20000793.pdfPERMIT EXPIRES
USE PERMIT /20091-73
CITY OF EDMONDS ZONE R" NUM - BER -
CONSTRUCTION PERMIT APPLICATION JOB < ITEIA T#
ADDRESS _E 'tffITE'l
DWNEANAMEIN ME OF BUSINESS PLAT NAME/SUSOIVISION NO D NO.
Ev-\(r L�. FEE S
I LOT NO
PUS'IG R
X,.T,N.
MAILING ADDRESS
PUBLIG RIGHT OF WAY PER OFFICIAL STREET MAP F
p-a (00 .1.1
CITY _ EXISTING PROPOSED —
ZIP
ITILEPHON'
FE.U' BE FT
F..UIRF.D�CICATICN
V PEOUIRED
8 0 NO
P
NAII'L:ot YE
ADDRESS R22'l_mTRkCTOR RESPONSIBLE FOR EROSION CONTAOUDRAINAGE
-6o>r gy�-_s
FIRE REVIEWED BY
DATE 1.
ZIP TELEPHONE
-'L 110 0 u
I/zs- d/10,5 17Z
Vh'.5
�Cu
_INSPFC BOND
5.—UNE H AGB� TION
STATELICEN E UMBER
POSTED
OYRE-ANO
ES I
HEIGHT
'471 VA-^l 'f21 ff
$ERA REVIEW
SIGN AREA
ALLOWED PROPOSE
4 PROPERTYTAX ACCOUNT PARCEL NO.
COMPLETE EXEMPT
ALLOWED PROPOSED
IiXP I
LOT COVERAGE
REQUIRED SETBACKS (M. PROPOSED SETBACKS (FT.)
&KEW RESIDENTIAL 0 PLUMBING I MECH
0
ALLOWED PROPOSED
FRONT SIDE REAR FRONT UR $I DE BEAR
0 ADDITION o COMPLIA NO OR
CHANGE OF USE
—
PARKING I LOT
AREA I PLANNING REVIEWhu by DATE
0 REMODEL 0 APARTMENT 0 SIGN
REO'D I PROVIDEDt
—37�� 0 FENCE
0 REPAIR FT)
0 DEMOLISH 0 TANK
oGARAGE 0 RETAINING WALL 0 RENEWAL
CARPORT
0 (TYPE BUSINESS O�,ACTIVITY) EXRLAI
CHECKEDly D CCU.
ON I -Rum N PULP
ITIPEOF
CR—CAL
T, NUMBER
SPECIAL INSPECTOR OCCUPANT
__4)
OF 'WELLING AREAS
JAF-
REQUIRED 0 YES
LOAD
N Ts NUMBER
DESCRIBE WORK TO BE DONE
REMARKS
GRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REQ'D
ILI) _/'z
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE GLAZING
BUILDING
PLAN p, ]VESTED DATE
UMBING
P —
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK I NOTED THIS PERMIT COVERS WORK TO
PU BUC
BE DONE ON PRIVAT ANY CONSTRUCTION ON HE
'
E.PWR E. 'Y ONLY' T QU.RE
op
GRADINGIFILL
ALI '"V -WAYS. MAR.U�... _c.) WK_L.�
DOMAIN (CURBS, St. ,
SE �JMIATE IERM'.S'...
'aTATE SURCHARGE
PERM ON: ISO DAYS
IT APPLICATI
ISODAYS
76rEW FEES
I Inn
P R IS STAAT��WITHIN
PERMIT LIMIT'. I YEAR � ROVIDED W C
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
eS
OF HIS OR HER SPOUSE. HEIRS. AS IGNS AND SUCCESORS
HARMLESS CITY OF
PfCrr. N F 5 E
cc
;NAP,PNLT'�'RA.N�T�,OA".'�EE'.A'FT. I..E.Ntl .�IIND AND HOLD THE LANDSCAPING
AND AGENTS FRO. ANY AND FEE
A NG ON TS OFFICIALS, EMPLOYEES,
EOMONOSSWF H.A.TA Eit.r WHATEVER NATURE� ARISING DIRECTLY OR INDIRECTLY
' .
INSPECTION
RE P T
AULGLAINI G
PERMIT SHALL NOT BE
ISSUANCE OF THI'DF
PL CHECK DEPOSIT
ANY CITY ORDINANCE
RECEI
DADINANCE PROVISION,' TOTAL AMOUNT DUE
HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
I HEREBY ACK�NDWTLlA0�ltE;,llAATT: A
GIVEN is Co THE OWNER, OR THE DULY AUT.OqIZED AGENT OF
Th.l.ppj.,.j.w.po,mij udl�Odby I
C IN, C.NSTBLC-
THIOWNER, IAGETOCOMLy,,�T�.0,TYA�l)�TATE.��E UIT
CALL
B"I dl hi —I D—W nd F .10 pal. a.
0 C'N. THE WORK AUTHO ". THEREBY. NO PERSON WILL BE EMPLOYED
TION; AN IN D RELATING TO
FOR INSPECTION
nkwI�d,.bI —... p—d.d.
WASHI
IN VIOLAT ON Or THE LABOR CODE OF THE STATE OF NGTON
I
DATE
WOSKMEN,�S COMPENSATION INSURANCE AND SCW 18,27,
GAT, SIGNED
(425)
OFFICIALS TUBE
SI ATILLREHO!fR-;,ii�W�__
A
—ASED
771-0220
BY
ATTENTION
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
1
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
519.
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACK$ ...........
FOUNDATION:
g'.
Footing ......................
Wall .............. ...........
pier/porch ..........
Retaining wall ...........
Stab Insulation ..........
a
-i "n. j a,
PLUMBING:
Underground
0 M
C:
...........
iW
IR 1
Rough -In
-4 0
0
0
Commercial Final
HEATING:
M,
Rill
C
Gas Test ....................
Piping
Ni
Gas ...............
Equipment
Commercial Final
M rn,
EXTERIOR SHEATHING
0
NAILING ............... —
C:
FRAMING ........................
In C).
FIRST FLOOR FRAMING
IN SULATION ...................
Floor Insulation
za
V�all Insulation ...........
Calling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
M
UMCELLANEOUS ..........
R'ct� f4�GEWT �EXORES��
CIE s
USE PERMIT
ZONE
J0 CITY OF EDMONDS �, NUMBER SUITEIAPT$
C&STRUCTION PERMIT APPLICATION
AUDIT
OWNER NAMEINAMI
1, NA.El�IP3DiliSK)N NO,
LOT NO,
I'D NO*
I
LID FEE S
MAILI G ADDRESS
RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSE,—
REOUIRED DEDICATION— FT
TESCP �AWd
F.qoi, d
CITY ZIP JTELEPHONE�
Lvw CLWj C,t4 Ohaoq�
()-C) 7�1.
NAMLE
F FIXTURES
:RV REQUIRED
YE 0 NO 0
C
ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY
El..N.
NAME
-EN—GINSERING
EX�
ed A06RESS
po /30Y 11-5V3
z
0
FIRE REVIEWED BY DATE
t
2. cl C)
CITY ZIP
,(,k0&wW4X,6
TELEPHONE
I-U
VARIANCE OR CU
SHORELINE OR ADEN
INSPEC
REOT11 N
G
OYES ONO�
BOND
POSTED
STATE LICENSE NUMBER EXINATIIN;�l
L
9q --$l/ 6
4z),44,w�Pi,, 166 'll
I
EDBY
SERA REVIEW
SE
CO.lLlIl EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO�
to
Xp
F p I
,
,
I
:3
rn
0
0 or
:0 rrn
m z
RESIDENTIAL PLUMBING MECH
COMPL NCEOR
3?4MMERCIAL
D ADDITION CHANGE OF USE
0 REMODE I L 0 1 APARTMENT SIGN %
LOT COVERAGE
W, ROPOSED
ALLOWED PROPOSED
REQUIRED SETBACKS (FT�)
FRONT SIDE REAR
PROPOSED SETBACKS Pl)
FRONT UR SIDE REAR
PARK
REO'D
KING
PROVO
I ED
LOT AREA
P NNING Fh7 IEWED By DATE
ENCE
All F X FT)
'0 REPAIR 0 OR 'No CYOS
DEwiOLISH 0 TANK
�GARAGE D. FIE
0 CARPORT ��tl =$G WALL
Z,
(j)
0
All m
'0 m-
c cl)
C 0)
REMARKS
AUT
U ..PySiNESS09 tVITY)'EXPLAIN
J�OCCUPA 'I
GROUP fc�
to �,NIJMSER
do ��GF
STORIES
NUMBEROP
DWELL NO
UNITS
CRITICAL
AREAS
NUMBER
SPECIAL INSPECTOR JAREA
REGUIRED YES
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
INSPECTIONS PER UBC 10WFINALINSP ION RE
t2i
PRO GRESS
0
07,
f f
VALUATION
FEE
PLAN CHECK FEE
z
GLAZING I %
HEAT SOURCE BUILDING
M
PLAN CHECK NZ. ESTED U. E PLUMBING
IV
THIS PERMIT AUTHORIZES ONLY THE WORK NOTEDi THIS PERMIT COVERS WORK TO
N ON THE PUBLIC
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTIO I E.U,�E GRADINGIFILL
DOMAIN (CURBS; SIDEWALKS, DRIVEWAYS, MARQUEES, FTC.) IN LL
SEPARATE PERMISSION.
STATE SURCHARGE
RMITAPPLICATON: 180DAYS,
P8 �6 I nc),
PERMIT LIMIT�. I YEAR PROVIqEDW RKISSTAFITEDV14HIN 180DAYS EVItW FEES
SEE SACK OF PINK PERMITIFOR MORE INFORMATION
APP . LICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS NSFE;TIONI FEE
IN INTCREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND A ANYAND INSPECTION FEE
DIGENTS FROM
AULCI-AIMS FOR DAMAGES OFWHATEVER NATURE,ARISING S CTLY OR INDIRECTLY OD
I Fn M THE ISSUA CE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
DEEMED TO MODIFY, WAIVE REDUCE ANY REGUIREMENT OFANY C, TY ORDINANCE
NOR LIMIT IN ANY THEC ITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION T TAL AMOUNT DUE PT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT, AND 7 AT I AM THE OWNER, OR THE DULY AUTHORIZED AGENJ OF. I, ho, , hohit onfil ,g,,d by the
THE OWNER. DIAGSEE To COMPLYWITH CITY AND STATE LAWS REGULATING CONSTRUC CALL Srhjl�hil Ipplil 11
di 9 011oi I P, .,he, put,: d F ... ... peid...d
h! 1)
Tp DING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED r I, cklmhld9ld,, space provided.
ION AND IN RELATING TO INSPECTION Ipt
N VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON FOR
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.21. .,OFFICIALS SIGNATURE DATE
st S!GNED (425)
T_ Elolw=_,10�_,7—;,�� ' I ,
Cl _Z e_:; 00)
Eu 771;-0220 �EEASED BY 4A
ATTENTION EXT 333
ITIS UNLAWFULTO USEOR OCCUPYABUILDING 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 PtNK-OWNER - GOLD. . ASSESSOR
!V98