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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
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PERMIT EXPIRES
USE ERMIT
ZONE NUMBER
866
JOB
ADDRESS -7
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FLAT NAMEISUBDIVISION NO.
LOT NO
LID NO.
LID FEE S
PUBLIC FIGHT OF WAY PER OFFICIAL STREET MAP
TESCP 4pl—d
F. P-11 R-1-
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
REQUIRED
0 No 13
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ENGINEERING
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ADDRES
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FIRE RE IEWEDBY
DATE
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N UMBER
STATE LICENSE NUMBER
611, . o m x I 7D/ t'90 I
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED I PROPOSED
EIGHT
ALLOWED PROPOSED
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ALLOWED
FRONT SIDE REAR
FRONT UP SIDE REAR
0 N
ADDITION COMMERCIAL ci COMPLIA CE OR
I CHANGE OF USE
PARKING
LOT AREA
PLANNING REVIEWED by DAT E
REMODEL C] APARTMENT 0 SIGN
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REaD
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E] FENCE
I (
REPAIR GRADING CYDS ( X _ FT))
REMARKS
DEMOLISH TANK OTHER
ARAGS C] R TAIN RENE VAL
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� TIVITY) EXPLAIN:
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DESCRIBE WORK TO BE DONE
I IC L
AR As SPECIAL INSPECTOF
NUMBER R5OUIREO C] YES
LOAD
PER
VALUATION I FEE
PLAN CHECK FEE
HEAT SOURCE
BUILDING
PLAN CHECK NO:
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
URCHARGE
PERMIT APPLICATI ": 180DAYS
PERMIT LIMIT. I 'AR, PROVIO ED WORK IS STARTED WITHIN 160 DAYS
YE P
Y
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MQRE INFORMATION
or
CKP'
P PLICANT. ON BEHAI F Or HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESCAS
ENG. INSPECTION FEE
;A CITY OF
NTEREST. AGREES TO INDEMNI DEFEND AND HOLD HARMLESS THE
I' ;Y.
I N TE �S T
I
LANDSCAPING
I ED MONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANYAND
1NSPECTION FEE
FORD MA ESOFWHATEVER NATURE. ARISING DMECTLYORINOIRECILY
CLAIMS FOR DAMAGES.'
ALL CLAIMS NOT BE
RECEIPT
b FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL
M T 'SSUA CE -
PLAN CHECK DEPOSIT
EoEMEDTo MODIFY, WA VE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
DE o MOD' IFY WAIVE o' 1-1-1-1
RECEIPT
NOR LIMIT IN ANY WAYTHE CITY'S ABILTY TO ENFORCE ANY ORDINANCE
TOTAL AMOUNT DUE
b;
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVE14 IS CORRECT, AND THAT I AM rHE OWNER. OR THE DULY AUTHORIZED AGENT OF
Th,, ppIt, . p.1 ��Ifl llglld by tha
THE OWNER , I AGREE To CoMPLYWITH CITY AND STATE LAWS REGULATING CONSTRUC -
CALL
B,d, o1j,1 ., 1—r Dly: ld F rl PlId.
TIOM. AND IN DO NG T. E WORK AUTHORIZED THEREBY, No PERSON WILL BE EM PLOYE D
"
INSPECTION .,pli,,.kl,.Iodg.dl�,p,.op,.,dad.
E L
IN VIOLATI ON OF THE LABOR CODE 01 THE STAT OF WASHINGTON RE ATING TO
WORKMEN S COMPENSATION INSURANCE AND PCW 18.27.
FOR
oFFIG SIGNAT DATE
s E NER
DATE S DINED
(425)
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771
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-0220
RELEASED By
ATTENT1014
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-
OBIGINAL-FILE - YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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RECORD OF INSPECTIONS
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INSPECTOR DATE AP PROVED
0 C K
T S
FOUNDATION:
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Wall............... : ..........
PledPorch .................
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Retainlrig Wall ...........
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Slab Insulation ..........
PLUMBING:
Underground .............
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Rough -In ...................
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0
Commercial Final
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HEATING:
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Gas Test ....................
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Gas Piping .................
Equipment .................
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EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ........................
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FIRST FLOOR FRAMING
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INSULATION ...................
Floor Insulation
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Wall Insulation ...........
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Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...........
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:qATE =RECEIVEDO
PERMIT EXPIRES
CITY OF EDMONDS
US' PERMIT
NUMBER
'Aov'!a66-""'
CONSTRUCTION PER
,MIT APPLICATION
JOB
ADDFESS
SUIT1111TI
OWNER NAMEINAME OF BUSINESS
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7—os 7,- AJ, /,u d-e-
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LOT NO.
LID 140.
MAILING ADDRESS / '
LID tEE S
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PUBLIC RIGHT OF WAY PER OFFiCMl STREET MAP
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NAME
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PFV REQUIRED
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YES El NO
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ADDRESS
[REMARKS
WNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAMAGE
I CITY ZIP ITELEPHONE
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FIRE REVIEWED BY DATE
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VARIANCE OR CU
SHORELINE OR ADS.
INSPECTION
REGO
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OSTED
STATE LICENSE NUMBER EXPIRATION DATE D BY
@KED
OYE� ONO
BE. E�IEW
1-1- EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
(�/i' . .6 M.T I I D D 1-2�-o
INCIOINT PARCEL[O.
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EXP
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Ex NEW
RESIDENTIAL PLU BINGIMECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACK$ (F`E)
FRONT SIDE REAR
PROPOSED SETBACKS (F"r)
FRONT UPSIDE REAR.
C] ADDITION
COMMERCIAL
C IUAKCE OR
CHANGE OF USE
LAMMING REVIEWED BY DATE
REMODEL
APARTMENT
SIGN
REC
C] REPAIR
GRADING CYDS
0 1 FENCE X rT)
REMARKS
C) DEMOLISH
n TANK
0 OTHER
o GARAGE
0 R.T/KNING WALL
E] RENEWAL
C ARPORT
P., .
ITYPE OF USE, BUSIEMIVITY) EXPI-AIN:
CHECKE
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GROUP
L
NUMBER
NUMBEROF
DWELLING
CRITIC L
AREAS
SPE.CIA
OCCUPANT .",j
OF
STORIES
UNITS
NUMBER
RE(
LOAD
:L
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPEC TION REO'D
t4w;T
f�_O A A D
VALUATION I FEE "I
PLAN CHECK FEE
L A
HEAT SOURCE LOT SLOPE %
D - N
BUILDING
U 'L
PLAN CHECK NO: ED DATE
M I
PLUMBING
P U
H A
MECHANICAL
L C
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THIS PERMIT AUTHO IZES ONLY THE WORK N.TEI). THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
F
GRADINGIFILL
SEPARATE PERMISSION.
URCHARGE
PEAMITAPPLICATiON! 1.0 DAYS
PERMITLIMr. I YEAR -PROVIDED WORK ISSTAR175DWITHIN IGODAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATIDN
ENG. INSPECTION FEE
;APPLICANT. ON BEHAL F OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESDRS
HOLD HARMLESS THE CITY OF
N NTEREST. AGREES TO INDEMNIFY. DEFEND AND
:E EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES, AMID AGENTS FROM ANYAND
LANDSCAPING
I SP
INSPECTION FEE
ALL CLAIMS FOR DAMAGES OFWHATEVER NATURE, ARISING DIRECTLY OR INDI RECTLY
RECEIPT
FROM THE ISSUANCE OF T IS PERMIT. ISSUANCE OF THIS PERM T SHALL MOT BE
DEEMED TO MODIFY. WAIVE R REDUCE ANY REQUIREMENT OF ANYCITY ORDINANCE
PLAN CHECK DEPOSIT
NOR LIMIT IN ANY WAYTHE Cl Y'S ABILITY TO ENFORCE ANY ORDINANCE IROV SlaN,
RECEIPT
fil
-
TOTALAMOUNTIDUE
o !�7 tAO
I HERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE IN50RMATION
APPLICATION APPRO L
GIVEN 15 CORRECT. AND THAT I AM THE OWNER,
GT.ATHI ULLY LIIHG�,�ED AGENT OF
�AVY
Thi. ppli,iiI6,1 rIt 0 �d"F' 'YA'.`.'�%rd
THE OWNER. I AGREE TO COMPLY WITH CITY AND S TE FE.U' CoNSTRuc-
EEMP
, LOYE
CALL
Bu,fdlrg Offici,l or hl,ih,, DI T.
1) _
TIOWANDIN DING THE WORK AUTHORIZEDTHMREBY� NO PERSON WILL
IN VIOLAT ION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION pt j, p— ,dod.
WO RKM ENS COMPEN SATION INSURANCE AND RCW 18,27.
DATE
DATE SIGNED
(425)
L
eL_ca_') , 4
_ _Z
I I
RELEASED BY
ATTENTION
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-
ORIGINAL -FILE - '.E�L�LOWINSPECTOF
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
BE
_AS ESSo
SS
PINK OWNER - GOLD - ssoR
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