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EXPIRES
P ERMIT
CITY OF EDMONDS
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NUMBER ;:�An 74��
CONSTRUCTION PERMIT APPLICATION
JOB
SUITEIAPTN
ADDRESS-L�T/ /
45
OWNER NAMENAME OF BUSINESS
PLAT NAMEISUBDIVISION NO.
LOT NO* 110 N
I 41D F E S
MAILING ADDRESS
T—P — 11
PUBLIC RIG iT OF WAY PER OFFICIAL
STREET MAP - —.11 S-- 0
P.— ." d 0
CITY TE
E.IB IN. — PROPOSED. 0
REQUIRED DEDICATION—
IT 0
METER SIZE LINESIZI
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NAME
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S MARKS
F — F-1— ..NTROLA.---
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NAME
ENGINEERING
REVIEWEDIDATE
ADDRESS
FIRE REVIEWED By
DATE
CITY
ZIP
TELEPHONE
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,
VARIANCE OR CU
SHORELINE 08 ADEN
INSPECTION
STATE LICENSE NUMBER
DATE
CHECKED BY
D JPBO�NTED
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ES [31,10
SEPA REVIEW
SIGN AREA
HEIGHT
COP APLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
PROPERTY TAX ACCO T PAR EL NO.
4'7-�',2 Mk2
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XP
LOT COVERAGE
REQUIRED SETBACKS JFT.j
PROPOSED SETBACKS (,rM.
NEW
RESIDENTIAL
E] PLUMBING MECH
ALLOWED PROPOSED
FRONT SIDE FEAR
FRONT US SIDE SEA R
ADDITION
Cl
COMMER AL
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CHANGEOFUSE
I
PARKING LOT AREA PLANNING REVIEWI- 11 DATE
REMODEL
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DESCRIBE WORK TO BE DONE REMARKS
PROGRESS INSPECTIONS PER 6BC 1081FINAL INSPECTION REO'Dill
VALUATION FEE
PLAN CHECK FEE
HEAT SOURCE LOT SLOPE I
BUILDING
PLAN CHECK NO: ED 'AT'
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
L BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS' MARQUEES, ETC.) WILL REQUIRE
:1 SEPARATE PERMISSION.
Er.V.AP.E
PERMIT APPLIGATION� 180 DAYS
PERMIT LIMIT'. I AS - PROVIDED WORK IS STARTED WITHIN 180 DAYS
YE
ENG. REVIEW FEES
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
-AFPLICANT� ON BEHALF F HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
ENG INSPECT ON FEE
IN INTEREST, AGREES T :NDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY 0;
ANY AND
LANDSCAPING
2 EDMONDS. WASHINGTON, TS OFFICIALS. EMPLOYEES, AN D AGENTS FROM
INSPECTION FEE
ALLCLAIMS FOR DAMAGES OF WHATEVER'NATUR5, ARISING DIRE—
THIS PERMIT SHALL NOT BE
DEPOSIT
F S PERMIT. SSUANCE OF
S M THE ISSUANCE OF TH C C
DEO FY. WAIVE OR REDUCE ANY REQUIREMENTOF ANY ITYORDINAN E
EMEDTOMODI
PLAN CHECK
DINA
WAYTHECIT 'S ABILITY TO ENFORCE ANY OR NCE PROVISION.'
a N ORLIMITINANY Y
TOTAL AMOUNT DUE
I HEREBY ACXNOIAILIDGE THAT: HAVE READ THIS APPLICATION: THAT THE INFORMATION
DULY AUTHORIZED AGENT OF
GIVEN IS CORRECT. AND THAT AM THE OWNER, OR THE
COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
THE OWNER. I AGREE TO
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. No PERSON WILL BE EMPLOYED
TO
FOR INSPECTII
11 VIOLATION 01 THE LABOR CODE OF THE STATE 0 F WASHINGTON RELATING
WORKMEN'S_qQMPGkSATION INSURANCE AND RCW 19.27.
DATE SIGNED
(425)
�EIOWNAGT)
9
771-0220
EXT 333
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTiFl-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDA'nON:
Footing ......................
wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab insulation ..........
PLUMBING:
Underground
Rough -In ...................
Commercial Final
HEATING:
Gas Test ....................
Gas Piping .................
Equipment ............
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...............
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PERM!TjEXIP�RES,
CITY OF EDMONDS
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PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB
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ADDRE ss 2;F1, 17
5
OWNS A NAME/NAME OF BUSINESS
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ADDRESS
REMARKS
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CITY TELEPHONE
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NAME VIII01111
ENGINEERING
x
ADDRESS
FIRE REVIEWED BY DATE
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CITY ZIP
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TDATI
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SIGN AREA HEIGHT
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EXP I I
LOT COVERAGE REQUIRED SETBACKS FT) PROPOSED SETBACKS (FT.
C3 NEW BE IDENT11 L C] PLUMBING MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UP SIDE REAR'
0
ADDITION COMMERCIAL o COMPLIA CE OR
CHANGE OF USE
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PARKING LOT AREA PLANNING REVIEWED 11 DATE
REMODEL C] APARTMENT [3 SIGN REQ�D PROVIDED
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OR ACTIVITY) EXPLAIN:
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CHECK5DBY ITYPE OF CONSTRUCTION C!tj OCCUPAN
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NUMBER N A ER OF ITICAL SPECIAL .E�YIE.R OCCUPANT
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Tc:R.MSER
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or
DESCRIBE WORK TO BE DONE
REMARKS
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UBC 108/FINAL INSPECTION REG D 5 co
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VALUATION
FEE
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PLAN CHECK FEE
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PLAN CHECK NO: ------- VEST DATE
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MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
T IS PERMIT Au'
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON T E PUBLIC
BE DONE ON P R'VATE P
GRADING/FILL
a , ETC.1 WILL REQUIRE
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS. MAROUSES
N S' SD"'
Do AIN 'CUR'
SEPARATE PERMISSION.
t:
u
-'
PERMIT APPLICATION; 180 DAYS
P
_HARGE
P PERMI f LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
..I ' LIMIT ' YEAR
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
EE.ACK OF
ENG. INSPECTION FEE
PLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
-AP L L
N INT REST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
I I
ANDSCAPING
M.NDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AS E NTS FROM ANY AND
EDMoE
A C 'M F. AMA.E FWHATEVER NATURE,ARISING DIR CTLY OR INDIRECTLY
ALLCLAIMS FOR DAMAGESO
INSPECTION FES
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERM T SHALL NOT BE
o
PLAN CHECK DEPOSIT
. To Mo., Y W IV REDUCE ANY REOUIREMENTOFANY CITYORDINANCE
DEEMEDTo MODIFY.WAIVEO
ANY ORDINANCE PROVISION.'
El T
0 No. L MIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE
NORUMIT
1
T07AL AMOUNT DUE
7
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
APPJJCATION APPROVAL
GIVEN IS COB RECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
Thl, IPPI-11,-, , p—it 01 llg by thP
THEOWNER. AGA5ETOC,m PLY INITH CITY AND STATE LAWS REGULATING CONSTRUC
1111-11 D
`
CALL
D.p.ty: Trld F111 P I Id.
TION; AND IN Di DING THE Wo RKAUTH RIZED THEREBY. NO PERSON WILL BE
RE ATING To
o L
Yd.
FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
OF ALS SIGNATURE DATE
__jjG �ARE G.A,!nA7,1 I DATE BIG ED (425)
? � , 7ELEASEDbY ..E
771-0220
ATTENtION EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE - YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER - GOLD . ASSESSOR
5,98