20000865 (2).pdff - -I DATE RECEIVED
I i w iii a -
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ADDRESS
m
ma
[PERMITEXPIRES
USE PERMIT
ZONE
NUMBER
JOB SUITEIAPT#
ADDRESS aL
PLAT NAME�SUBDIVISION NO.
LOT NO,
I. NO.
U. FEE S
PUBLIC FIGHT .1 WAY PER OFFICIAL STREET MAP
P-1:11A.I.I.- 0.
EXIS ING - PROPOSED-
0
0
REQUIRED DEDICATION- FT -
OF
PAY REQUIRED
LIES 0 0
NO 'I
l'EW-lA2KrS.nNTAACTOR RESPONSIBLE FOR EROSION CONTS AINA..
NAME
ENGINEERING
DATE
ADDRESS
FIRE REVIEWED By
DATE
CITY ZIP
TEL HE
fl, qe'unj
VARIANCE OR CU
SHORELINE OR ADS.
INSPECTION
[3YFtSEO'ooND
I BOND
1POST.
STATE LICENSE NUMBER
lin'6% kC_XrJSQn
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED I PROPOSED
HEIGHT
ALLOWED I PROPOSED
4 PROPERTY TAX ACCOUNT PAR El.-
EXP
0 New
RESIDENTIAL
0
LUMBINGIMECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT)
FRONT SIDE BEAR
PROPOSED SETBACKS (FT.)
FRONT Ll SIDE BEAR
ADOITION
CUAfEMODEL
0 COMMERCIAL
C] APARTMENT
0
CWPUANCE OR
CHANGE OF USE
SIGN
REaD I PROVIOED..
FIEVIjE;
.7 DATE
@,,i
C] CAADIN. GYGS
C]
('ENCE X T)
WEMAR-
0 DEMOLISH
C3 TANK
f-1
OTHER
C3 GARAGE FIETAI.M.WALL
CARPORT _C. .. E-1
CHECKEDDY ITYPE OF CONSTRUCTION CODE -0 CUPANT
. _A�Gpoup 0
NUMBER NUMBER OF A��l I IGAI OCCUPANT
DWELLING EAS R SPCE�GIJALEJONSPECTOR JARPEA
.L R LOAD
OF UiR
STORIES UNITS NUMBS BE Uri E 0 YES
DESCRIBE WOAK TO BE DONE B S
SEMA KS
PAi INSPECTIONS PER UBC 108/FINAL INSPECTION
VALUATION I FEE
PLAN CHECK FEE
IS Z IN
LOT SLOPE %
-
HEAT SOURCE
!=VEETIG
BUILDING
PLAN CHECK NO:
PLAN CHECK NO.
DATE
PLUIAS"D
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I. A HER - Y H
IT -T Q. .L T - WORK NN
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONST RUCTIONON THE PUBLIC
BE -NE'o- PRIVATE PROPERTY ONLY- A
GRADINGIPILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETCI WILL REQUIRE
GO A IN ... S' SIDEWALKS, DRIVEWAYS
SEPARATE PERMISSION.
ABATE P.R"
STATE SURCHARGE
P RMIT APPLICATION: 180 DAYS
be
PERMIT UNi I YEAR - PROVIDED WORK IS STARTED WITHIN 18D DAYS
I
ENG, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. INSPECTION FEE
PPL C NTo . L, OF IS OR HER -P-U SIGNS AND SUCCESORS
*a 'APPUCANTTOAN.SEPALF 01 HI: .13 HER SPOUSE, HEIRS. As
IN E E ' AD IN MNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
E
'NTEREB R ES TO NO M I Y .
.T R S FEES To
AND AGENTS FROM ANY AND
LANDSCAP NO
NDI WA "GTo ITS o lICIALS, EMPLOYEES,
' __NGS W RHIN Toid� ITS o"'C' L.
G H ' ' 4T'V'R NATURE. ARISING DIRECTLY 08 INDIRECTLY
A DM CLA'M�o ' DAMAGE 01 WH
L'
INSPECTIONFEE
RECEIPT
F . THE IS UANDE F THIS 'ER.'T ISS GANCE .1 THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
R� GUEA YR 1!
EYE To. G"Y E _ N EQUiREM6NT OF ANY CITY ORDINANC
-E " o WAIVE
R'M'T'N NY W Y ", CITY B A.'UY TO ENFORCE ANY ORDINANCE PROVISION
4
I NO A E
TOTAL AMOUNT DUE
RECEIPT
t'4uq__l
c'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AIPTLICATI�OLNY.; THAT THE INFORMATION
A PLICATION APPROVAL
'E . ZED AGENT .1
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR H
T , app,anan �a a., . p-,d ,l $,gnld by In-
S FIAUT.O�
TH NIG�.IAGRETE M Ly.VTH'CITYANlEliE.TAlINL.AW E.UITIN-I.NSTRUC�
ToWORK 65 EMPLOYED
C ALL
E�' Id,ng offi 111 anUnD, D.puty� and Fads ,, a,,d, and
OHDAN HE A TH. "E.TH Y. F.SON WILL
T E W G, O'N. RELATING 10
FOR INSPECTION
llklo.lDdgud 'a space pnovdied,
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
DATE
WORKMEN'S COMPENSATION INSURANCE AND RCW 18,27.
FFICiALS 51 UBE
SIGNATURE (Ow�llop_�
BE SIGNED
(425)
-'Z&-DD
771-0220
R LEASED.Y DATE
ATTENTION
EXT/333
IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
IT
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
"s
z
9 � `
0
m
3:
c m
m a I
0
0
c
rn
z
C:!
z
0 -n
m M
0
0
o
C co)
r co
M 0
Z
:0 1
z
0
d
0
m
Wall ..........................
Pier/Porch
Retaining Wall ...........
Insulation
Slab
rn
C:
PLUMBING:
M
Underground .............
f
Sough -in ...................
M
M
commercial Final
10
HEATING:
Gas Test ....................
Gas Piping .................
M rn
Equipment .................
cw
0_�
- Fn
Commercial Final
EXTERIOR SHEATHING
M 0
NAILING .....................
FRAMING ........................
FIRST FLOOR FRAMING...
Z,
INSULATION ....................
'Floor Insulation
FP
ID- RECEIVED
[PERMIT
EXPIRES
s ZO
NDS
CITY OF EDMOND
PERMIT
AS 7-
NUMBER oce6s
CONSTRUCTION PERMIT APPLICJATION-
SUITEIAPTN
AO.BDRESS
JrEI�7A�711N 11
PLAT NAMEISUBDIVISION NO.
—NO
LID NO.
Ofvn
Lt. 111. S
MAILINGADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
0.
0�1 11CNll -11
9XIS ING — PRO OSED—
0
_.,H E
CITY ZIP ON
ITIL111IONE
,E
REQUIRED DEDICATION— IT
d SL
METER SIZE
LINE E,Z.
I NO.OFFIXTURES
REQUIRED
NAME r_1 —
I
YEPROV NO 0
Z Z,;
TSLE HONE
95=j 1 z) z,5-- 6-7 2 0
ENCIIN -ERN.
FIRE REVIEWED By
D V " OR C
Y At AN(3E
Ty
NAME
�AA�V,L ENGINEERING
ADDRESS
,sop FIRE REVIEWED BY
C Y TEL NE
IT
VARIANCE OR C
STATE LICENSE NUMBER EXPIRATION DATE CHECKEDBY .
k
0 NEW
0 RESIDENTIAL
LUMBING/MECH
0 ADDITION
0 COMMERCIAL
COMPLIA CE OR
CHANGE OF USE
M-6MO.St.
0 APARTMENT
0 SIGN
GRADING
F
0
W.ffrAIR
CYDS
(ENCE X ITI
0 DEMOLISH
0 TANK
0 ER
oGARAGE
CARPORT
0 RETAINING WALL
RQQKERY
Oa-11-ENEIAL
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
N
I Nut
SEDONE
DATE
___7EPA REVIEW SIGN AREA HEIGHT
I
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
G
EXP
LOT COVERAGE REQUIRED SETBACK$ ) PROPOSSO SETBACKS (F-T.)
A LLOW (FT PONT � R_R
ED PROPOSED FRONT SIDE REAR FRONT UPSIDE FEAR
OT R PLA . V Y DATE
PARKIN. L A EA NNIN R IEW
�HECK_jTYP5 OF CON
EDBY T UCTION ICODE CCII�
ROU
SPECIAL INSPECTOR QCU
REQUIRED 0 YES JAREA O—D
PENA KS
PROGRESS INSPE�TIONS PER UBC 10-8/FINAL INSFM
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE GLAZI
SU LDING
C00
PLAN CHECK NO:
L MIRING
MECHANICAL
AUTHORIZES LY THE WORK NOTED. THIS PERMIT COVERS WORK TO
THIS PIRMIT
BE DONS ON PRIVATE P OPERTY ..- ANY ... STIIUC`RON ON THE PUBLI
ON C
DOMAIN JCURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION,
STATE SURCHARGE
PE MITAPPLICATION: 180DAYS
PERMIT LIMIM I YEAFIRPROVIDED WORK IS STARTED ITHIN 180DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
;APPLICANT.
N INTEREST, AGREES TO �NDSMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPIN
EOMONDS.WASHIN TON TS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
All CLAIMSPORDAIGIA iI01 WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
INSPECTION FEE
RECEIPT
FROM THE ISSUANCEGOEF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
DEEMEOTO MODIFY. WAIVE OR REOU E ANY REQUIREMENTOF ANY CITY ORDINANCE
PROVISION.'
NOR LIMIT IN ANY WAYTHE CITYS ABILITY TO ENFORCE ANYORDINANCE
TOTALAMOUNTOUE
IPT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROV AL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
ThId application to act- -not.201 crop by In,
WITHCITY AND STATE LAWS REGULATING CONSTRUC-
THE OWNER I AGREE TO COMPLY EMP LOYED
PERSON WILL BE
CALL
, pin
Bitilding allow ., wofta, O.pafy:Ia,d F .1 'it. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. No
L
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RE ATING TO
FOR INSPECTION .coipt is aAkn..Iodg.d in Pc- P—Ind
WORKMENS COMPENSATION INSURANCE AND HCW 1827.
FFICIALS S19NATURE DATE
DA E SIGNED
(425)
771-0220
R LEASEOBY
ATTENTION
EXT1333
OR STRUCTURE UNTIL
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
GRANTED. UBC SECTION 109
ORIGINAL - FILE YELLOW - INSPECTO
PINK, OWNER 10�,,ASSEPSOR
CATE OF OCCUPANCY HAS BEEN
51138