20000792.pdfPERMIT EXPIRES
6SE PERMIT
CITY OF EDMONDS ZO"E NUMBER Q'w
CONSTRUCTION PERMIT APPLICATION JOB '(_ "I El
ADDRESS 1 _4
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OW A FIAME/NAMEOF BUSINESS
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PLAT NAMEISUBDIVISION NO. LOT NO*
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LID FEE S
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REMARKS
OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP
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NAME
ENGINEERING REVIEWEDIDATE
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ADDRESS
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FIRE REVIEWED BY DATE
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STATE LICEN E NUMBER
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0 ADDITION 0 COMMERCIAL 0 CHANGE OF USE
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REMARKS
EMARKS
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A AS 0 RETAININYG WALL.., 0 RENEWAL
AL
0 GCAIRIP.IEIT ROCHE
RC108/FINALINSIPECTIONREO
O`Ypq�;," BUSINESS OR ACTIVITYJ EXPLAIN:
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GROUP
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OCCU
NUMBER
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CR ITICAL
AREA
NUMBER
IPECU%LINSPECTOR
REQUIRED [3 YES
I OCCUPANT
1A.1A AN��
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
0 U
PROGRESS INSPECTIONS PER UB
VALUATION I FEE
PLAN CHECK FEE
E LOT SLOPE %
BUILDING
�T.
PLAN CHECK -NO:
PLUMBING
MECHANICAL
THIS PERMIT AUTHOAOTSS ONLY THE WORK NOTED, THIS PERMIT COVERS WORKTO
A U Ly THE WORK N'
FE MIT A THO"ES ON
_ PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
E E A R Ly' AN
8 DON 0 PR`V T P OF T' ON
BE .. E ONPRVA E
GRADINGIFILL
S
D DOMAIN ICURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
OMAN I 'RO' ' QEWAKS '0 '
S
I.,
PER
SEPARATE PERMISSION,
SEPARATE '
SURCHARGE
2 MIT APPLICATION: 180 DAYS
P SIR
PE
A. . PROVIDED WORK IS STARTED WIT
PERMIT LIMIT'. I YE W HIN ISO DAYS
E , L Y
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
CK 0
LCN
ON BEHALF F HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
0 F OF HIS 0. �Ed EF-U
ENS, INSPECTION FEE
;APPLICANT T
R To , :NDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
IN INTEREST. AGREES TO
FROM ANYAND
f
LANDSCAP! G
�R
E To TSOFFICIALS� EMPLOYEES� AND AGENTS
OR INDIRECTLY
INSPECTION FEE
�EWAY
R A A E OF WHATEVER NATURE, ARISING DIRECTLY
r SPO S N
L I. E R AT'
A L ' - P PM T '.SU 5 PERMIT SHALL NOT BE
PRO. THE ISSUANCE 0, THIS E .
PLAN CHECK DEPOSIT
FEC—EIPT
,
CEE..D To .."Y . WAVE OR REDUCE AN R OF ANY CITY ORDINANCE
E ORDINANCE PROVISMN.�
RECEIPT
NOR ".IT IN ANY WAY TH. CITY.. ABILITY To
TOTAL AMOUNT DUE
4-1142-
1 6��
I IER.Y ACKNOWLEDGE THAT I HAVE READ TH S APPLICATION; THAT THE IN ORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNE'�, OR THE DULLY AUTHORIZED CENT
CITY AND STATE LAWS REGULATING CONSTRUC
CALL
Tla A111111- A 1—d "On-1 dl
THE OWNER. I AGREE To COMPLY WITH
THEREBY. NO PERSON WILL BE ED
Suftng OjIjI ., Ns-1 Doplty! and F p.d.
TION: AND IN DOING THE WORK AUTHORIZED EMPLOY
OF THE LABOR CODE 0 THE STATE OF WASHINGTON RE ATING TO
FOR INSPECTION
.Fa,IIdoP dap... p,o,dNd,
IN VIOLATION
WORKMEN'S COI,PENSATION INSURANCE AND RCW 18.27.
OFF NATUR D
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A EQWN 0
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T;
mTE S
(425)
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771-0220
L
IVEASED BY ATE
EXT 333
T E NT`ION
Al I OR STRUCTURE UNTIL
IT IS UNLAWFUL To USE OR OCCUPY A 13UILDINO
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
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ...............
FOUNDATION:
Footing ............
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wall .................
Pier/Porch
Retainlrig Wall ...........
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Slab insulation ..........
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commercial Final
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ExTERIOR SHEATHING
NAILING ..........................
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�RAMING ....................
FIRST FLOOR Fl,� �`IING
INSULATION ...........
Floor insulation
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Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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F P; �IRMIT EXPIRES 17:
.. PERMIT
CITY OF EDMONDS ..E 9 -� - ) _" NUMBER a'o Diu
CONSTRUCTION PERMIT APPLICATION JOB <�JEIAPTI
ADDRESS `I,__ - I
1 �6 u C�z:) UNIM
01 BUSINESS
PLAT NAMEISUBDIVISION NO,
LOT No,
LID NO-
b —
I
11. FEE E
MAILINGADDRSSS
0
5 1 +�
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
P.— I I'll 0
...' U.. P." 0
EXISTING PROPOSED—
'S"W�- P__ 0
CITY ZIP
JTEIEPIOIE
0
REQUIRED DEDICATION— FT
71n
MPTL. 11Z. LINE SIZE NlL011IXTUREl
PAV REQUIRED
NAME
I
YES C3 No 0
16-
ADDRESS
REMARKS
YMPPInONTRACTOR RESPONSIBLE FOR EROSION CONTROLMSM�GE
----TE—VIEWEDIDATE
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FIRE REVIEWED BY
DATE
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VARIANCE OR CU
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STATE LICENSE NUMBER
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FRONT SIDE REAR
PROPOSED SETBACKS
AS
FRONT US SIDE Rl'
0
c
ADDITION
COMMERCIAL
0 COMMERCIAL
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COMPLIANCE OR
CHANGE OF USE
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By DATE
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0 REMODEL
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0 SIGN
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REVIFWED
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REPAIR
0 FENCE
GRADING ONCE X FIT
REMARKS
REMARKS
TITER
0,
A
DEMOLISH 0 TANK
0
0 _n
GAR GE RENEWAL
0 RETAINING WALL E L
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0
-n
CARPORT R.CK.Y
8 ACTIVITYI EXPLAIN:
CHECKEDBY
TYP E
CONS'RU. TJDN
CCUPANTK
10 SOUP
m M
NUMBER
NUMBER
CA L
AREAS
SPECIAL INSPECTOR OCCUPANT
LOAD
0
0—
I F
I. ?RIES
DWELLING
UNIT S
EE
NUMBER
IAR
REQUIRED C] YES
a
nPFCRiBE WORK TO BE
DONE
j.:
9 ca
m
PLAN CHECK FEE
LOT SLOPE %
BUILDING
PLUMBING
ESTED DATE
MECHANICAL
PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
- 14 ON TH
EDONEON PRIVATE PROPERTY ONLY. ANYCON RUCTIO ONTH`S.p.'�',IRC
RA INGIFILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MA GUEES. ETC�) WILL
M SEPARATE PERMISSION,
: .. 0 Y
PEI!M ION AT S
P R IT
PERMIT LIMIT. I YEAR )RK 1S STARTED WITHIN 180 DAYS
END FIEVIEWISES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
F HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
END N.I..TI.N FEE
;,AFPEANST,.0Al.8EHALFO
AT RSEE To INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
NOSCARING
2 EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYC., AND AGENTS FROM ANY AND
INSPECTION FEE
ALLCLAIMSIORDAMAGE SOIWHATEVER MTUMARISiNGOIDECTLY S'�B'RECTLY
ISSUANCE OF THIS PERMIT SHALL NOT 55
PLAN CHECK DEPOSIT
FF THE'ESUANCE 0, THIS PERMIT.
DEEMED TO MODIFY. WAIVEOR REDUOSANY REQUIREMENTOF ANY CITY ORDINANCE
I NOR LIMIT WANYWAYTHE CITY'S ABILITYTO ENFORCE MY ORDINANCE PROVISION.'
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONY. THAT THE INFORMATION
ZED AGENT OF
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE OUL AUTHOR
AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
THEOWNER. I
TION;ANDINDOIN THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
RELATING TO
FOR INSPECTI,
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMCN'$ COMPENSATION INSURANCE AND SCW 18.27,
DATE
(425)
771-0220
'77TENI'ION
EXT 333
UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
IT IS
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI�
A FINAL
HAS BEEN GRANTED. LED SECTION 109
FAX
CATE OF OCCUPANCY
ER UBC 1081FINAL INSPECTION REC'D 11
0
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0
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VALUATION
FEE
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ORIGINAL - PILE YELLOW INSPECTOR
PINK - OWNER GOLD - ASSESSOR