20000804.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
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PERMIT EXPIRES
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USE PERMIT
ZONE NUMBE 2cx"
'0' SUITEJAFTN
ADDRESS
PLAT NAMEiSUBDIVISI.W NO� LOT No LIO NO.
U. 1. S
PUBLIC FIGHT 01 WAY PER OFFICIAL STREET MAP R, P-4 P
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EXISTING — PROPOSED
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REQUIREDDEDiCATION— FT —
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II YES . No
NTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWEDIDATE
ENGINEERING
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DATE
TELEPHONE
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VARIANCE OR CU
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INS�1.1.CTION
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0 YES ONO
"OND
STEC
�TATE LICENSE NU MEER
EXPIRATION DATE
c HECKED By
SEPAREVIEW
com FILETS I EXEMPT
EXP
SIGN AREA
ALLOWED I PROPOSED
HEIGHT
ALLOWED PROPOSED
I
ROPE L NO.
,Igll ACCOUNT 1 11
10 noo U:*-j no
7NEW
0 ADDITION
REMODEL
0 REPAIR
0 DEMOLISH
ED GARAGE
CARPORT
53"REEIGIINTIAL 2"'PLUM.ING I MECH
[3 COMMERCIAL ci COMPLIANCE OR
CHANGE OF USE
11 APARTMENT 0 SIGN
0 FENCE
0 GRADING CYDS x FT)
X
0 TANK o OTHER
0 RETAINING WALL
oC Y 0 RENEWAL
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SET ACKS (FT.3
FRONT SIDE REAR
I
PROPOSED SETBACKS (FT.)
FRONT LIR SIDE HE.
I
PARKING
REQO
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I PROVIDED
LOT AREA
I PLAIN RING REVIEWED By DATE
REMARKS
CHECKEDBY IT T I
IV
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CUP
oc URA;�
NUMBER
OF
STORIES
NUIMESL EIR OF
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UNITS
CHi i,CAL
AR EAS
I NUMBER
S ECIALINSPECTOR JARhA
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REQUIRED 0 YES
I OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
..n('RFqS INSPECTIONS PER UBC 1081FINAL INSPECTION REQ'
VALUATION I FEE
PLAN CHECK FEE
HEAT SOURCE GLAZING %
LOT SLOPE %
BUILDING
I LAN CHECK
VESTEORATE
PLUMBING
MECHANICAL
0
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION QN THE PUBLIC
GRADINGIFILL
Z_
DOMAIN (CURES, SIDEWALKS, DRIVEWAYS. MARQUEES� ETC.) WILL REQUIRE
SEPARATE PERMISSION
STATE SURCHARGE
PERMIT APPLICATION: j8DDAYS
KIS
PERMIT LIMIT. I YEAR - PROVIDED WOR STARTED WITHIN 180 DAYS
ENG REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORM ION
-APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIFS ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD ARMILESS THE CITY .1
LANOSC ING
2
EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANYAND
INSPECTION FEE
A`_Cl_AIMSF0R DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
HOT BE
RECEIPT
FROM THE ISSUANCE OF THIS SSUANCE OF THIS PERMIT SHALL
PERMIT I
EEMED TO MODIFY, WAIVE OP.,, EDUCE ANY RpgM;NYT O�F.Ar CITY ORDINANCE
PLAN CHECK DEPOSIT
r,� AN ANCE PROVISION'
N OFILIMITINANYWAYTJECIJ ',SA&ITYTOE
TOTAL AMOUNT DUE
RECE
T
I HERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE WFO MAHON
Z D AGENT OF
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHO
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
T ,P, P h�.,,t C p 1, 1.11 y
N ty -d FIll.— PlId.,
TION, AND IN DOING THE WORK AUTHORIZED THEREBY. No PERSON WILL BE EMPLOY ED
RELATING TO
FOR INSPECTION
_o ".,.d.d
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
IOFIIENICOMPENSAH_9��ANCEAN RCWiS.27,
DATE
'=0,I
SIGNATURE (OWNER
DATE SIGNED
(425)
I. _�, _(
771-0220
HILEASED61
ATTENTION
EXT 333
XIT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE - YELLOW INSPECTOR
A FINAL INSPECTION
CATE OF OCCUPANCY HAS BEEN GRANTED. LEG SECTION 109
FAX
PINK- OWNER - GOLD ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch ........... . ....
Retaining Wall ...........
C) M
M
Slab Insulation ..........
-40
0 C
PLUMBING:
.............
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-Underground
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Rough -In ...................
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Commercial Final
HEATING:
0,
Gas Test ....................
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Gas Piping ...............
0
:F Equipment .................
M
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Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
;0.
FRAMING........................
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FIRST FLOOR FRAMING
--I
INSULATION ...................
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Floor Insulation
Z
0
0
Wall Insulation ...........
171
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR -6
ee,5
OCCUPANCY ................... .....
DA E RECEIVED PERMIT EXPIRES o f
0
PERMIT
CITY OF EDMONDS NUMBER 2
CONSTRUCTION PERMIT APPLICATION JOB SUITEJAPTN
ADDRESS
C�NfbRNAMEINAIECI��ll SS
fra PLAT NAMEISUBDIVIStON NO LOT NO. L�G NO
I . FEE S
MAILING AD;ESS,, PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP ..P.-
E ISTING - FFOPOSED� 0
T03E k)o 0
44Ui� I RE.UIREOI)EDICATK)�- FT - Q
METER SIZE I LINE SIZE 110. 01 FIXTURES PFV RIOUIIED
NAME YES E3 NO 13
REMARKS
ADDRESS OWNFRMONTRACTOR RESPONSIBLE FOR EROSION CONTROIJORAINAGE
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CITY ZIP ITELEPHONE
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NAME
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AD71�FIRE
/ nitYN�
REVIEWED By DATE
C
TELEP HON
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VARIANCE OR CU SHORELINE OR AOBb
_5T 'ON
INSPEI
RECIM
OYES ONO
I PBOND
DST ED
SIT E UIENII��E�, DATE
T
'OF
CHECKEDB
SERA REVIEW SIGN AREA
COMPLETE I EXEMPT ALLOWED I PROPOSED
EXP
HEIGHT
ALLOWED , PROPOSED
TAX ACCOUNT Pl� EL NO.
PROPE ACCOUNT R�R
l(o noo! OID60 0 o
VREEME14TIAL 2""lL .. IN. I F.H
OMPLIANCE OR
0 M
ADDITION C] COMMERCIAL Cl CHANGE OF USE
REMODEL C3 APARTMENT 0 SIGN
REPAIR 0 ..A.M. Cy.S 0 FENCE
X IT)
E3 DEMOLISH E3 TANK o OTHER
o GARAGE RETAIN RENEWAL
WALL E]
CARPORT
LOT COVERAGE RIOUIRED SETBACKS
ALLOWED PROPOSED FRONT SIDE REAR FT
PROPOSED SETBACKS (IT.)
FRONT URSIDE RE . A
PARKING
REDD PRO IDCD
I V
LETT AREA
PLANNING REVIEWED BY DATE
REMARKS
I ROCKV
P (TYPE OF USE. 8 §SCACI�LY EXPLAIN:
CHECKEDBY
TYf?F C ,Trpr�,
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OCCUPAN
GROUP
NU BER
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OF
STORIES
N MEER OF
DW
UN.��UNG
CRITICAL
AREAS
NUMBE
SPECIAL INSPECTOR
REQUIRED [] YES
OCCUPANT
AREA LOAD
DESCRIBE WORK TO BE DONE
INS PER UBC 108/FINAL INSPECTION REO'D
a,
VALUATION FEE
PLANCHECKFE5
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HEAT SOURCE GLAZING %
LOT SLOPE %
BUILDING
9
0
m
PLUMBING
PLAN CHEC���
IVESTED DATE
MECHANICAL
THIS.PERMIT AUTHORIZES ONLY THE WORK NOT D* THIS PERMIT COVERS WORK TO
E ..... PRIVATE PROPERTY ONLY. AN' CONSTRUCTION ON THE PUBLIC
A. �CUR.G. DRI MA OUEES, ETC.) WILL REQUIRE
SIDEWALKS, VEWAYS
SEPARATE PER�ISSI'O'N.
G""NG'FLL
STATE SURCHARGE
PERMIT APPLICATION: 1-0 DAYS
95 BACKO IN P A TFOR MORE IN 0 MATION
PLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
OF
;AP
N NTEREST. AGREES TO INDEMNIFY� DEFEND AND HOLD HARMLESS THE CITY
I'
LA -SC ING
I F
2 EDMONDS. WASHINGTON. ITS OFF CIALS. EMPLOYEES. AND AGENTS ROM ANYAWO
ALLCI-AIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
INSPECTION FEE
RECEIPT
FR M THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
MODIFY. WAIVE OR REDUCE ANY EMENTOFA CITYORDINANCE
OEOEMEDTO ACE PROVISION.'
CC NY.R+
Ep A
HECE
PT 0 12�
SABILITYT
0 NORLI TMANYWAYTJEC[f�'.
0 MI
TOTAL AMOUNT DUE
Lj
I HERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
SIS
APPLICATION A�!R AL
GIVEN CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
�i?�
Thl, Ppli-11-1- I P01-1 I
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
. CALL
Blil-9 Off,,i,l 11 hl.lhel DOPUIY
TICK, AND I N DO NO THE WORK AUTHORIZED THEREBY� NO PERSON WILL BE EMPLOYED
WASHINGTON RELATING TO
FOR INSPECTION
lpt i. -k-lIdg.1 �P P-11-
IN VIOLATION OF THE LABOR CODE OF THE STATE OF
DATE
WORK.ENS CO.PENSAT=�TNCE AND RCW 18,27.
(
FFICIALS SIGNATU�E
OWNER (FI AGENT),/
ATE SIGNED
(425)
[SIGNATURE
771-6220
R LEAJS'EG BY DATE
EXT 333
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW INSPECTOR
A FINAL
HAS BEEN GRANTED. UBC SECTION.109
FAX
PINK - OWNER GOLD - ASSESSOR
CATE OF OCCUPANCY