20000949.pdfDATE RECEIVED
FPEFIMIT EXPIRES
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"E PERMIT 24T"
CITY OF EDMONDS Z.HE QS_ 2— NUMBER — —
JOB SURVAPT.
CONSTRUCTION PERMIT APPLICATION ADDRESS A—ItAi
OWNER NMI-:;�Z �Sl PILAT NAMEISUBDIVIStON NO. I LOT 10. 11, NO,
LID FEE
MAILING ADDRESS TESC1 Appl.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW — .
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EXIST NO — PROPOSED —
ITY ZIP JTE1_EP"111
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METER SIZE I LINE SIZE I NO, 11 FIXTURES V R70UIREO
NAME YE'."3 NO 13
REMARKS
ADDRESS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY
NAME
ENGINEERING—
--WEVIEWEDIDATE
ADDRESS
REVIEWED By DATE
FIRE
CITY
VARIANCE OR CU
SHORELINE OR ADEN
INSPECTION
OYRE 'D
ESO[3 NO
BOND
IPOSTED
STATE LICENSE NUMBER
SERA REVIEW
EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE
370 o no4tnooq — EXP
0 NEW CRI RESIDENTIAL 0 PLUMBING I IVEC- ALL
LOT COVERAGE
OW ED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (IT.)
FRONT UR SIDE REAR
C3 ADDITION COMMERCIAL ci COMPLIANCE OR
CHANGE OF USE
REMODEL C] APARTMENT SIGN REOD
PARKING LOT
I PROVIDED
AREA
PLANNING REVIEWED By DATE
[] GRADING FENCE REMAHKS
REPAIR CYDS cl I _ X FT)
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RETAINING WALL
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ITICAL
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EMARKS
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PLAN CHECK NO:
11ESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PEAMIT COVERS WORK TO
N "OIEIT' ONLY, ANY CONSTRUCTION ON THE PUBLIC
DONE 0 P.RIVATE
B P
A , BID . IF V EWAYS MARQUEES. ETC.) WILL REGUIRE
CIE AIN (C U EINAL �T
BE RA E PERMISSION
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. 1 YEAR. PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
SS
"E' ORMEASP.LSE..EIR5,A ONSANDSUCCESCRS
;APP"�C�AE�T�.OAN.DEEHALTF.OF
N HT A E. ,,. MNIFY, DEFEND AND HOLD HARM LESS THE CITY OF
AND AGENTS FROM ANYAND
2 EDMONDS WAIIII GTON, ITS OFFICIALS. EMPLOYEES�
A WHATEVER NATURE, AIIIING DIRECTLY 0 1 INDIRECTLY
LL CLAIMS FOR DAMAGES OF
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PER.IT,SHALL NOT BE
OF ANY C TY ORDINANCE
DEEMEDTO MO0IFy4yWTAHjVEG0Ay�SEABICE ANY REQUIREMENT
UTY TO ENFORCE ANY ORDINANCE PROVISION,
NOR LIMIT IN ANY W E IT
I HEREBY ACKNOWLEDGE THAT I HAV E READ THIS AP ILIC�ATIULNY 'HAT THE N.FORMA' ON
AUTHOA,, AGENT OF
GIVEN IS COAREC CRT G
T,AN' THAT' A" THE OWNER S EGU"TING C NS RUC
CITY AN6 STATE LAW A 0 T
THE OWNER. I AGREE TO COMPLY WITH
0 EPSON WILL BE EMPLOYED
TION; AND IN DOING THE WORK AUJHORIZEU THERE BY N 'ASH
IN VIOLATION OF THE LABOR ODE OF THE STATE OF W INGTON RELATING To
WORKMEN S COMPENSATION INCURANCE AND RCW 18.27.
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DATE 51—t.
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PLUMBING
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PLAN CHECK DEPOSIT
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TOTAL AMOUNT DUE
RECE P
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CALL
FOR INSPECTION
(425)
771-0220
APP ICATION APPROVAL
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OFFICIALS SIGNATURE DATE
LEASED B DATE
ATTENTION E A 11333 . -12 �
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 YELLOW - INSPECTOR
A FINAL Ns PE CTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE
CATE OFIOCCUPANCY HAS BEEN GRANTED. LED SECTION 109 FAX PINK � OWNER GOLD - ASSESSOR
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MARrOB-1999 04:5S CITY OF EDMONDS 4257710221 P.05.�06
FLUE, CHRVINEY AND EQUIPMENT INSPECTION
CHECKLIST
Each you before a stave or fireplaris is put into service the chimney flue should be throughly cleaned of
soot and other residues- Prior to installation Ofa solid fuel burning appliance in an existing masonry
chimney, the fbilowing items must be i0pected by the owner or professional chimney sweeper. This
ub
form must be completed and.s mined to the Building Division with the permit application
1. CEmqm LINING:
Is the chimney lined with fire I fl tile, firebrick or other approved lking?
79-up
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No
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Is the lining in good condition? No voids, craclo or deterioration?
r0i,
NO
2. CLEARANCE To COMBUSTIBLES:
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Are all combustible materials, i.e., wood framing members, a minimum Of I" away from the
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chimney walls?
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NO
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3. GENERAL CONDMONS:
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Is the exterior masonry m good condition, free oforacked of broken liners, rotten mortarjoints
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or structural defects?
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NO
4. EQUIPIVIENT:
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Have you read the manufacturers instructions fbr the equipment instWlafion and is the existing
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chimney compatible for instaHo'
0
No
I hereby acknowledge that I have read these inspection requirements; have personally impacted the
chimney; that the information given is true and
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accurate; that T am the owner or the duly authorized
agent ofthe owner.
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Signat-
DATE /I/
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CIMVINEY SAFETY:
65
Please observe the following warnings in order to install and use solid fuel burning equipment.
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I - Use all appliances in the Precise manner described and tested by the manufacturer.
2. Follow listing instructions for clearances to combustibles.
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3. Inspect chirrmay flues and Wlianceswarly for needed repairs.
4. If creosote accumulates in the flue and starts to bum call 911 irnmediately.
S. Keep
an extinguisher on hand and make sure all yoursmoke detectors work.
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WMTVEH0.1)CCJW11/94
MICROFILM
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
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Pier/Porch .................
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Retaining Wall ...........
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Slab Insulatlon ..........
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Underground .............
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Rough -in ...................
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Commercial Final
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HEATING:
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Gas Test .............
Gas Piping .................
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Equipment ..................
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Commercial Final
0
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NAILING ..........................
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FRAMING ........................
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FIRST FLOOR FRAMING
INSULATION ...................
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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
MISCELLANEOUS ..........
F14AL APPROVAL FOR
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OCCUPANCY ..................
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7_ 7,
DATE RECEIVED
? FpERMN EXPIAES
00
PERMIT
ZONE NUMBER
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APTe
ADDRESS
OWNER N MEINAME OF BUSINESS PLAT NAMFISUBDIVISICN NO LOT N�7—ss., LID NO.
oeel U FEES
I MAILING ADDRESS TEICP
jPUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP P.
po, &Y % 3 __
C =IS q.1- 0
EXISTING �`FFOPOSED— . El
zip
CITY ITELEP"INE U--s
U),4 4*L,5*)_711 0
Lqnnwood REQUIRIDDEDICATION— FT -
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METER SIZE LINE SIZE NO, OF FIXTURES PRVREQUIRED
NAME Y SO NO 0
ADDRESS REMARKS MFCEM61ON CPtd. MIQRAWVJ"W�
in
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CITY ZIP %A7 %vigil. 1W.W11 Fw
NAME
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ADDRESS
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VARIANCE OR CU OBT
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DION JPBON�D.
—E LICENSE NUMBER REO
S
OY ONO
SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
PROPERTY TAX ACCOUN PARCEL NO.
I
0 m
c
370oo,3004Mg90 9 EXP
M 0
fFT PROPOSED SETBACKS (FT)
LOT COVERAGE REQUIRED SETBACKS I
SIDE REAR
0
0
8
NEW 0 PLUMBING I MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UP
0 1
1.
c
��FESMENTIAL,
IANOE R
C MPL 0
PAR ING LOT AREA PLANNIZ REVIEWED By DATE
C3 ADDITION 0 Co�AH. 0, USE ------ T
4 m
M M
In Z
C3 REMODEL APARTMENT C] SIGN REGO I PRO IDED
0 REPAIR GRADING CYDS 0 FENCE X FT) MARKS
I_
E:
0 DEMOLISH 0 TANK EL
_ d� ele Ll
C3 2W 0
clGARAGE [3 gFTAIIPSING WALL RENEWAL -e -2w-o
CARPORT FOG
CHECKEDBI coo OCCUP
(TYPE OF USE. BUSINESS OR ACTIVITY) EXP IN: ITY1
ROUP;Z3
mm
se
NUMBER SPE 'L.AD
Oa
I DW LUNG AR AS R GGjALGSPECTOR JAREA
OF RE US c] YES
S j
S NU SER
STORIES
DESCRIBE WORK TO BE DON
_,Aj)j�p on A&I 9)64�� REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'DIS
IT 0
11
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(A)D r net
1,4(,4 17
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VALUATION FEE
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PLAN CHECK FEE
03
HEAT SOURCE GI-AIIN LOT SLOPE 1 8 LOING
0
m
PLAN CHECK NO: 1111TED DATE P UMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE
PIF.IVAT. PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC G-DING"'LL
t! N CUR SIDEWALKS, DRIVEWAYS . MARQUEES, ETC.) WILL REQUIRE
MA.I.%DN
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATIO : 160 DAYS
PERMIT LIMIT. i YEAR, PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES
SEE BACK Or PINK PERMIT FOR MORE INFORMATION
ENG. INSPECTION FEE
0 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
CITY OF
`Y. DEFEND AND HOLD HARMLESS THE OIL
IN INTEREST, AGREES TO INDEMNI
ITSOFF! Ns�.B�r.,H FEE
E MONDS, WASHINGTON. CIALS. EMPLOYEES, AND AGENTS FROM ANY AND
X REG I T
ALLCILAIMS FOR DAMAGESOFWHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
I HECK DEPOSIT
I FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN C
0 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANC�
I PROVISION. REG 00
HE CITY'S ABILITY TO ENFORCE ANY ORDINANCE
NOR LIMIT INANYWAYTH TOTAL AMOUNT DUE 1p� 61it� 1 S
I HEREBY ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION; THAT THE INFO RMATION POCATION APPROVAL
GIVEN IS CORRECT, AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF �.d b, the
T" applic-'an I. "'I - p"" "'I
CONSTRUC- die 1 -1 his/he, D-pul': hd F ... ... p.,d—d
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS RE.111-ATIN. CALL bu,t O"'p11',,
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED kh,wI,dg.d 1. sp— pr.,id.d,
WASHINGTON RELATING TO FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF T14E STATE OF
DATE
INSURANCE AND RCW 18,27,
WORKMEN'S5OMPENSATION OFFICIALS SIGNATURE
DATE SIGNED (4 //-
_T.NATU4pWNq1 OR AGENT, 25) e
—2
I 771-0220 ELEA ED B DATE
I
EXT/333
ATTENTION A I
IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
IT
A FINAL INSPECTION H AS BEEN MADE AND APPROVAL OR A CERTIFI, ORIGINAL FILE YELLOW INSPECTOR
PINK OWNER GOLD -ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX