20000820.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
MAILING ADDRESS
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CITY ZIP
NAME
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ADDRESS
FPERIMT EXPIRES
USE
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PERMIT
NUMBER
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BY
FIRE REVIEWED By
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DATE
CITY
ZIP
VIEWED
AR AN-E OR CU
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EXPIRATION DAI I, -Y'
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REQUIRED ETBACKS (Frj
PROPOSED SETBACKS (FT)
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FRONT UR SIDE REA R
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by DATE
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REO'D I PROVIDEDI
0 REPAIR
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MARKS
0 DEMOLISH
0 TANK
o OTHER
CGARAGE
I CARPORT
0 RETAIN G WALL RENEWAL
F.GKE�L
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CHECKEOBY
TYPE
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NUMBER
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STORIES
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DESCRIBE WORK TO BE DONE
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- INS, PER UBC 108/FINAL
INSPECTION REQ'
VALUATION I FEE
PLAN CHECK FEE
G LOT SLOPE I
BUILDING
C
PLAN CHECK NO' EST5D 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
GRADINGIFILL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
CHARGE
PERMIT APPLICATIoNl,SB0 DAYS
'ER'
PERMIT LIMIT. I YEAR - PROVIDED WORK STARTED WITHIN 1 8D DAYS
EARF'
ENO IEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-'f I F HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SLOCESORS
HAL'-F
ON BEHAL C17Y OF
ENG. INSPECTION FIE
;APPLICANT,
NNTEREET - AG �TNDMNIFy EFEND AYNEE�E.LB HARMLESS 'HE
EES To "
N INTEREST. AGREES TC
FROM ANY AND
LANDSCAPING
S
OFF ,LD
EDMONDS, WASHINGTON IT EMPL. AND AGENTS
E INDIRECTLY
INSPECTION FEE
p OFWHATEVER NATUREARI SING OIRECTLYOR
L _, S C .
AULCt-AIMS FOR DAMAGES LANCE OF THIS PERMIT SHAUL NOT U
ISE
REG IPT
PLAN CHECK DEPOSIT
A OF THIS PER."
R T EEU N
F FROM THE ISSUA CE A "a RENIENT OF ANY CITY ORDINANC
a D M�.T. Mo IFY WAIVED.. ..GE
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DEEMEDTO MODIFY, N
ENFU
N.Ru. TY ORCE ANY ORDI NANCE P ROI
N R IT IN ANY WAY THE CITY'S ABILIT 0
. LIMIT IN Y W YTHEC
TOTAL AMOUNT DL 1;
READ THIS AIR NF' ATION
IPTLI�CATIUN� THAT "R"11E.
APPLIC ION APPROVAL
I HEREBY ACKNGW ANENT OF
GIVEN IS ,,,,,LIDGE THAT I HAVE
T"TA" THE OWNER B AUTH.
Thla PFI-a- 'a a- P-and -" 1,gald by IhO
THE OWNER. I AGRT EAN' G CONSTRUG
ET GoMpLy WITH CITY AND SoTAIE LAWS REGULATIN
ED
CALL
daqOjj,-halhll' owy and Foos allalla, and
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oWORK AUTHORIZED THEREBY. NO PERSON WILL EMPLOY
TON: AND IN DOING THE BE ATMG o
RE, T
FOR INSPECTION
p- a—allag,d,, spac. p—ld—
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN 5 COMPENSATION INSU RANCE AND =.27,
T RE DATE
DAT - NED
(425)
ULdAL2
51&�: A51
5-60
'.ELEASEDBY'
771-0220
EXT1333
ATTATION G OR STRUCTURE UNTIL
IT IS UNLAWFULTO USE OR OCCUPY ABUILDIN
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR AqCERTIFI-
ORIGINAL FILE - YELLOW -INSPECTOR
ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 10
FAX
PINK . OWNER - GOLD -
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
t
Pier/Potch .................
Z'
Retaining Wall ...........
Slab Insulation ..........
M
PLUMBING:
Underground
101
Flough-In ...........
Commercial Final
AN
HEATING:
I Lo -0
GasTest ...........
Gas Piping .................
Equipment .................
Comme rcial Final
mT f 'f:
E)7ERIOR SHEATHING
NAILING ..........................
Fn
fj),
FRAMING ........................
M C'
FIRST FLOOR FRAMING—
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INSULATION ...................
Floor insulation
Z
Wall Insulation ...........
Ceiling insulation
SHEETROCK NAILING
Z
0
SPECIAL INSPECTION
IR
MISCELLANEOUS ..........
FINAL APPROVAL FOR rv%S
I C) -00
OCCUPANCY ..................
1'rA
W� I
7,
1620 PERMIT EXPIRES
IS, PERMIT
CITY OF EDMONDS — NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITIVAIT.
ADDRESSC�J/ 7.
FLAT NAMOSUBDIVISION NO,
LOT NO,
LIO NO,
I
LID FEE S
'AILING ADDRESS
T:Appl-
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
P
;W'41-7
EXISTING — PROPOSE. —
F.,N
CITY
TELE, HONE
L
-779- 0
REQUIRED DEDICATION — FT
METER SIZE
LINE SIZE
NO-011IXTURES
V REQUIRED
NAME
I
I
p
YE 0 NO 0
REMARKS
ADCRESS
NERICONTRACTOR RESPONSIBLE FO�CROSION CONTROUDRAINAGE
CITY� ZIP
ITIIEI..NE
/-,47. mx /a,--
FIRE REVIEWED BY DATE
CITY ZIP
TELEPH ONE
CMA
42:;-77!%-44�L-1
VARIANCE OR CU
SHORELINE OR IDE�
LY,6W�
-
STATE LICENSE NUMBER EXPIRATION -b D BY
D4yo_TpNoqqcm 1-7-01 1W
—
COMPLETE, EXEMPT
'
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
PROPERTY TAX ACC UNTRARC L NO.
AFXF
I
WR
,
LO COVERAGE
7EouTREDSETBACKS(FT)
PROPOSED SETBACKS (Fr.)
NEW PLUMBING I VS.-
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
ADDITION c3 C MPLIANCE OR
CHANGE OF USE
PARKIN EA
PLANNING REVIEWED By DATE
0 REM ODEL SIGN
REG'a I PROVIDED
0 F
GRADING CYGS
C3 REPAIR (ENCE X FTJ
OTH 'R
DEMOLISH TANK OTHER
TANK
c GARAGE RETAINIRNYGWALL
CARPORT HODIKF RENEWAL
CT ,V,T" EX LA IN
dHECKE5BY
ITYPE C NSTRU I C ION
GR.U`PA"�t
NUMBER
'-B R F
E OF
NUMBEIgo
IIICAL
PECIAL INSPECTO
SP"C`
AREA .. ...
OF
STORIES
.WELL N,
IELL,N.
'ITS
UNITS
A REAS
I NUMBER
REQUIRED E] YES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTION$ PER UBC 108/FINAL INSPECTION REO
VALUATION I FEE
PLAN CHECK FEE
LOTS�OPE%-?-
BUILDING
PLAN CHECK NVj__
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
GRADINGIFLL
DOMAIN CURB% SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REGUIFIE
SEPARATE PERMISSION.
CHAR R
PERMIT APPLICATION: 1.0 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INIF DRMATION
la
I HIS OR HER Ep.LSE, HEIRS, ASSIGNS AND SUCCESO.s
ENG. INSPECTION FEE
;.App�,gA.g�oAN.SEHAIFOF
FIEES To INDEMNIFY. DEFEND AND HOLD HARMLESS THE Hy .1
AND
LANDSCAPING
2 EDMONDS. WASHINGTON, IT FICIALS. EMPLOYEES. AND AGENTS FROM ANY
S.,
RECTLY OR INDIRECTLY
INSPECTION FEE
RECEIPT
PERMIT SHALL NOT�jC31E
, ANYCITY oRGINA E
PLAN CHECK DEPOSIT
RDINANCE PROVISION'
RECEIPT
TOTAL AMOUNT DUE
'HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLIC ION APPROVAL
GIVEN I CORRECT. A D THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT 01
S N
T I, pplicati.ii,� .f. P -it ,ltil llg by
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGUI-ATING CONSTRUC
CALL
6�Ij ,�,olbI-W-D.Fu� gdFp.`Td
TION AND,IN 0 ING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE LEMPLoYED
o T
RE AT NG 0
FOR INSPECTION
.c.,I.wI.dg Im
IN VIOLAT ON OF THE LABOR CODE OF THE STATE OF WASHINGTON
OR Ki"EN INSURANCE AND RCW 18,21,
'CoM
_
SIGN TURE DATE
w o
TI
(425)
w AD/111 A�6
'GN UR -NI
t2 E �l
WW
I UW15 - ao
1614,16 11)
e
771-0220
ASED By* DAYE
ATT TION
EXT11333
IT 15 UNLAWFULTO USE OR OCCUPY ABUILDING OR STRUCTURE UNTIL
771-0221
A FINAL NSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE YELLOW- INSPECTOR
CATE OFIOCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
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