20000802.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAMEINAME OF E S C,) (� FLAT A.E,S..DIVISIOI NO. I LOT NO, LI NO.
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VALUATION FEE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I_ BE DONE ON PRIVATE PROPERTY ONLY. AMY CONSTRUCTION ON TH E PUB
GRADINGIFILL
DOMAIN (CURBS, SIDEWALKS, DRIVE MARQUEES, ETC.) WILL REQUIRE
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CHARGE
PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT. I YEAR " PROVIDED WORK IS STARTED WITHIN 18D DAYS
E NEI, wfVIEw FEES
SEE'BACK OF PINK PERMIT FOR MORE INFORMATION
T, N BEN LF F IS ER SP SE. EtES� ASS11 SAN SU ES RE
PP I I Y F
EFE AN L PA 'EBB
ENG. INSPECTION FEE
LANDSCAPING
IN I E REES T EFNiFY.
YEES.AN A IIT F A AN
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INSPECTION FEE
& ALL tSS'F R A A BE F HATEV R TURE.ARISIN DI TLY IN IS TLY
NOT BE
RECEIPT
x Fn THE ISS AN E F THIS PER IT. ISSUAN E F THIS PERMIT SHALL
CITY ORDIN ANCE
PLAN CHECK DEPOSIT
DEE E DIFY AIVE E A E IRE ENT F ANY
DDINANCE PROVI SION
REC
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TOTAL AMOUNT DUE
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WASHINGTON FELATN
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IN VIOLATION OF THE LABOR CODE 0 HE AT
oSK.ENSG%lENSAllON INSURANCE AND RCW 18.27,
ICIALS SIGNATURE DATE
S'.NA' ATE SIGNED
(425)
771"0220
RELEASED By
ATTENTION
EXT1333
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 YE �OW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ................
FOUNDATION:
Footing ......................
wall ..............
Pier/Porch .................
Retainirig Wall
...........
Stab Insulation ..........
0
PLUMBING:
Underground ............
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M,
Rough -in ...................
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Commercial Final
HEATING:
M T,
Gas Test ............
Of
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Gas Piping .................
Equipment
Commercial Final
EXTERIOR SHEATHING
M M
NAILING ..........................
C,
6 Fn
FRAMING .................
FIRST FLOOR FRAMING
0.
7.1
INSULATION � ..................
;D
FloorInsulation
Wall Insulation
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
NFORCE
- ."7417. -- — -------------
DATE RECEIVED PERMIT EXPIRES Z
US E M
PERMIT
t
'0 N
P N U M EIE R
CITY OF EDMONDS NUMBER
D S
JOB PTF
P L 'CAT'O N JO B
AD D R E S
CONSTRUCTION PERMIT APPLICATION ADDRESSZ�
LO No
GA—r,�s FLAT NAME/S.13.110.14 NO. LOT NO* U NO,
LID FEE $
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ADDRESS T—P u
PER OFFICIAL -T PET
PUBLIC RIGHT .1 WAY PER OFFICIAL ET VAR W
P I I I G T—W AT 0
P'Ill
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X IS T PROPOSED
CITY EXISTING — PROPOSED� 0
TELEPHONE sis-s. 0
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C70 olory 4/7 a 7 REQUIRED DEDICATION— FT — 9
775
75-
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METER SIZE LINE SIZE NO. OF FIXTURES
NAME PRV REQUIRED
YES 0 NO 13
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W E� ARKS
REMARKS
ADDRESS NERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
.W . TR CTOR RESP.NE'SLE P.SO C T.
OWNER' N A F RE N 0
ZIP ITELEPHONE
CITY INE
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13 DATE
FIRE REVIEWED By
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STATE LICENSE NUMBER oYREaO
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— SERA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT I RQEl NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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LOT COVERAGE REOUIRE SETBACKS IFT SETBACKS (FT.)
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CHANGE OF USE
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DESCRIBE WORK TO BE DONE
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L DONE ON'PAlVATE PROPERT",,oNLpy..ANl COHlT.8,U.CT'lON,.ON THE PUBLIC GRA61NOIFILL
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OMAIN (OU 'B"B'DEW.LKS, 'WE"A'.'sIA".. _T' ) WILL E.UI.E
D 'r
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R�FARATE
S �40CHARGIF
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT'. I YEAR - PROVIDED ORK IS STA TED WITHIN 180 DAYS ENO. Ri FEES
SEE BACK 01 PINK PIRMIWT FOR MORE"INFORMATION
ENG. INSPECTION FEE
A '0' HIS OR HER SPOUSE� HEI RS. ASSIGNS AND SUCCESORS
LT
IF LANDSCAPING
HTERBr 11 E. OIN.ENN Y, OBIEN. AN...LG HARMLESS THE CITY OF
*A'PJCANTjCAN.SER
IN
WASHINGTON� ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANYANO INSPECTION FEE
EDMONDS.
ALLOLNIVIS FOR DAMAGESOFWHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
x ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL HOT BE PLAN CHECK DEPOSIT
RECEIPT
FROM THE
DEEMEOT FY, WAIVE OR REDUCE ANY REOUIREMIENTOF ANYCITY ORDINANCE
0 MODI
ANY UHUN11— 1— 1-11
RE
tl
0 NORLIMIT INANYWAYTHE CITY SABIUTYTO E
TOTAL AMOUNT DUE
]HEREBY ACKNOWLEDGE THAT I HAVTHREAD THIS APPLICATION� THAT THE INFORMATION
APPLICATION
AP RO AL
E
GIVEN SC."ECTIAND.IHATIA. OWNER, OR THE DULY AUTHORIZED AGENT OF
CITY AND STATE LAWS REGULATING COMSTRUC
CALL
is 6,0,y
u7
This Ipplical- is X I PQlmI d bysh.
MPLY WITH
THE I ABR TO E
OWNER
,,TION IN 0 IN THE WORK AU ORIZED THEREBY. NO PERSON WILL BE EMPLOY D
AND 0 G RELAT NG TO
FOR INSPECTION
Sulldmg 0111.1.1.1 hilft' D.PWY "d Fos' ". Ps' iJ md
—olpt Is ack—lodgld i—pace p—idod.
IN,VIOLAT ON OF THE LABOR CODE OF THE STATE OF WASHINGTON
1
WORKMEN'S COMPENSATION INSURANCE AND RCW 18,27
0 ICIALS SIGNATURE DATE
RAGE
DATE SIGNED
(425)
11,1i'l
=tc—'
771-0220
R LEASED BY I DATE
EXT1333
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 CERTIFI�
ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
$198
----------