20000857.pdfF_
_PERMIT
li .1 -01
EXPIRES
CITY OF EDMONDS
USE -2 PERMIT
�..E — NUMBE
CONSTRUCTION PERMIT APPLICATION
JOB SUITM
ADDRESS
ul-12-
;NEH:71NAM
i�OF BUSINESS
C
FLAT NAMEISUSDIVISION NO,
LID NO.
LID FEE E
M ILINGADDRE S
PUBLIC RIGHT 01 WAY PER OFFICIAL STREET "A'
"' " " , 0
0
11 0
XISTING— PROPOSED�
CITY Zip TELEPHONE
0-5
7 75 -1
REQUIRED DEDICATION— FT
0
IETEA SIZE
LINE VIE
10. Ol FIXTURES
P V REQUIRED
N ME
Y ES NO
ADDRESS
EMARKS
EROSION CONTROI-10FAINAGE
CITY
NAME
NGINEERING —Y—EDIDATE
0
ADDRESS
FIRE REVIEWED By DATE
CITY
0
VARIANCE OR CU SHORELINE OR ADBII
INSPECTION
BOND
STATE LICENSE NUMBER
RE
0 YES 0
Y S
TED
POSTED
SERA REVIEW SIGN AREA
COMPLETE EXEMPT ALLOWED PROPOSED
HEIGHT
#ALLOWEDPROPOSED
PROPERTY TAX ACCOUN[dTARCEL NO.
/027- q3 -116 - 00
X NEW
RESIDENTIAL
V
0 PLUMBINGIMECH
LOT COVERAGE REQUIRED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR,
P . BE FT)
PROPOSED SETBACKS (FT)
S
FRONT UPSIDE REAR
1.
IPLANCE OR
1
20 11) 2,s
_Y_�l
C3 ADDITION
C3 COMMERCIAL
XO
COHANGEOFUSE
PAR""
L)lAl
TJTV�R VI7Dr
I DATE
E] REMODEL
APARTMENT
cl SIGN
REQ'D
.3
PROVIDED
I
CIO,
C] FENCE
Cl REPAIR 0 GRADING CYDS ( — X FT)
AV,
DEMOLISH TANK c3 OTHER
o GARAGE C] RETAININLG WALL C3 RENEWAL
CARPORT g
BUSINESS OQCTIVITY) EXPLAIN:
_rPE
C, ou
(VPE OF USE.
61 C 0 VIV E-1 IV 2 "1/-
q, ,
CHECIKEDBY
OF CONST UCTION
DURAN
UP
q GRCU
t� NUMBER
DWELLING
A
P EA
SPECIAL INSPECTOR
OCCUPANT
LOAD
OF U
STORIES '9
L I. E
B:R:
REOLIPED cl YES
DESCRIBE WORK TO BE DONE
E.,
IFMARKS
PER UBC 108fFINAL INSPECTION REQ'D
0
A AT..LF.E GLAZING I
LOT SLOPE I
ft
LAN CHE K NO:
_L4��n
v", U,
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
IT USLIC
BE DONE ON PRIVATE PROPERTY 0 LY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC,I WILL REQUIRE
m
SEPARATE PERMISSION.
PE MIT APPLICATION: 180 PAYS
ARR PROVIDED ORK STARTED WITHIN 160 DAYS
PERMIT LIMIT. I YE IS
M
SEE BA K OF INK PERMIT FOR ORE INFORMATION
0
ON BEHALF F HI S OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
;APPLICANT,
INDE Fy. DEFEND AND HOLD HARMLESS THE CITY OF
N INTEREST. AGREES TO MNI
I
2
NO , A NO N ITS OFFICIALS. EMPLOYEES. AND A ENTSFROM ANYAND
SOMO 5 W SHI To
C.
IMS 0 MAG B OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
ALL CLA F RDA E
NOI BE
I
FROM THEISSUANCE OF THIS P ERMIT ISSUANCE OF THIS PERMIT SHALL
CITY CRON
LCEANY R'OUIREMENT OF ANY
OVIANCE
P To MODI Y I
U EEME F WA VE OR ED
IF SIOW'
ITY 0
N R NAN E T ENFORCE ANY ORDINANCE
0 LIMIT I YW YTH CITY S ASIL
IHEREOY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
AND THAT' AM TH' 0 WNER, OR THE DULY AUTHORIZED AGENT 01
GIVEN JE
CORRECT
C�
THEOW'l- IA -IRE T----ILYW'TH TY AND STATE LAWS REGULATING CONSTRUC
E
I ION. AND � DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
RE LAT, NG TO
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN'S COMPENSATION INSURANCE AND RCW 113,27.
AGENT)
DATE SIG ED
.AN CHECK FEE
UILDI.
LUMBING
ECHANICAL
ENG. REViEW FEES
ENG. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
CALL
FOR INSPECTII
(425)
771-0220
rA 1 000
AFE-NTION
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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX
VALUATION I FEE
APPLICATION APPROVAL
T — . F�l .."I �, �l -
..,Iy: �ld F... — PlId.
I NOW -1 w1l", il"l- � I
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
z
0
m
M Q
0
80
c
A m
z
c
o -n
In
Im m
0 r_
0 m
0
fm
M 0
Z
z
ri)
z
9
0
m
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
iN�
Wall..........................
z
0
Pier/Porch .................
6
Retaining Wall ...........
Slab Insulation ..........
ca
PLUMBING:
0,
T,
i r
Unclerground .............
0
Rough -In ...................
Commercial Final
M
M Z,
HEATING:
>
Gas*Test ....................
Gas Piping .................
Equipment
.................
rn M
Commercial Final
0
Fn
EXTERIOR SHEATHING
C 0)
NAILING ........... . .............
V)
ITIO
FRAMING .........................
z
74
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Co
z
Ceiling Insulation
0
j SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
60000"
ATE RE��j Ir "k
MIT EXPIRES
oc)
PERMIT
CITY OF EDMONDS ZONE 2- NUMBER AooFZ7
CONSTRUCTION PERMIT APPLICATION J.. SUITM
ADDRESS OcP-A
",-Q
OWNER NAMEINAME OF BUSINESS
LID NO.
LID FEE S
M ILING ADDRESS TEIC ""' 0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP P= �-
U.. P� R�l d [03
EXISTING — PROPOSE.— cl
0
CITY ZIP ITELEPHONE
7 75- 7 Z I REOUIRED DEDICATION— FT — U=." 0
- METERSIZE LINE SIZE NO, 01 MIXTURES PRV EQUIlEO
NAME YES 0 Nox
I
REMARKS
I: ADDRESS OWNER/CONTRACTOR RESPONSIBLE F09 EROSION CONT�ROLJORAINAGIE
AGREES
CITY
NAME
ENGINEERING
ADDRESS
FIR REVIEWEDBY DATE
CITY ZIP TEL�PHONE
0
z
STATE LICENSE NUMBER NO
DYES �HIGITTI
0
SEPA REVIEW SIGN AREA G OPOSED
PROPERTY TAX ACCOUNFARCELNO�f COMPLETE I EXEMPT ALLOWED PROPOSED
/e27- /71 �5 00 EXP
X
m
I=
f,
0
0
C
LOT COVERAGE REQUIRED SETBACKS (M. PROPOSED SETBACKS (FT)
R151DENTIAL PLUMBINGIMECH ALLOWED PROPOSED FRONT SIDE FEAR, FRONT LjFEIGE FEAR
NEW X. MPUAI,I.E OR 101 �-rs -y'
AUDITION COMMERCIAL CO 2ry
HANGE OF USE DATE
PA- KING LOT 771'f%NG�Vl%'�&Y
C] REMODEL APARTMENT j SIGN 11�2*D' PROVIDED
P-23
I �
FENCE r 1 0 1
13 X FTI H—
FAIR o GRA,.IN. , Cyos ?,5FSfp-- 'boo -Woo - I
n OTHER
CEMGL'SH TANK
M
AT
GARAGE RETAININYG WALL C] RENEWAL
C3 CARPORT ROCKERY
5
0
-n
m M
0 vi
0 -
0 r
C CM
0
;CE OF USE. BUSINES OXlf';)4E>XZ; 41n;,L
NS��
'CUPA
'OU2T
NUMBER .2
OF
0 STORIES
N BER 01
DUIME LING
CRITICAL
AREAS
NUMBER EOUIRED C3 YES ..
A P.A
DESCRIBE WORK TO BE DONE
REMARKS.
PROGRESS INSPECTIONS PER UBC 101URNAL INSPECTION REO'D
It lcg-� Lc�a /vl
m o
M
z
--I
VALUATION
PLAN CHECK FEE
z
0
AT SOURCE GLAZING I
LOT SLOPE I BUILDING
-j
0
jVE5TEO 'AT' PLUMBING
m
PLAN CHR !�-
!�'--ntn
MECIAWCAL
THIS PERMIT AUTHORkims-ONLY THE WORK NOTED T i PERMIT COVERS WORK70
BE DONE ON PRIVATE PROPERTY ONLY. AN CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS. SIDEWALKS. DRIVEWAYS , MARQUEES, ETC.1 WILL REQUIRE
:J SEPARATE PERMISSION.
SURCHARGE
P" MIT APPLICATION;, 189 DAYS
W
PERMIT LIMIM I YEAR - PROVIDED ORK S STARTED WITHIN 180 DAYS ENG. REViEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
p -
END INSPECTION FEE
0 'APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS. AS I NSANOSUCCESORS
TO INDEMNIFYDEFEND AND HOLD HAR LESS THE CITY OF LANDSCAPING
!q IN INTEREST.
I EDMONDS. WASHINGTON. ITSOFFICIALS. EMPLOYEES. AND AGENTS FROM ANYANO
INSPECTION FEE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDiRED.
OF THIS PERMIT� ISSUA CE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
E SSUANCE
`TG IVEORREDU
EMilQM MCI Fy CEA YAEOUIREMENI - ROVISION."
PROVISION.
0 NOR LIMIT IN ANYWAY THE CITY'S AS LITY TO ENFORCE ANY ORDINANCE
TOTAL AMOUNT DUE
REC
HHEREB ACKNOWLEDGE THAT I HAVE lEAC, THIS APPLICATION; THAT THE N1 F.ATI.N
APPLICATION APPROVAL
GIVEN IS CORRECr. AND THAT I AM THE OWNER OR THE DULY AUTHORIZED AGENT OF
Th" p,,,,t by the
6 ATE LAWS REGULATING CONSTRUC-
THE OWNER. I AGREE TO COMPLY WITH CITY. ST
BE EMPLOYED
CALL
BUlI,Llg 011l.ial 11 D.p,ty: nd F- - p,,d. -d
TICM� AND IN DOINGT E WORK AUTHORIZED THEREBY. NO PERSON WILL
IT
E RELATING TO
LABOR CODE OF THE STATE OF WASHINGTON
FOR INSPECTION
d,n p- P-d-
IN VIOLATION OF TH
WORKMEN'S COMPEN ATION INSURANCE AND RCW 18.27.
1
(425)
StQ ATURE, D
�A AGE17)
DATE SIGNED
FAB B DIE
�771-0220
EXT 333
R �9
AtTtNTION
IT IS UNLAWFUL TO USE OR O.UPI A BUILDING OR STRUCTURE UNTI
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIF -
01IGINAl - FILE YELLOW INSPECT.
PiNK - OWNER GOLD _ ASSESS.R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX