20000867.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PLAT NAMEISUBDIVISION NO I LOT NO* L D NO -
LID FEE S
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REMARKS
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FIRE FEW ED By DATE
CITY
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REMARKS
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRAD,�., I
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YS
� PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG, R EW FEES
SEE BACK OF PINK RE RMIT FOR MORE INFORMATION
ON B5HAL' OF HIS OR HER SPOUSE� HEIRS, ASSIGNS AN. SUCCESORS
ENG. INSPECTION FEE
;APPLICANT.
u N NTEREST. AGREES TO :ND MNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
'OFFICIALS, FROM ANYAND
LANDSCAPING
E EDMONDS. WASHINGTON. TS EMPLOYEES. AND AGENTS
AULCLAIMSFOR DAMAGESOIWHATEVER,NATURE, ARISING DIRECTLYOR INDIRECTLY
INSPECTION FEE
CE OF THIS PERMIT SSLIA�CE THIS PERM T SHALL NOT BE
ROM THEISSUAN OF 'CITY
ILAN CHECK DEPOSIT
Fy WAIVE OR REDUCE ANY REQUIREMENT OF ANY ORDINANCE
DEEMEDTO Mool ON'
TO EN FORCE ANY ORDINANCE PROVIS10-
RE E T
R
NOR LIMIT IN ANY WAY THE CITIS ABILITY
TOTAL AMOUNT DUE
A
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATI N
oF
PPLICATION
APPROVAL
GIVEN T, AND THAI I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
IS CGRAEC
�AT'o
Thl, IPPIIlltlll 1�
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING COI,ISTRUC-
EMPLOYED
CALL
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TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE
I
WASHINGTON RELATING TO
-1- -0 R INSPECTION
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IN VIOLATION OF THE LABOR C ODE OF THE STATE OF
WORKMENS COMPENSATION INSURANCE AND ROW 18,27.
or �1_4S �IGNAIJ DATE
ol c'�L�-
SIGN::"",9WNETT`D
(425)
771-0220
ELE�A;1.�. BY
EXT)333
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING 08 STRUCTURE UNTIL
INSPECTION HAS BEEN MADE AND APPROVAL OR A rERTIFI-
771-0221
�
ORIGINAL - FILE - YELLOW - ll�P.CTCIR
A FINAL
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER - GOLD, ASSESSOR
S,98
N
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACK$ .....................
FOUNDATION:
Footing......................
wall ..........................
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EXTERIOR SHEATHING
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NAILING ........... ..........
0
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FRAMING .............
FIRST FLOOR FRAMING...
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INSULATION ..............
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Floor Insulation
Wall Insulation
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Coiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FO R
OCCUPANCY ....... ... iffis
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7,
fATE RECEIVED ERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER
,UITS/AlT*
CONSTRUCTION PERMIT APPLICATION 'AOBORESS .2,:;13 HcvX ffOA W 11
OWNER NAMENAME OF BU INESS
'r PLAT NAMEISUBDIVISION NO. I LOT LID NO.
Tbf t1v No
LID FEE S
A,
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0
CITY ITIL NE EXISTING — PROPOSED— 0
ZIP
PA. ?��4 36zl7q3 PRV REQUIRED
NAME 7 7177-VT 6e-f- YES 0 NO 0
REMARKS
ADDRESS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP TELEPHONE
NAME
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IF ADDRESS
0 A \z
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CITY
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STATE LICENSE NUMB R l'-tilt-I nNO
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TW 14 SEPA REVIEW SIGN AREA HEIGHT
EXEMPT ALL ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE 11011,
-4
Exp I �5 1 /4_ i
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m
LOT COVERAGE REOUIRED SETBACKS IT PROPOSED SET ACKSiM,
C3 FLUMBINGIMECH ALL E N F
NEW OWED PROPOSED FRONT SIDE REAR FRONT UP SID
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INSPECTIONS PER USO JOBIFINAL INSPECTION REO'D
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VESTED DATE
1AN Cl N
MSCHAVICAI.�, I,
kRK TO
THIS PERMIT AUTHORIZES ONLY THE ORKNOTEO. THIS PERMIT C64ERS kRK TO
W
t:I
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADINGift
FTC.) WILL FlpU RE
7,
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS , MARQUEES,
SEPARATE PERMISSION. IT Il'A'.P
PERMIT APPLICATION; 180 DAYS WITHIN ,,BdAYS�
PERMIT LIMIT: 1 YEAR � PROVIDED WORK IS STARTED
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG.R IEWIFEES
RILA "11.11 AIII.UICEIYlll I
ON BEHALF OF HIS OR HER SPOUSE. HI �'H. 'HAR
I �G. INSPECTION FEE
;APPLICANT.
w DEFEND A , L. CIT OF
, N INTEREST, AGREES TO INDEMNIFY. NoiS, Y
FROM ANY AND
ANDICANNG
'N
MOND$. WASHINGTON, ITS OFFICIALE, AND AGENTS
I ED . EMPLOYE
1. ALLCLAIMSFOR AMAGESOFWHATEVEf3NATURE�ARIStN(��,��--�l-l�-11�--l-�
'T'O 'BE
I N
SPEC
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FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
CE
PLAN CHECKDEPOSIT
0 EMED TO MODIFY. WAIVE 0 REDUCE ANY REOUIREMENTOF ANY CITY QROIWAN
E PROVISION.
ANY
NOR LIMIT IN ANY WAY THE CITI'S ABILITY TO ENFORCE 99DINANCE
TOTAL AMOUNT DUE
HIT
I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION; T THE N�F�AIR ATION
%�T
6'�'
."
GIVEN IS CORRECT AND THAT AM THE OWNER, OR THE DULY AUTH OF
�
LIC
STATE LAW S REGULATING CONST!l -
N -CA L L
TO a LY WITH CITY AND
THE OWNER. I AGREE C NIP No, ,
THE WORK AUTHORIZED THEREBY, EPSON WILL BE BMPLO,' ED
710N� AND IN DOING
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTJP
INSURANCE AND RCW 18-21
ATE S71ED
(425)
771-0220
EXT)333
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 OFIOCCUPANCY HAS BEEN GRANTED, USC SECTION 109
FAX
5ma
AIiPj_IC,ATION APPROVAL
A,— by II,.
�'d F... .1. l.kL
p—ld.d.
IkIAL6 SIGNATURE DATE
EASED By 6ATE
ORIGINAL -FILE YELIGIN"ISIECT&
PINK -OWNER GOLD - ASSESSOR