20000885.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
IER NAMEMAME OF BUSINESS
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NAME
CITY
PERMIT EXPIRES
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NUMBER gq . L9 0
JOB
ADDRESS
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PI -AT NAMEISUBDIVISION NO.
IDNO,
LID FEE S
PER OFFICIAL STREET MAP
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EXISTING — PROPOSED-
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METER SIZE
LINE SIZE
NO.OFFIXTURES
PRV REQUIRED
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YES 13 NO 0
RE ARKS
CWNFRJCONTRACTOR RESPONSIBLE
'OR EROSION CONTROUDRAINAGC
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ENGINEERING
REVII WEDIDATE
I ADDRESS
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FIRE REVIEWED BY
DATE
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STATE LICENSE NUMBER
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SHORELINE OR ADS. INSPECTI
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SIGN AREA HEIGHT
SEPA REVIEW
COMPLETE EXEMPT
ALLOWED PROPOSED ALLOWED PROPOSED
PROPERTY TAX ACCOUNT
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PARCEL NO.
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EXP
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REQUIRED SETBACKS III PROPOSED SETBACKS (I I
NEW
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ALLOWED PROPOSED
FRONT SIDE REAR IF.- IJR SIDE FEAR
0 ADDITION
COMMERCIAL
ci COMPLIANCE OR
CHANGE OF USE
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-PARKING
LOT ARFAJ PLANNING REVIEWED By DATE
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0 APARTMENT
SIGN
REDO I PROVIDED
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REMARKS
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TANK
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NUMBER
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MBER
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E7YE.
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION FIF
VAILUATiON
FEE
PLAN CHECK IFE
ACE GLAZING I LOT SLOPE I
BUILDING
PLAN CHECK NO: IVETTED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
tl BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUC11ON)OWITHE POOLIC
GRADINGIFILL
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES. ETC. LL RE UIRE
:1 SEPARATE PERMISSION,
SU CHARGE
PERMIT APPLICATION: 180.AYS
PERMIT LIMIT: I YEAR. PROVIDED WORK IS STARTED WITHIN 180DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'AlP HIS O��, HER EPOUS�. NE�.E, ASSIGNS AND SUCCESORS
ENG, INSPECTION FEE
NlIOANTj0A.lEHAllT.0F
IN ' FY. DEFEND AND HOLD HARMLESS THE CITY OF
TER. R E, NQEM
LANDSCAP NG
ANYAND
2 ED'MONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM,,,
INSPECTION FEE
ALL CLAIMS FOR DAMAGESOF WHATEVER NATURE, ARISING DIRECTLY OR IN ECTLY
BE
RECEIPT
FR TH' S PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT
OM THE ISSUANCE OF
PLAN CHECK DEPOSIT
OF
DEE.E.T...D"Y.�A'��',��EDUI:EA�YR�.�l�E.E�T ANY ITYORDINANCE
NOR LIMIT IN ANY WAY THE CITI'S ABILITY TO ENFORCE ANY OPOINA.-
TOTAL AMOUNT DUE
LED�DTT�HAATT READ THIS APPLICATION. THAT THE'NF.FMATI.N
APPLICATION APPROVAL
THEREBY
: A-.AVTE
GIVEN ,S=T, A HE OWNER, OR THE DULY AUTHORIZED AGENT OF
h
THE OWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
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TION;ANDINDOIN THEWORKAUTH RIZED THEREBY, I'D PERSON WILL BE EMPLOYED
0 RELATING TO
OTHE F THE STATE OF WASHINGTON
FOR INSP ECTION nM.�g A, ... P-1—
IN VIOLATION OF CODE 0
COMP SLABOR
WORKMEN S EN ATION INSURANCE AND RCW 16.27.
OFFICIALS I NATURE D E
3,11) DATE S DIED
(425)
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0
DAT
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RELE EDBY
ATTENTON
EXT 333
--------------------------
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTI L
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGtNAL-FILE YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK OWNER GOLD -ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ......... . .........
FOUNDATION:
Footing ......................
Wall..........................
pier/Porch ................. ------
purtaining Wall ...........
Slab Insulation ..........
PLUMBING:
4; Underground .............
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Rough -in - ................. -------
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commercial Final
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HEATING:
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Gas Test ............. ------
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Gas Piping ..................
Equipment
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commercial Final ....... -------
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EXTERIOR SHEAT14ING
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FRAMING ........................
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FIRST FLOOR FRAMING
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INSULATION ...................
Insulation
Floor
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Wall Insulation ...........
Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
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MISCELLANEOUS ..........
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FINAL APPROVAL FOR
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OCCUPANCY ..................
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OWNER NAMEINAME OF SU INESS
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FLAT NAMEISUBDIVISION NO.
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LID NO
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MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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NAME
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PRV R:EOUIIED
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PR_
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fYE C3 :NO 0
ADDRESS
R MARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP
IIAMW
ADDRESS
LA-100
STATE LICENSE NUMBER
-6-1
WAS
IROPERTY TAX ACCOUNT PARCEL NO.
00 4ka N ( o k
C)n a 10 k
figj�PE.I.ENTIAL
I�VFI..WN. I MEC.
0 ADDITION
C] COMMERCIAL
o C MPLIANCE OR
CHANGE OF USE
C] REMODEL
y�RTMENT
SIGN
C] REPAIR
F NCE
0 GRADING CYDS ( X F7)
0'-DEMOUSH
[] TANK
X#R-OjA-
I`AR AD'
CA P.RT
0 RETAINING WALL
ROCK. Bx—
ACTIVITY) EXPI-,MN:
C] RENEWAL
REVIEWEOIDATE
FIRE REVIEWED By
VARIANCE OR CU
SHORELINE OR ADSN
INSPECTION
RM.D
I BOND
POSTEE
0 YES
SEPA REVIEW
SIGN AREA
I I HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWS D PROPOSED
EXP
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LOT COVERAG
REQUIRED SETBACKS JFT,)
PROODSED SETBACKS
ALLOWED PR
FRONT SIDE REAR
FRONT UR SIDE REAZI
I
PARKING
L-Al Z
PLANNNGREVIEWED BY. DATE
REaO I PROVIDED
I I I
CHECKEDBY
JTY���
T3
NUMBER
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EGIALINSPECTOR
SE
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OF
STORIES
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CENTS
AREAS,
R QUIRED
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t�E..AK.KLS
JAREA
oA
DESCRIBE
WORK TO BE DONE
PRnrRFSS INSPECTIONS PER UBC 1081FINAL INSPECTION
,F
VALUATION I - FEE
PLAN CHECK FEE
FIDE GLAZING %
LOT SLOPE %
5 ILDING
PLAN CHECK NO:
P UMBING
MECHANICAL
THIS PERMIT AUTHOFI�ES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
2
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES. ETC.) WILL REQUIRE
1.
SEPARATE PERMISSION.
WAo6SU CHARGE
PE MIT APPLICATION: IN DAYS
I
PERMIT LIMIT. I YEAR PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE. HEIRS� ASSIGNS AND SUCCESORS
CITY OF
WALLC�IMS
ENG. INSPECTION FEE
2
;APPLICANT.
N INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE
EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANYAND
LANDSCAPING
INSPECTION FEE
FOR DAMAGES .1 VVHATE�ER �-�RE,A.����..�R�.T-.�IN.IR�.TL-Y
RECEIPT
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT $HALL NOT BE
PLAN CHECK DEPOSIT
9 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
TO EN FORCE ANY ORDINANCE PRoVISIo"
REC EVIT
0 NOR LIMIT IN ANY WAY THE CITY S ABI LITY
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
(4 'it-
A Ll ATION APIFICIIAL
GIVEN IS CORRECT, AND THAT AM THE OWNER. OR THE DULY AUTHORIZED AGEN r
NEIFL I AGREE TO DIMPLY ITH CITY AND STATE LAWS RE.UI-ATING CONSTRUC
THE oW C W
EMPLOYED
CALL
_,B Dllul 11 .... ... l"*
:1—
T ERSON WILL BE
TION;ANDINDOINGTOEWORKAU HOR12ED THEREBY. NO P
THE STATE OF WASHINGTON RELATING TO
FOR INSPECTIO
—Pp 1. ll� p--
IN VIOLATION OF THE LABOR CODE OF
WORKMEN'S COMPENSATION INSU RANCE AND RCW 1 B.27.
OFFICI��TURE
DA7�?�
(425)
/
=,,%
I
-2
771-0220
FELEAIIED By
EXT 333
ATTENTIdN
-----------
IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
IT
BEEN MADE AND APPROVAL ORJA CERTIF1-
ORIGINAL - 'ILE 111-10W,INIPECTO%�,
A FINAL INSPECTION HAS
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 09
FAX
PINK - OWNER GOLD - ASSESSOR
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