION,'
RECEIPT
TOTAL AMOUNT DUE
THAT THE INFORMATION
APPLICATION PPROVAL
AD THIS APPLICATION.
I HERE ACKNOWLEDGE THAT I AVE FEWNE, OR THE DULY AUTHORIZED AGENT OF
ThIS pPIl--II IS by th,
GIVENly A" THE ITY TATE LA S -E-LEN. C-NSTRUc_
CTGITF Ly W, N . A
C ALL
dj,jF,,gd
'u" III, oll.1 .1 h1l,bl, OlGltY 3- CGS GG, PICC. .,,d
THE OWSE`R`RlAECTiIE`TNO
N
THERE - N PERSON W`L' BE E
Y
TION. AND ll� GOING THE WORK AUTHORI�ED -'LGYFG
RELATING
FOR NSPECTION
I
Gpi's IS ... dgld 11 10 G1 Od-
IN VIOLATION OF THE LABOR CODE OF THE STAT E OF WASHINGTON
INSURANCE AND RCW 18.21
OFF CIAILS S GNATUR A E
WORKMEN'S COMPENSATION
(425)
p
7AT.��ER (�EINT�
771-0220
RE EASED Y DATE I
—ENTION
EK 1'333
71-1
TO US E OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
IT IS UNLAWFUL I.
HAS BEEN MADE AND A PPROVAL OR A CERTIF
ORIGINAL -FILE YELLOW -INSPECTOR
A FINAL INSPECTION
GRANTED. UBC SECTION 109
FAX
PINK -OWNER GOLD -ASSESSOR
CATE OF OCCUPANCY HAS BEEN
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