20000852 (2).pdfDATE RE L
I PERMIT EXPIRES 4-0**
USE ER"T
CITY OF EDMONDS ZONE NUMIR .9,OOR5Z
rcONSTRUCTION PERMIT APPLICATION 'A'DOPIES SUITEMPTIt
CITY ZIP
ifSPJ600�/)_Ul 'PLA-cl
6fl. SL41 I-r-- 100
ZIP , JTELEIHOIE _7, f
N -6 7 :5r2_t- loll,
PLAT NAMEISUBDIVISION NO,
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
=11— "
.11 R.qOl,td 0
EXISTING — PROPOSED —
te'_ l I.qd o
S.—O, P-,:iz.
REQUIRED DEDICATION— PT
METER SIZE
LINE SIZ71-77;7URES
PRV REQUIRED
I
YES 0 No 0
�E_MARKS
OWNERtCONTAACTOR RESPONSIBLE FOR EROSION CONTLoUORAINAGE —
tjE-r(_ A/C rr
ENGINEERING REVIEWEDIDATE
EN E-N.
-ow,
WDRESS
f BY T;
I
ZIP
ILEPHONE
SHORELINE OR ADBe
INSPECPON
RED 0
YES , NO
ONI�IG
CST
I'S
STATE LICENSE NUMBER EXPIRATION DATE
CHECKED By
I
SERA R
COMPLETE EXEMPT
EXP
SIGN AREA
ALLOWED PROPOSED
I
HEIGHT
ALLOWED PROPOSED
I -
-ROPERTY X ACCOUNT PARCEL NO
4-544-ClIZ-00i
0 NEW RESIDENTIAL FLII.131N.C.7-
AGE
LOTO
ALLOWED O"PROPOSED
REQUIRED SETBACKS IlTI
FRONT SIDE REAl
PROPOSED SETBACKS FTI
FRONT L,R SIDE HEAR
ADDITION COMMERCIAL n C MIUANCE OR
CHANGE OF USE
PA13KING
LOT AREA
PLANNING REVIEWED By DATE
C& REMODEL 0 APARTMENT SIGN
AEO'D I PROVIDED
0 REPAIR 0 GRACING CYCE FENCE
( X FT)
E.ARIB
C3 DEMOLISH TANK OTHER
ci GARAGE r-1 RETAINING WALL 0 RENEWAL
CARPORT _ ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CA&
CHECKED BY
Ty E OF CONSTRUCTION
04 ,
ICODE I OCCLPANTp
jq2 IG ROU,
NUMBER N MBEROF
ON
OF UWELL No
2
STORIES NITS'
CRITICAL
AREAS ij
NUMBER IIJ /q4
!PE N�PECTOR JASEA
OCCU ANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RED'
PLAN CHECK FEE
'No LOT SLOPE
IN
BUILD G
L
PLA71 ��f JVE.TED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
BE .. E ON PRIVATE PROPERTY ONLY. ANY CONST4UCTION ON THE PUBLIC
GRADINGIFILL
BS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
DOMAIN (CURB
SEPARATE PERMISSIoAL
STATE SURCHARGE
PERMIT APPLICATION: 10 Ay�
ZW��BIIEW
PERMIT LIMIT, I YEAR - PROVIDED WORK IS STARTED WITHIN 18G DAYS
FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ZZPE.TI..
FEE
-APPLICANT, ON BEHALF OF HIS OR HER SPOUSE� HEMS. AEEK3NE AND SUCCESORS
ki
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
ANY AND
2 EDMOND% WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM
OF WHATEVER NATURE, ARISING D RECTLI 11 1 1 -
ALL NOT
IE-1 ISSUANCE .1 THIS I IT SH BE
PLAN CHECK GEIGER
ol-AZ-Y CITY ORDINANCE
ORDINANCE PROVISION,'
TOTAL AMOUNT DUE
HAVE READ THIS APPLICATION: THAT THE INFORMATION
',HBEE'y A-KNo-LEGO.T."AT
,,VBN IS CORRECT AND 1. THE OWNER, OR I.E DULY AUTHORIZED AGENT 01
T HE NE . I A REE T PLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
ION I D ING THE 0 K AUTHORIZED THEREBY, No PERSON WILL BE EMPLOYED
T NGTON RELATING TO
0; WASH[
FOR INSPECTII
IN VI LATI N OF THE LAB R CODE OF THE STATE
OR E E PENSATI N INSURANCE AND RCW 16B7,
S! TURE (OWNER AGEN� AT
qNj
(425)
,
1
771-0220
EXT 333
N
LTO USE OR OCCUPYABUILDING OR STRUCTURE UNTIL
771-0221
A FIN INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI�
HAS BEEN GRANTED. UBC SECTION 109
FAX
CATE F OCCUPANCY
5198
VALUATION I FEE
Th., 1PO111110h 11 - , p,m,t P,,tA Slglad by the
B jd,�q 011,6,1 " h,Vh" Deptey: .d FOOS Sht PiOd. 0,0
-,,pi IS llkllwildgld 1� pace p—ded. I
�T'
T�
0
ORIGINAL -FILE YELLOW -INSPECTOR
PINK - OWNER GOLD - ASSESSOR
z
0 m
c
M
0
80
m
z
0
-n
m m
0
0
6 Fn
C 0)
c cl)
M 0
;a
z
_q
X
co
z
m
I IN
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ..................
wall.........................
Pier/Porch ...........
Retaining Wall ...........
Slab Insulation ..........
PLU MBING:
Underground .............
Rough -In .......... 7,
commercial Final
HEATING:
Gas Test ...................
Gas Piping .................
Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
NAILING
SHEETROCK
INSPECTION
j
SPECIAL
MISCELLANEOUS ..........
FINAL APPROVAL FOR
a
OCCUPANCY ..................
_0
Z
0
-4
C.)
M
1 14,
a M
C a
M 0
-110
0 C
IT! M
Z
C
>
Co
0,11
n LD
j
m In
0 f—
C
mo�
Z
z
till
Z.
0
0
M
I m
ATE RECEIVED
q PERMIT EXARES -
PERMIT
ZONE NUMBER �Z 0 OSS2,
CITY OF EDMONDS
JOB SUITFJAPT.
APPLICATION
CONSTRUCTION PERMIT ADDRESS/
Z L )l)
Ss
OWNER NAMI�AMI 01 'U"ll PLAT NAMEISILWDIVISK)N NO. NO,
-r,-Itj 6-s peivne-s...
ra.?
'�O
MAILING AWRL i-P AF-` D
W " r 0
PUBLIC RIGHT OF WAY PER OFFICI L STREET MAP P-1
cU6u--(5olj A W1 U.. PK R��d 0
0
0
EXISTING - PROPOSED 0
ZIP TELEPHONE a
FT W'g
/114 RE.UIRED DEDICATION -.,11110
q gl 711 Zt)( , ----------
, .U,._
METER SIZE N, 0, ,XTU,,,, PRY REQUIRED
NAME YES 13 NO
0
5 PL(- C
REMARKS
ADDRESS OWNERIGONTRACTOR RESPONSIBLE FOR EROSION CONTROILDRAINAGE_
A sr sc4or— io&
0
CITY ZIP T54P�HO �NE
> 6f
'PAIL
I NAME
o"k- ENGINEERING REVIEWEDIDATE
ADDRESS
F1 R Y
z
C ZIP TELEPHON I
CITY 10
01
0
SHORELINE 08 ADS. INSPE�1-101 BOND
POST ED
G /A.IANCE
CHE KE B
oYREQ'D
STATE LICENSE NUMBER
SS ONO
R(U
SEPA REVIEW AREA HEIGHT
COMPLETE IXE ALLOWED PROPOSED ALLOWED PROPOSED
PROPEaY TUCOUNT PARCEL NO.
7 ,
EXP I
55 � i
om
co
m
IFT, B.I.SEDSET.ACKSIll
LOTCOVERAIE REQUIRED SETBACKS I
0 NEW 0 RESIDENTIAL ILUNI.M.I(ED ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
OR
0
COMMERCIAL C] COMPLIANCE
ADDITION CHANGE OF USE
c:
PARKING AREA -;N N&.EtAy DATE
REQ� D PFXjLOT
MAEMODEL APARTMENT SIGN K 7, �P
I
m
0 REPAIR 0 GRADING CYDS FENCE X FT) REMAH11
I_
DEMOLISH 0 TANK 0 OTHER
GARAGE
ORT BOC ENEWAL
CARP 0 BET WALL 0 R
o -n
n
0 .1 OR ACTIVITY) EXPlIN!
CHECKED 8 OF CONSTRUCTION
Y -'eA
CRITICAL
M M
NUMBER NUMBER OF
SPECIALEINSPECTOR JAIIA
OF GWIL IN. AREAS EOU R
STORIES UNITS' NUMBER R YES
a 5
0
0
DESCRIBE WORK TO BE DONE
r-
A
REMARKS
PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION REO'D
co
M C)
tjv I Mo-J A-0 r-) I I 12., J C-)
z
VALUATION
FEE
PLAN CHECK FEE
'HECK FIE
BUILDING
TAT SOURCE .-IIN. T"'. BUILDING �ka 0
m
PGRADINGIFILL
PLA�� JVIITIO DATE PLU.-N.
MECHANICAL
N N,
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
ION ON THE ��.L' ,..'FLL
L BE DONE ON PRIVATE PROPERTY ONLY. ANY CONrTBUCTIll O.N,T PUBLIC
2 DOMAIN (CURBS. SIDEWALKS. DRIVEWAYS, MARQUEES, ETC., L, R .. IFIE
SEPARATE PERMISSION.
STATE SURCHARGE 4/�
PE MIT APPUCATION: 1.0 DAYS
HIN ISO DAYS I.S
A. PERMIT LIMIT.- 1 YEAR. PRO IDED WORK IS STARTED WIT
SEE BACK OF PINk;RMIT FOR MORE INFORMATION
PLICANT, ON LF 0 HIS OR HER SPOUSE� HEIRS, ASSIGNS AND SUCCESORS
;A :ND MNIFY. DEFEND AND HOLD HARMLESS THE CITY OF LANDSO"M I-"/
N I TEREST, ACRE S
FROM ANY AND
AS"NGTON, TS OFFICIALS, EMPLOYEES, AND AGENTS I"qPecTtaN+EE Ll -1
S-MONDSSW �711IPT
ALLCM I.R.A.A.ES.IWITATEIISSIN URE. ARISING DIRECTLYOR INDIRECTLY
NOT BE
x FROM THE ISSUA CE OF THIS PERMIT. SSUANCE OF THIS PERMIT SHALL PLAN CHECK DEPOSIT
MODIFY, WAIVE OR REDUCEANY REOU tREMENTOF ANYCITY ORDiNA.0
9 DEEMED To
IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- RECEIPT
NOR LIMIT
TOTAL AMOUNT DUE
I HEREBY ACKNOWL DOE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT. AND TH I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF Th-pk.".. i. -I . P-a uo' �i' I t,y-
R
AD E LYWITHCI YANDSTATELAWS EGULATINGCONSTRUC- CALL olf,,f,l 11 hil/hIl DOPUIY: a-d F ... .. P d-d
I A BEE
ER I RE To COMP T
N
TH 0 NE .
'OW 'ORZED I
TIHOEN AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
UT'
' RELATING TO FOR INSPECTION d.
CODE OF THE STATE OF WASHINGTON
I V CL . OF T CO T
N VI LATIS N F THE LABOR UP /0,/DATE
BKMEN'. COMPENSATION INSURANCE AND RCW 18.27, OFFCI
(425) 0
6�
S14N URE(OWNER GENT
Ir
�90 771-0220 RE
— EXT 333 o/,,-,o oz)
-T
10
ON lz�
T rI'UL
TT W TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
'U W
YELL INSPECTOR
A IINANSIECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI ORIGINAL FILE OW
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER - COLD - ASSESSOR