20000675.pdfDATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
17NAME
.,,,o/FBusl"C A-,-,� ro,_
ZIP
NAME
w,40--
[PERMIT EXPIRES
USE PERM';R
ZONE NUM.
joB NITVAPTI
ADDRESS JCJ jb5..(qd0' NW-)
LID NO.
PI-U NAMEGUBDIVISION NO. I LOT NO U. FEE S
PUBLIC RIGHT OF WAY PER OFFICIALSTREET MAP X;.411
P._
EXISTING — PROPDSEB� AI,.d
REQUIRED DEDICATION— FT — WIll, -�td
METER SIZE I LINE SIZE I NO,OFlWTURES PRY REQUIRED
YES 0 NO 0
RE -ARKS
--l—T-1— —1—SIBLE FDA EROSION CONTROIJORAINAGE
IRE REVIEWED By DATE
P
ccql
0
VARIANCE OR CU SHORELINE OR AD5# INS�PEE.GTION I PNT.D
B ND
OYES ONO
STATE LICENSE NUMBER Fx 11 ION DATE
CKED By
COMPLETE EXEMPT
EXP
__70T
SION AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
PROPERTY TAX ACZ PA-1. NO.
_13 a
... NO M
COVERAGE
ALLOWED PROPOSED
FB.1111E. SETBACKS III
FHONT SIDE FEAR
PROPOSED SETBACKS 11.1
FRONT URSIDE FEAR
C PLIANCE R
0 ADDITION 0 COMMERCIAL CHANGEOFQSE
T_
PARKING LOT
AREA
PLANNING REVIEW EDBY DATE
REMODEL 0 APARTMENT E] SIGN
REPAIR [3 GRADING CYOS 0 FENCE
( X IT�
DEMOLISH TANK ci OTHER
0 GAAGE C] FETAININO WALL RENEWAL
CARPORT JOCKSR
9 ffy�� ��SS OR ACTIVITY) EXPLAIN:
CHECKED By
JqTION
iiTRLIOTION
0
RC
CODE OCC UpAop_:---�
'C P
OG 0,
NUM.Ell
OF
R BE
I ST: I
I D�
OF
DAELL NO
CRI TICAI
—
R EAS
AR
NU MEER
SPECIAL INSPECTOR JAPEAl
REOUIRED C3 YES
GCODE
OCCUPANT
C
LOAD
L
DESCRIBEWO
REMARKS
PROGRESS INSPECTIONS PER UIE31C 110801NAL INSPECTION REO'D
1c, o Z, In Ck 0
onle
VALUATION
FEE
Latw\c(,(
LOT SLOPE %
BUILDING
PLAN CHECK NO: �VESTED OAT'
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK To
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURDS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.� WILL nEOUIRE
D SEPARATE PERMISSION.
It
GRADINGIFILL
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
P IS
PERMIT LIMIT 1 YEAR - ROVIDED W RK STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INF DRMATION
5NG, REVIEW FEES
P ON BEHALF 0 US' E2 A�Sl.�S AND SUCCE1011
F H:.ONR,,H'R SIPEON HARMLESS THE CITY OF
;A PLICANT. Y, E . �NI) HOLD LANDSCA
N I OTEREST',AAGIE.ITOT�0. �,,�ANOIAE.I;Llylol�,," ARYAND I NFEI
EDMONDS Y SHIN ITS .1110ALS, EMPLOYE INSPECT .
NATURE. A RE NO CTLY
ALL CLAI Nl�,FO I I.A�IAIESTI.F, S`PU'VE R LL NOT BE
'... TH UA 0 R. ISSUANCE .1 THIS PERMIT SHA PLAN CHECK DEPOSIT
DEEMED OMODIFYWAIVEOR CEAN REOUIREMENTOFANY ITYORDINANCE —
REDULIlYTY E ORDINANCE PROVISION
..FLI.ITINANYWAYTHECITY'SABI 0 NFOnCEANY TOTAL AMOUNT DUE
RECEIPT
REC�l T,
clz
I HERE Y ACKNOWLEDGE THU I HAVE READ THIS APPLICATION. THAT THE INFORMATION A PLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER . OR THE DULY AUTHORIZED AGENT OF Tl,,� -� 1 - P-1-11 U""'l— �l ""
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULAI ING CONSTRUC CALL B.'uq oll,l o, , D.P.ly ,:i F. P�Id,
I TION AND IN DOING THE WORK AUTHORIZED THE REBI, NO PERSON WILL BE EMPLOYED FOR INSPECTION
N VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE ANO RCW 18.27, FI A SStGNATU DATE
GNATURE (OWNER 0 (425) 6117hC
c_,Qkc_ 771-0220 REL ASE By tDATE
ATT64TION EXT 333 �
ITIS UNLAWFUL TO USE OR OCCUPY ABUILDINGOR STRUCTURE UNTIL 771-0221 YELLOW INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR
5196
z
0 m
m 0
c
� c 1�
m
r- -4
om
n
m IT,
0
0;;
C ca
z
CA
z
9
0
m
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall...............
z
0
PierTorch .................
S.
0
Retaining Wall ...........
IT,
Stab insulation ..........
PLUMBING:
M
Underground
M 13
0
0
Rough -in ................... .
Commercial Final
M MZ
10
HEATING:
Gas Test .............
Cj)
Gas Piping .................
0 -n
n
Equipment .................
M M
Commercial Final
0 vi
0
EXTERIOR SHEATHING
0
NAILING ...........
M C.),
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ................ . .
Floor insulation
Wall insulation
Z
Calling Insulation
0
SHEETROCK NAILING
M
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
RECEI]�
PERMIT EXPIRES
USE
USE'
�.N.
ZON
IdNDS
CITY OF EDMONDS
PERMIT
2�� F2- NUMBER
T'O�
PPL,CA 'A
CONSTRUCTION PERMIT APPLICATION 'AOD80
08
D R E S S 0AVtjjT
OWN' A FBUSIC k
---1-7j'T
T NAMEISUBDIVISION NO,
No.
LI NO.
mzPL
(�r�
UD FEE $
-6RESS
MMUNGk[D
PUBLIC RIGHT OF WAY PER OFFICIALSTREET MAP
ss �' 0
EXISTING — PROPOSED
L.. I.— A, d 0
NE
CITY ITELEPHQNE Cq
5:S) LPLID
�Dn Lp —WA'W
FE..IFE..E.ICATION— FT
ME—
REQUIRED
NAME
YE"CV3 No 13
S R
ADDRESS
R MARKS R I, la
Mt.11—T.—T— FlIF-SI.L. FOR EROSION CONT.Q.D AIN.
NUMBER
0 AUDITION
C] REMODEL
[] REPAIR
C] DEMOLISH
C GARA E
I FPGAT
OF
STORIES
DESCRIBE
TELEPHONE
FIRE REVIEWED BY DATE
VARIANCE OR CU
SHORELINE OR ADBN
INSPECTK)
HE 10
BOND
STE.
m YES 0 NO
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED I PROPOSED
EXP I
I —
--
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS FT.)
;8zTLUM5 No I MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT 1JR SIDE REAR
COMPLIANCE OR
CHANGE OF USE PARKING LOT AREA PLANNING REVIEW DATE
M SIGN REDD PRDV
C, FENCE
E] GRADING GYDS X
FTI
REMARKS
TANK El OTHER
RE.I
R CK
0 RENEWAL
OR ACTIVITY) EXPLAIN:
CHECKED BY
TYPE OF GO ��C'TION
iTEL
0 CUP1
]CODE GROUP
CRITICAL
SPECIAL INSPECTOR
ARE OCCUR
DWELLING
AREAS
NUMBER
REQUIRED C] YES
LOAD
_UNITS
REMARKS
PROGRESS INSPECTIONS PER UBC 11081FINAL INSPE(
c� . (3
VALUATION I FEE
01
u
PLAN CHECK FEE
G11INI I
LOT SLOPE -%
BUILDING
+ I
PLAN CHECK NO:
ED DATE
PLUMBING
ICAL
MECHANICAL
SO
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
TH' PERMIT AUTHORIZES o NL`
,
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
B NE o I ATE PRO'
B o N PR
E
GRADINGIFILL
9 'a'WAL S MARQUEES, ETC.) WILL REQUIRE
DOMAIN (CURBS, SIDEWALKS, DRIVEWAY
t: SEPARATE PERMISSION.
STATE SURCHARGE
I
PERMIT APPLICATION: IDD DAYS
.RM"
I
T PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
I Y R - P'.
ENG, REVIEW FE S
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
OF P
[
ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
N OF
;APPLICANT
NTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
I' - 'N.I
IN IP T S , G T
ANYAND
LANDSCA ING
DMONDS.WASHINGTOK ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM
E ED TS'-
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
INSPECTION FEE
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SH�;�nj,"E
NYG,TY
PLAN CHECK DEPOSIT
DEEMEDTo MODIFY, WAIVE OR
' PROVISION.-
CIO
0 NOR LIMIT IN ANY WAYT.E CITY'S ABILITY TO ENFORCE ANY ORDINANCE
W Y '.
TOTAL A ... NT DUE
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
I
'AI.IUN
APPROVAL
GIVEN IS Go RECT. A D THAT I AM THE o INNER 08 THE DULY AUTHORIZED AGENT OF
�7PLI
, . , .
THE OWNER. RIAGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRU G-
CALL
B." puty: ,d F %.`d.
TION; AND IN I DING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
OF WASHINGTON RELATING TO
FOR INSPECTION1
.... ipt is a.kwI,dg,d I. spaca D—d-
IN VIOLATION OF THE LABOR CODE OF THE STATE
WORKMEN'S COMPENSATION INSURANCE AND RCVJ 1 B.27.
..
FI ALS SidNATIJ DATE
NT�
(425)
Slr?/�
771-0220
FIL 11 By 'DATE
Aft-6TION
EXT 333
-
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFl-
ORIGINAL FILE - YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK OWNER - GOLD -ASSESSOR
z
0
c m
M 0 - I
-10
00
c
� m . ,
m T
0 -n
m M
0
M C)
Z r,
z
em
z
0
1
0
m