20000961.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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REMARKS
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VALUATION I FEE
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HEAT SOURCE Gl_AlINO % LOT SLOPE I
BUILDING
PLAN CHECK NO: IVE5TID DATE
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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 . MAROUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
P' RANT APPLICATION; 180 DAYS
I
PERMIT LIMIT'. 1 YEAR ' PROVIDED WORK S STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. INSPECTION FEE
ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
;APPUCANT.
N iNT DEFEND AND HOLD HARMLESS THE CITY OF
AGREES TO �NDEMNIFY.
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DMOEREST, ANYAND
E NDS,WASHINGTON� TS OFFICIALS. EMPLOYEES� AND AGENTS FROM
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I FOR DAMAGESOF WHATEVER NATURE.ARISING R- -
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FROM THES ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
REC IPT
DEEMEGXODI EVENT OF ANY CITY ORDIN-C
0 0 MODIFY, WAIVE OR REDUCE ANY REOUIR
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NORLI Y
TOTAL AMOUNT DUE
RE EI.T
ACKNOWLEDGE THAT' HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION
APPROVAL
[HEREBY
GIVEN I S CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZE. AGENT 01
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THE OWNE . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
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WORKMEN'S COMPENSATI .27,
OFFICIALS S r5l DATE
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DATE S�IGNE
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771-0220
DATE
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL- FILE YEL " INSPECT A
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CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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LANNING DIVISION DATE—
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A field inspection was conducted to determine compliance with approved plans. Final approval denotes that
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P rmance Bonds associated with the project may be released
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
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SETBACKS
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Stab Insulation ..........
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Wall Insulation ........... I
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
DATE RECEIVED
EXPIRkS (0 -S
PERMIT
PERMIT Z"m (A
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CITY OF EDMONDS
NUMBER
CONSTRUCTION PERMIT APPLICATION JOB
ADDRESS
SUITVAPTN
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DWNER�MJ7
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ij P. �A"S450
PILAT NAMEISUBDIVISION NO.
I LOT NO-
LID NO.
11. FEE
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METER SIZE
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NO, 05 FIXTURES
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NAME
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YES 0 NO 0
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ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP
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NAME
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FIRE REVIEWED BY
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INSPECTION
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BOND
POSTED
STATE LICENSE NUMBER
-
A4425CO66
:EjClEllY
SEFAREVIEW
MVI
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
PRGPERTY TAX ACCOUNT PARCEL NO.
01 Od
EXI
,
,
0 NEW ESIDENTIAL 0 PLUMBING I MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS CFT.1
FRONT SIDE REAR
PROPOSED SETBACKS (Fl)
FRONT RSIDE BEAR
C] ADDITION C3 COMMERCIAL o C MPLIANCE OR
CHANGE OF USE
PARKING
LOT AREA
PLANNING REVIEWED BY DATE
C3 REMODEL APARTMENT SIGN
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FENCE
C] REPAIR X FT)
REMARKS
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TYPEOFCONST
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NU� F
NUMBER OF
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SPECIALEIDNSPECTOR
JAREA
LOAD
UNITS
REGUIR 0 YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ
-Pvml, :,,,jze -4 SEPt '900 C,4tLOAJ V.S-r
VALUATION I FEE
CHECK FEE
HEAT SOURCE GLAZING I LOT SLOPE %
BUILDING
EC K 0
PLAN CHECK NO:
A N C H
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
.I P ER IT ALT .OR 'ZES o
BE DONE ON PRIVATE PROPERTY a NLY. ANY CONSTRUCTION ON THE PUBLIC
- ON PRIVATE 'R
E G ME
.
GRADINGIFILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS' MARQUEES, ETC.) WILL REQUIRE
o". 'CUR BE ' '..W A
fANPLAN
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
PER.
KI
PERMIT LIMIT. I YEAR - PROVIDED WOR S STARTED WITHIN 180 DAYS
ER , L
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
"L" LF F HIS OR HER SPOUSE HEIRS. ASSIGNS AND SUCCESORS
o
A APPLiCA'Ti N BEHALF OF
;N T . I DEFEND AND HOLD HARMLESS THE CITY OF
ENG, INSPECTION FEE
S �NOEMNIFY,
N INTEREST, AGREES
INTE FES
MID GE W E I o ITS .1110ALS. EMPLOYEES. AND AGENTS FROM ANY AND
EDMONDS. WASHINGTON,
IS .�E
L C', S oFWHATEVER NATURE. ARISING DIHECTLY OR INDIRECTLY
A L
CEIPT
�SL�.M.S.FORDAMA-ES E
, . THE SEUA.lF.FTH1 PERMIT ISSUANCE OF THIS PERMIT SHALL MOT BE
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PLAN CHECK DEPOSIT
C BE E TO Mo.IY . WAIVE OF ANY CITY ORDINANCE
PROVISION,'
FE
ErT
T. ORDINANCE
N R M'T IN ANY WAY E
TOTAL AMOUNT DUE
` HAVE READ THIS APPLICATION: THAT THE INFORMATION
,.HE EBY G.E
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APPLICATION APPROVAL
TT�HAT �
T - Ul AUTHORIZED AGENT `
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THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
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CALL
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TION. A IN 130M. HE RK AUTHOR12ED THEREBY. NO PERSON
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OF WASHINGTON RELATING TO
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FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF
A , WT
WORKMEN'S COMPENSAT19IIIILLN5Q�A>PE, 'S .27.
OFFICIALS SIGNAYRE DATE
_
NER 0 A
DATE
(425)
lxxll4k7 12 - 1�__ c
771 0220
JELEAS
D BY DATE
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE YELLOW- INSPECTOR
A
HAS BEEN GRANTED. UBC SECTiON 109
FAX
PINK - OWNER GOLD - ASSESSOR
CATE OF OCCUPANCY
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