20000708.pdfDATE RECEIV
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
H�Ft NAMEINAME OF BUSINESS 6 _
MAILING
C
CITY
NAME
ZIP I TELEPHONE
,-�A o [PERMIT EXPIRES
.5� 1 C) (:)
USE PERMIT 700-7m
IG�E NUMBER
'05 SUITE/APTY
ADDRESS
S
0
'0
AD
E
S
D
E
R C' P
ER
P
M
E
NU'
R
T
M
M
B
E
E
T
X
R
P
'RE
OT No
F' I FEET MAP
T
L ST
OS —
N F XTUP.
-F7
PI.AT NAME/SUBDIVISION NO. I LOT NO. LID NO*
LID FEE S
CP APP—d
PUBLIC RIGHT OF WAY PER OFFICIAL MAP RW P1 R1-
P-1
EXISTING — PROPOSED-
5CI F�OUM�D.E=AATI.N_ IT
VT FFIXTURES PRV EOUIRED
METER SiZ
YES NO 13
REMARKS
OWNFRIGONTRACTOR RESPONSIBLE FOR EROSION CONTI.I.IRMNAGE
REVIEWED By
DATE
VARIANCE 0 cu SHORELINE OR ADS.
A ED. U
INSPECTION
REQ'D OSTED
I PBO D
TATE LICENSE NUMBER ElHj
T A �lh HECKED By
tFIRE
t
C3 YES ONO
2)
�o P6
-
'14M
21
SEll RE111W SIGN AREA
HEIGHT
ROPERTY TAX ACCOUNT PA.UE_ NU
COMPLETE EXEMPT ALLOWED PROPOSED
M T X
ALLOWED PROPOSED
X
X p
P
LOT COVERAGE REQUIRED SETBACK$ (FT.)
PROPOSED ETBACKS (FT)
NEW '>6—E.I.SNTIAL
LUMBING/ ECK
�r..FL
ALLOWED PROPOSED FRONT SIDE REAR
FRONT USSIDE REAR
C] ADDITION COMMERCIAL
A..E OR
CHANGE OF USE
I I
PARKING REVIEWED
LOTARIA
DATE
REMODEL C] APARTMENT
SIGN
JPILANNING
REGO I PROVIDED
GRACING
CYDS
FENCE
I — X FT)
-REMARKS
DEMOLISH TANK
OTHER
GARAGE RETAININYG WALL
CARPORT
�SSOR
C] RENEWAL
E AC`RVITY) EXPLAIN:
CHECKEDBY
UITION
CUPAIT
ITYPEOPCO
.soup
_7 1
NUMBER
NU�
NUMBER OF
CRITICAL
AREAS
SPECIAL INSPECTOR
JARSA
)PANT
LO
OCAtU
OF
STORIES
DWELLING
UNITS
NUMBER
iRED
REQUIL E] YES
DESCRIBEW$MDBE 0
V9
Y—\
REMARKS
ftm INqPFrTHlNS PER U8C 1081FINAL INSPECTION REO
K F EE
PLAN CHECK FEE
P' AN C C
G I
E U CE GLAZING I
E `
LOT SLOPE %
LOT SLOP
G
8 ILDING
8 U'LD
H E 0 K No
PLAN CHE K NO:
PLA NC
0
..... ....
ESTIO AT'
A'
IN G
PLUMBING
LUM
p
-
-CH A N I' ;A L
MECHANICAL
PERM�T COVERS W. FIX TO
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
T.' IT .U' I Z E S NLY TH E
E CT,.N ON THE P U.LC
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DONE ON PRIVATE P. P T'
GRADING/FILL
RA FILL
'ND'
U
ETC., WLLFECU IRE
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL VISO IRE
S -EWA K
I L-P
SEPARATE PERMISSION
- '
STATE SURCHARGE
STATE U .. ARGE
-
PERMIT APPLI-ATION: 180DAYS
IT A P
.0". ' WITHIN I " DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 1 8b DAYS
B P
EE
ENG. REVIEW FEES
EN G R V' W ' S
PE RMAT'ON
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
HK
-
S R A AND S
GANT ON - EHALF OF 9 SPOUSE, HEIRS. ASSIG14S AND SUCCESORS
'APPLICANT. ON BEHALF OF HIS OR HE
E C Ty 0 F
THE CITY OF
SENS S I CC SO":D
T
N SS
DE II HARMLE
I R S GR LESS
I TO IN
IN INTEREST AGREES TO INDEMNIFY. DEFEND AND HOLD HARM
N
T N
S SOF G AGE -TS'RO" ANY A
TFSV0FlIClAES.E ILOYS-S.ANDACENTSlFOM ANYA D
LANDSCAPING
LANDSCAPING
INSPECTIONFEE
I NS E. I N E
TO
i DMONDSiWAS",A.,AlN Y
W. �G . ECTLY OR '.DIRECT'
F A 'R
A L ". FONDA A.E�g V, ATE R NATURE, ARIS NO DIREC LYORINDIFECTLY
UL", S ON T
F - SS
rEE
IS P R PE SHAL No -E
IS IS P FMT L T
I SSU G ER.T SHALL NOT BE
FROM THE ISSUANCE OF THIS PERMIT. SUANCE OF THIS
T
PLAN CHECK DEPOSIT
P LAN , HECK E,..'T
M VE OR REDUCE ANY REQUIREMENT ANY CITY ORDINANCE
0 Mo. N 0, G RDNANCE
I Y W R RED, T 0, ANY Ty 0
F A' I G E OVS'.
DEEMED To MODIFY. WAI RD NAN PH N
ANY OR DI NANG E PROVI SION,
Y
NOR LIMIT IN ANY WAY THE CITY'S ABI LITY TO EN FORCE
N R L, IT I Y Y T E CITY
.. T D
..Al AMOUNT DUE
T T
0
DGEIHAT:HAVTEFEA THISAPPLICATION:T.ATTRE INFORMATION
0
HERIBYACKNO*L E
GIVEN IS CORKFEGT�A�. THAT A. HE OWNER. OR THE DULY AUTHORIZ D AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
EMPLOYED
WILL BRFE
CALL
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON
OF THE STATE OF WASHINGTON LAT I NG TO
FOR INSPECTII
IN VIOLATION OF THE LABOR CODE
WORKMEN'S COMPENSATION INSURANCE AND RCW I B-21
_9�NATURE
(425)
I
771-0220
EXT 333
ATTIff4TION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING 08 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
519.
7--1 _�Ls__-oo
APPLICATION APPROVAL
T b pq �,n.d by —
B.,ldimg OVI-I Pl --Pu" .,,d F ,,d..,p.,d. nd
,lbdgbb� � �P PIP .
7777=�� . DATE
ORIGINAL - FILE YELLOW - INSPECTOR
PINK OWNER GOLD -ASSESSOR
z
0
0 m
c
M 0
0
80
m m
Z
10, , .
c
0 _n
'n
M m
0 —
0',
0 rn
M 0
Z
7-1
;D
z
z
m
I IIIIIIIII
----------
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ................
FOUNDATION:
Footing ......................
wall ................
z
Pier/Porch .................
0
M
RetairI Wall ...........
Slab Insulation ..........
M
PLUMBING:
0
0
Underground .............
0
Rough -in ..............
C.
t:�,
In
In zi
Commercial Final
C
pl,
HEATING:
>
%q
Gas Test ....................
Gas Piping .................
Equipment .................
I M.
Commercial Final
0 M,
EXTERIOR SHEATHING
C co
NAILING ..........................
M 0:
Z
FRAMING ........................
17
n
1
FIRST FLOOR FRAMING
INSULATION ...................
>
z
Floor Insulation
Wall Insulation ...........
0
Ceiling Insulation
=! I ,
SHEETROCK NAILING
0
M
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
CC�;;/NjME Z ZI�ESSC
, , j�
MAILING ADDRESS I
00 PERMIT EXPIRES
.BE PERMIT Z'Sid?, I QJz:
ZONE
NUMBER
JOB S ITEMPTN
ADDRESS
PI -AT NAMEISUBDIVISION NO. LOT NO* 110 NO -
LID FEE 5
TESCPAPPI..d I
PUBLIC FIGHT .1 WAY PER OFFICIAL STREET MAP F. .1.1 .--
So- J.. P—h R�jd
.P.
EXISTING — PROPOSED—
PEOUIRED DEDICATION_ FT
PRY REOURED
YES 0 NO 0
REMARKS Ala
OWNFRICONTRACTOR RESPONSIBLE FOR ERO.J4 T UDRAIMAGE
CITY zip
ITELEPHON'
AME
'N ME
IFIRE
ENGINEERING REVIEW—UAIE
D BESS
-VicryNcItAlb
z
REVIEWED BY DATE
TELEPHONE
VARIANCE OR CU
SHORELINE OR AOBN
INSPECTION
OYRE '
ES [3NO
BON
POSTEV
0
STATE LICENSE NUMBER EXPIR JGIN 5ATE
(4
CHECKEDBY
SERA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED I PROPOSED
HEIGHT
ALLOWED I PROPOSED
PROPERTY TAX ACCOUNT PA
EXP I
rn
c:
m a
0
0
0 c:
M
9=RESIDENTIAL
0 NEW LUMBING I MECH
'�E
(o C MPLIANCE OR
ADDITION COMMERCIAL CHANGEOFUSE
C] REMODEL APARTMENT SIGN
LOT COVERAGE
ALLOWED PROPOSED
REaUIR9D SETBACKS (17.)
FRONT SIDE HEAR
PROPOSED SITBACKSEA(FT
FRONT L/A SIDE R
3
1 z
A
AR LOT
P P KING
RED I PROVIDED
0 D
ARIA
PLAN NING REVIEWED By DATE
CYBE 1 NCE
In 0 GRADING
( X FT)
HE
AN K S
REMARKS
E
DEMOLISH 13 TANK OTHER
GARAGE RETAINING WALL RENEWAL
CARPORT P.,KERY
0 -n
m
rn m
0
0
o
a cl)
K (1)
o
(TYPE USS, NESS OR ACTIVITY) EXPILAIN:
C"ECKEORY
CHECKED
ITYPEOICON1 RUCTI.N
0 CUPANT
ICODE GROUP
I NUMBER
OF
o $TO IES
NUMBEROF
DWELLING
CRITICAL
AUEN'ER
SPECIAL INSPECTOR 1AREA
E BE,
F OU,
PEOURED 0 YES
OCCUPANT
LOAD
DESCRIBE W TO BE
;D Y
REMARKS
FIRMA KS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RE.
P 0
z
VALUATION
FEE
PLAN CHECK FEE
z
HE E GLAZING %
LOT SLOPE I
BUILDING
0
m
PLAN CH04% NO:
VESTED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE W.PK NOTED. THIS PERMIT COVERS WORK TO
BEDONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CUASS, SIDEWALKS. DRIVEWAYS, MARQUEES. ETC-) WILL REQUIRE
SEPARATE PERMISSION,
GRADINGIFILL
STATE SURCHARGE
PERMIT APPLICATION; ISO DAYS
PERMIT UMIT-. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. REVIEW FEES
;APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HOPE. ASSIGNS AND SUCCESORS
IFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
tj N ITERI.T
ED I CIALS. EMPLOYEES, AND AGENTS FROM ANY AND
M.NGE
INSPECTION FEE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
M FIT M THE ISSUA CE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
0 CE
PLAN CHECK DEPOSIT
C F
DEEMEDTO MODIFY. WAIVE OR REDU EANYBEQUInEMENTO ANYCITYORMNAN
0 NOR UMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
1 0 OF
GIVEN 15 CORRECT, AND THAT I AM THE OWNER, 00 TH1 DU.LY�AUTHOTI, I.E
COAG.ITIRT
THEOWNER. I AGREE TO COMPLY WITH CITY AND STAT LAI' ED., N N UG.
CALL
TIO�, AND IN DOING THE WORK AUTHORIZED THEREBY. No PERSON WILL BE EMPLOYED
WASHINGTON RE ATING 10
FOR INSPECT11
IN VIOL TION OF THE LABOR CODE OF THE STATE OF
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27
(425)
F
77NGNED
LNATU�RE LN
771 -0220
EXT 333
E
ATT'KTION
IT IS UNLAWFULTO USE OR 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
T
"T
A
p '�c
T,
P. U!7-on� L`'
�o offIcIll .1 D
1,pt 11 .1111dUld 11 -P010 P'Gwd0d.
FFICIALS SIGNAT DATE
R LEASED BY UAII
ORIGINAL - FILE YELLOW INSPECTOR
PINK OWNER GOLD - ASSESSOR
. m