20000829.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAMENAME OF BUSINESS I —
CITY — ZIP I TELEPHONE
TELEPHONE
�71TY_ ZIP I TELEPHONE
"O'NT'AL
RESIDENTIAL
0 PLUMBING/MECH
0 ADDITION
COMMERCIAL
0
COMIL ANCI OR
CHANCE OF USE
0 REMODEL
0 APARTMENT
0 SIGN
0 REPAIR
0 GRADING CYDS
0 PENCE
, _ 11 ITI
0 DEMOLISH
0 TANK
o OTHER
GARAGE
0 RETAINING WALL
0 RENEWAL
0 CARPORT
R.,
'KERV
(TYPE OF USE. BUSINESS OR?,TIVETY) EX —IN;
P_
ER OF
LNG .17
CRITICAL
AREAS
:;I—
NUMBER
DESCRIBE WORK TO BE DONE
PERMIT EXPIRES :Llj�
USE PERMIT , ci
ZONE NUMBER 000 o4
SUITEJAPTN
ADDRESS
FLAT NAMEiSUBDIViSIDN NO, I LOT NO- LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP ww;—e als—c
L.. ,hl lh�c
EXIS ING — PROPOSED— call —a
REQUIRED DEDICATION— FT — —a—
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YEPRV lOUIllD
S C3 NO 0
MMARKS
FQN.IBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING
FIRE REVIEWED BY DATE
VARIANCE OR CU
SHORELINE OR AIDE.
INSPE.CTION
,E .
I BOND.
STE
OYES ONO
,EPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
`XP I
I
I
LOT COVERAGE
REQUIRED SETBACKS (FT.j
PROPOSED SETBACKS (IFT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT. URSIDE REAR
PARKING
LOTAREA
VIETY DATE
VIDED
REO'D I PRO 1
JPLAIING
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CHECKED BY TYPEOFC NS7`R TION CO OCCU NT
GROUP z _4
FECAL INSPECTOR AREA OCCUPANT
0 YES
REQUIRED = LOAD
FRSMARKS
'D 5
oan�noqqlmqPrCTIONSPE.U..I..11..AL.INSPECI....E�.. ,
PLAN CHECK FEE
LOT SLOPE %
BUILDING
PLUMBING
ED DATE
MECHANICAL
2
:I
PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
E DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC�) WILL REQUIRE
SEPARATE PERMISSION,
GRADING/FILL
CHARGE
at
A.
PERMIT APPLICATION: 18Q DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 'SO AS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
EN4EVEW FEES
;A PLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
as P
IS N INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
a EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Is ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDMECTU,
OF THt
X FROM THE ISSUANCE OF THIS PERMIT ISSUANCE S PERMIT SHALL HOT BE
DEEMED To MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROYI SION..
se -
ENG, INSPECTION FEE
LANDSCAPING
INSPECI ION FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
t HEREBY ACKNOW EDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORREC' AND THAT I AM T14E OWNER OR THE DU�LY AUTHOTR, 'ZID AGENT 01
T' LAW F GULA , , NETFU
THE OWNER. I AGREE To COMPLY WITH CITY AND STAT E N1 '.
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYE%
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27�
SIGNA'7VR 0 TE SIGPED 1
CALL
FOR INSPECTII
(425)
ATTENTION
771-0220
EXTf333
IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109 FAX
Isms
VALUATION I FEE
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PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing.......... ...........
wait...................
Pier/Porch
Retaining Wall
M,
Stab Insulation ..........
PLUMBING:
-4
Underground .............
M
Rough -in ...................
ma
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comme�clal Final
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to
GasTest .....................
Gas Piping
................
Equipment .................
:.Commercial Final
0 -n
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EXTERIOR SHEATHING
NAILING ......................
FRAMING........................
FIRST FLOOR FRAMING
M
INSULATION ...................
Floorinsulation
Zr
Wall Insulation ...........
Ceiling Insulation
z
SHEETROCK NAILING
0
a
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
C)
OCCUPANCY .............
V/10"
=PERMIT EXPIRES
�1--442
PERMIT
CITY OF EDMONDS NUMBER
SUITFJA T1
CONSTRUCTION PERMIT APPLICATION RES, ---
CITY ZIP
CITY ZIP I TELEPHONE
A—
ARESIDENTIAL
0 PLUMBINGIMECH
0 ADDITION
0 COMMERCIAL
1
COMPLIANCE 01
CHANGEOFUSE
REMODEL
[3 APARTMENT
0 SIGN
n REPAIR
0 GRADING CYDS
ENCE
o F — X
DEMOLISH
TANK'
OTHER
GARAGE
0 RETAINING WALL
RENEWAL
o CAPPO RT
RCXRY
....
ITYPE OF USE, BUSINESS 014;�,TIVITYt EXPLAIN:
R
OF
I NUMBER OF
DWELL NO .19
I
CRITICAL
AREAS
STORIES ig
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
SLOPE %
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PETIMIT COVERS WORK T
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION`
PERMIT APPLICATION; 180 DAYS
PERMIT LIMIT'. I YEAR - PROVIDED WO`IKIS STARTED WITHIN Too DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
;APPLICANT. ON BEHALF 0 HIS OR HER SPOUSE HEIRS, ASSIGNS AND SUCCESOR
N INTEREST, AGREES TO INDEMNIFY EF,,D AyNEoESoLN0.=LE1S 'HE CITY C
Ii ED
,4LD
MONDE. WASHINGTON. ITS OFFIC S, E L. A TS FROM ANY AN
ALLCLAIMSFOR DAMAGES OFWHATEVER NATURE� ARISING DIRECTLYOR INDIRECTLY
PROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT 6
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REOUPSMENTOF ANYCITY ORDINANO
E' - =ION N — - '.
PLAT NAMtSUBD' O._ j
lot"i .—.'9
LOT NO,
LID 140.
LID FEE S
PUBLIC FIGHT OF 'WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED—
REQUIRED DEDICATION— FT
Kw P-15-1-1
.... Us. m.. A.,
Im.— an-aa. a
sul—la, P.1-d 13
cl
STER SZE
LINE SIZE
NO, OF FIXTURES
PRV REQUIRED
YES C3 No 0
REMARKS N TO E
TOR RESPONSIBLE FOR EROSION CONTRO"'A"
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REVEWEMIDATE
ENGINEERING REVIEWEDIDATE
ENG, NES'"N.
Y DATE
FIRE REVIEWED BY DATE
FIRE REVIE SOB
VARIANCE OR CU
VARIANCE OR CU
SHORSUNE OR ADER
INSFFE.G!TI N
'S Q
0 YES 0NO
BOND
POSTED
$EPA R IEW
COMPLETE 9V EXEMPT
-P
E P
FALLOWEDPROPOSED
SIGN AREA
ALLOWED PROPOSED
I HEIGHT
ALLOW D , PROPOSED
I 3E
LOT COVERAGE
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT
FRONT� UPSIDE REAR
PAR
=Vl DATE
REMA K
TYPE I
iMLON
O'CUPANT
'177 COOL, z —,I
SPECIAL INSPECTOR IA—,.
RE.0 EDO YES
OCCUPANT
LOAD sC::�
REMA KS
ROGRESS INSPECTIONS PER UBC 10111FINAL INSPECTION REQ'D
11
VALUATION
FEE
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
0
GRADINGIFILL
URCHARG9
EN REVIEW FEES
S ENG. INSPECTION FEE
F LANDSCAPIN
D INSPECTION FEE
E PLAN CHECK DEPOSIT
E
RECEIPT
NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,
TOTAL AMOUNT DUE
[HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INF RMATION
GIVEN By CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
IS
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
THEW RKAUTHORIZED THEREBY, No PERSON WILL BE EMPLOYED
TION� AND IN DOING 0 THE E
IN VIOLATION OF THE LABOR CODE OF STAT OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
FOR INSPECTII
-St EN
DATE SIG�ED
(425)
aladsaaaa_j
771-0220
ATTENTION I
EXT/333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL 08 A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
FAX
a
APPLICAT
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uing OfjKIgI .1 his. , puty: ad arat .. paid. and q
—.1p, 14 ad 11 Paco pmaVid.d.
JIALS SIGNATVBE_ DATE
ASED By E
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ORIGINAL -FILE VELLO111 A�PIICTOR
PINK -OWNER GOLD - ASSESSOR
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