20000788.pdfPERMIT EXPIRES Zf�2V
ERMIT 9 o( -3F
,77L
ZONE NUMBER
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
ADDRESS,
MAILING ADDRESS
CITY
ADDRESS
CITY
NAME
70—DRESS
_�ITY
STATE LICENSE
/,//v "' rID7
1144
USINESS
PLAT NAME/SUBDIVISION NO.
LOT N 0
LOT NO,
LID NO.
I
U. FEE
Z�]
PUBLIC RIGHT70F WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED —
TESCP Appl—d
.-I
, d
zip
17 Io
JTILEP-O"E
`4 L
I A_N _ F' _
REQUIRED DEDICATION— FT —
METER SIZE LINISIll
F_
NO. OF FIXTURES
V PEOUIRED
I
so NO 0
YEP
1
REMARKS
_F—ONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ZIP ITELEP"INI
Zip TELE7HONE
0 NEW RESIDENTIAL PLUMBING I NIECH
. PUANCE.R
0 ADDITION COMMERCIAL CHANGE OF USE
0 REMODEL 0 APARTMENT 0 SIGN
E] E] FENCE
0 REPAIR ( � _ ITI
E] DEMOLISH n TANK 0 OTHER
oGARAGE 0 RETAINRINLG WALL 0 RENEWAL
CARPORT — ROCKS
IVITY) Expl-AIN:
NUMBER NUMBER OF
OF D NELL N.
U T.
STORIES
DESCRIBE WORK TO BE DONE
FIRE REVIEWED By DATE
VARIANCE OR CU SHORELINE OR ADEN INSRPE TION BOND
E 'D POSTED
OYES ONO
SERA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
EXP I
LOT COVERAGE REOUIRED SET AC�S 11) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE HEAR FRONT �RSIDE REAR
PARKING I LOTAREA IPLAIININ.BEIIEWEDBY DATE
REDO I PROVIDED
TYPE
C C EDy L
P _' LN- T
E'
CRITICAL
��E��
NUMBER H`�`El UiA. E - "TY E S
CCU PA
GROUP
lcq.7 P �E
OCCUPANT
LOA.
PER UBC 108ITINAL INSPECTI.N
VALUATION I FEE
PLAN CHECK FEE
HE IURCE GLA7LN.G/- LOT SLOPE
BUILDING
PLAN CHECK NO: 55TIO 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
RADINGIIILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MAROUEES. ETC.) WILL REQUIRE
Z)
— SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT' I YEAR . PROVIDED WORK IS STARTED WITHIN 18D DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
— AppCANT�o.N.=F OF HI�S OR HER Elo!JS�. HEIRS. ASSIGNS AND SUCCEScRS
ENG. INSPECTION FEE
IN NTERES .,N. MNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
AND AGENTS FRO. ANYAWD
LA A
E
EDMONDS, WASHINGTON, ITS OFFI CIALS. EMPLOYEES.
RECTLYOR INDIRECTLY
IN
RECEIPT
PERMIT SHALL NOT BE
PLAN C K DEPOSIT
F ANY CITY ORDINANCE
ROMANCE PROVISION.'
llc7T
TOTAL AMOUNT DUE
THAT I HAVE R EAD THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
I HEREBY ACKNOWLEDGE
GIVEN CORRECT. AND THAT I AM THE OWN 'R OR T" DULY ..FZED A. ENT OF
LAWS AEGUILATI.G
SER.
Thl, PPIll't'l
THE OWN AN6 STATE CON�IFUC
I AGREE TO COMPLY WITH CITY
EMPLOYED
CALL
B"I
ED THEREBY, NO PERSON WILL BE
TION; AND IN DOING THE WORK AUTHORIZT
OF WASHINGTON RELATING TO
FOR INSPF-CTIPN
,pd P,d-
IN VIOLA OF - ABC CODE OF HE STATE
IS 0
NATURE DATE
KME TIC �S.FANC. AN. PC-
W.R jK�2,01VIPTENIAL
F IALS 11
IIGI�l I WNE
ATE SIG�ED
2
(425)
0
&o
771-0220
HELEASED By
ATttNtION
EXT1333
iTISUNLAWFULTOUSEOR OCCUPY A BUILDING OR sTRucTu"E NTL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND Al "RO'AL OR A c,�
ORIGINAL FILE YELLOW INSPECTOR
CATE OF OCCUPANCY HAS 13EEN GRANTED. UBC SECTION lD9
FAX
PINK OWNER GOLD - ASSESSOR
$me
z
0
d
0
El
M
c a � I
M 0
80
c
M M
z
JO
O.n
-in
-4
M M
0
0 C -
: (J)
r. rj)
Mo
Z
z
-4
cl)
z
0
1
M
0
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall ..........................
Pier/Porch .................
Z'
Retaining Wall ...........
0
Slab Insulation ..........
:PLUMBING:
Underground .............
M
M
Rough -In ...................
0
—10
Commercial Final
ITI M
HEATING:
v Gas Test ...................
Gas piping .................
Equlpmsnt m ...............
-n�
commercial Final
IT T
EXTERIOR SHEATHING
0
NAILING ..........................
FRAMING ...............
0:
FIRST� FLOOR FRAMING
INSULATION ...................
Floor Insulation
Z
Wall Insulation ...........
j
C4
Ceiling Insulation
z
SHEETROCK NAILING
0
SPECIAL INSPECTION
M
MISCELLANEOUS ..........
F14AL APPROVAL FOR
OCCUPANCY ...............
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
DWNEj!,AME1,NAME OF BU;ZSS
�� _ lA 9-h-cla—
MAILING ADDRESS
ir I ),Ai- 6-� sw
CITY ZIP TELEPHONE
4, '24 f- -I Li 2
ZIP
LEE PERMIT
f)g7WV1
ME NUMBER 61
B SUIT&APTN
ADDRESS _7//�5L 0,41�(- 51 Sly-2--
PUT NAMEISUBDIVISION NO.
LOT No.
LID NO,
I
LID FES S
P
PUBLIC RIGHT .1 WAY PER OFFICIAL STREET MAP
A ' -
_, , I P-11
W-p;' 0
-it Miq` 0
�d 0
EXISTING — PROPOSED
A— "i
A
11=11.111.�
C'. T, FT
REOUIRED DEDICATION _ FT
U
U
W1"qu,.d
METER SIZE
LINE SIZE
URES
PAY REQUIRED
0
YES 0 NO 0
REMARKS
FR1NTAACTOR RESPONSIBLE FOR EROSION CONTROL,-1- E
CITY
zip TELEPHONE
FIRE REVIEWED BY
DATE
VARIANCE OR CU SHORELINE OR ADBO
ON ...
INSPEC 7�'
_CTATE LICENSE NUMBER
EXPIRATION
DATE CHECKED BY
"a I POSTED
1-R
PROPERTY TAX ACCOLINT RGEL NO.
SERA REVIEW SIGN AREA
COMPLETE E XEMPT ALLOWED PROPOSED
I
HEIGHT
ALLOWED PROPOSED
P
0 NEW
A
PLUMBING I MECH
OVERAGE REQUIRED SETBACKS (FT.)
ALIDWTIC PROPOSED FRONT SIDE REAR
PROPOSED SETBACKS III
FRONT UPSIDE REAR
0 ADDITION
COMPLIANCE OR
CHANGE OF USE
PARKING L
C] REMODEL
A
SIGN
REDD I PROVIDED
REPAIR
GRADING CYDS
C:] FENCE
( X FT)
REIVAIIII
DEMOLISH
0 TANK
E] OTHER
'E
C3 2AIRIPORT
A A'
C] FRISTANINY3 WALL
C
RENEWAL
0
(TYPE OF USE. BUSIN S A ACTIVITY) EXPLAIN:
CHEC11D BY TYPE 11 C01151 LOTION
OUPAIT,
1 1
NUMBER
16�
NUM SEA OF
CIA TICAL
AREAS
JCOIE
q17
SPEC" L'�; CTOR AREA
GAO P
I
OCCUPANT
OF
STORIES
DWELLING
NUMBER
REQUIRED [D YES
LOAD
1
DESCRIBE WORK TO BE
DONE
REMA KS
.AnARF9S INSPECTIONS PER JEC 1081FINAL
INSPECTION REQ1
PLAN CHECK FEE
HEAT
a2.U_RCE GL&ZWG V- LOT SLOPE %
BUILDING
PLAN CHECK NO: I-STED DATE
PLUMBING
— MECHANICAL
THIS.PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK To
....... PRIVATE PROPERTY ONLif% ANY CONSTRUCTION ON THE PUBLIC
DOMAIN 'CUP.S. DRIVEWAYS MIA QUIES, ETC.) WILL REQUIRE
SIDEWALKS.
-'-- SEPARATE PEOIssION.
GRADINGIFILL
STATE 5 RCHARGE
P MITAPPLICATI N; 18QDAYS
PER'
E
PERMIT LIMIT. 1 YEAR � PROVIDED WORK IS STARTED WITHIN 180 DAYS
BAR"
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
C
K
ENG. REVIEW FEES
;APPLICANT, ON SEPAL - OF HIS OR HER SPOUSE, AEIRS. ASSIGNS AND SUCCESORS
L'.F' LD HARMLESS THE CITY OF
IN NT REST. AGREES TO:NDEMNIFY, DEFEND AND Ho E A YAND
ES To
I ' - i N,
EDMoEDS, WASHINGTON, TSOFFIGIALS. EMPLOYEES. AND �G NTSFROM N
L _, o OFWHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
A CLAIMS FOR DAMAGES S PERMIT SHALL NOT BE
LL M T I.E. C S PERMIT. ISSUANCE OF TH' ANY CITY ORDINANCE
FROM THE ISSUANCE OF TH
AIVE-GA
DEEMED TG.oDFy W REDUCE ANY REQUIREMENT .1
oN
p o ODI 15 ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
NOR LIMIT IN ANYWAYTHE CITY
NOR LIMIT IN Y W Y .EC
END. INSPECTION FEE
LA A
IN E
PLAN C X DEPOSIT
TOTAL A.OUNT DUE
RECEIPT
RE(MT —1
I
IHERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN By CORRECT, AND THAT I A. THE OWNER. OR THE DULY AUTHORIZED AGENT 01
'S CONSTRUC
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING
TON THE WORK AUTHO"IIED THEREBY, NO PERSON WILL BE EMPLOYED
V� AN� 1NDOINP3 ATING 10
IN TH. 1AB ODE 0 THE STATE OF WASHINGTON REL
�NEATI S
.;FURANCE AND RCW 18.21.
__7ESI.NED
APPLICATION APPROVAL
Th', IPPlIcal- 1- 1-1 - P—il �l �,Sd by th,
-d F111 l. �,id
CALL B�.Id,,X oil,-, o, li,�Ih.l D.PUIY: _ P�
FOR INSPECTION
IALS SIGNATURE DATE
E] �NT) __ I
(425
771-0220
,,
ATtEktION EXTP33
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
BEEN MADE AND APPROVAL OR A CERT!FI-
ORIGINAL FILE YELLOW -INSPECTOR
A FINAL NSPECTION HAS
CATE OFIOCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
1. FAX
PINK - OWNER GOLD - ASSESSOR
z
0
Fn
0 m
m C3
0
0
m m
Z
a -Z
0 -n
m m
m
0
0
0
cn
0
3:
>
z
--I
z
0