20000992.pdf� IIIIIII
DATE RECEI
—F—VE:e
PERMIT EXPIRES _4�w
CITY OF EDMONDS
PERM T
'UMEIER 20099,,t
CONSTRUCTION PERMIT APPLICATION
'JOB SUITEIAPTO
ADDRESS
jo o
OWNERNAMENAME OF BILISINE S
PL
LOT NO�
LID NO.
4
LID FEE S
MAILINGADDREgS I
0 0 7 3-
PUBLIC RIGHT OF WAY PER OFFICIAL STREET A'
EXISTING— PROPOSED-
FE.USE..E.I.ATI.N_ IT
TESCFAppd 0
W P. r� R.'O.o
So— ft R.od 00
rR`.Rll.o
.: A CO3
cl ZIP ITELEPHONE
7 71)
NAME
METER SIZE
LINE SIZE
NO.OFFI-UPES
PRV REQUIRED
U
I
I
IE. 0 NO 0 M
I
1- ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTR0LJ.. or
CITY ZIP
NAME
f4f 1KC,
ENGINEERING REVIEWEOIDATE
ADDRESS
Iq 7 3-1 Ajl'w';�e
Z
FIRE REVIEWED By DATE
a:
CITY zip
YAA&VJ 4!1 6,3
TELEPHONE
qx�. - 77 ?v I _�
SfATE LICENSE NUMBER EXPIRATION DATE
0 Y
VARIANCE OR DO
SHORELINE OR ADS#
INSPECTIO
REOD
80 0
POSTED
:rl _5 0�,� d . /
) M �,C
0Y ES C)NO
-4
M
SERA REVIEW
COMPLETE I EXEMPT
EX,
-SIGN AREA
ALLOWED I PROPOSED
HEIGHT
ALLOW 0 PROPOSED
"PROPERTY TAX AC L NO.
rn
0
0
c
c : � :
X m
M Z
NEW L bo PLUMBING i MECH
ADDITION m COMPLIA CE OR
C ANCE OF USE
C] REMODEL SIGN
LOT C VERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (M.
FRONT SIDE HEAR
PROPOSED SETBACKS (Fr.)
FRONT US SIDE REAR C
PARKING
11CID
PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
GRADING PENCE
0 REPAIR 0 CYDS I X FT)
I
Z
-AS-
0 DEMOLISH 0 TANK m OTHER
3:
'T fRiOEMING WALL E] RENEWAL
C] 13ARAG C3
CAMPOS FLY
ca
0 -n
-n
TYPE OF USE. BUSINESS 0 N:
CHECKED BY JTYP��
GCCUIN
ROU
3
11
065
0
0 'M
c
r co
M 0
Z
-4
NUMBER
OF
UMBER7
DWELLIN
CRT
AREAS
'NUMBER
SPECIAL IN SPECTOR
REOUIREDC] YES
JAREA OCCU NT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSP ECTION R�W'.
?L3-j Oob 197t/
Z
-4
VALUATION
FEE
ED
PLAN CHECK PEE
Z
'I'lOUrE GLAZING % LOT SLOPE I BUILDING m
0_5
PLAN CHECK NO: PLUMBING
MECHANICAL
THIS PERMIT AUTHO IZES ONLY THE WORK NOTED. THIS PERMIT COVER WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADING15ILL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE
SEPARATE PERMISSION.
=&..E
PERMIT APPLICATIO : 180DAYS
PERMIT LIMIT'. I YEAR � PROVIDED WORK IS STARTED WITHIN 160 DAYS
SEE BACK OF PINK PERMIT FOR MORE INI.....N
*APPUCANT* Oil IEHAL F HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS ENO, INSPECTION FEE
IN INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE
E D ROM CITY OF LANDSCAP NG
MONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS F ANYAND _INSPECTION FEE
ALLCLAIMS FOR IIAVAGESOFWHATEVER NATURE, ARISING OtRECTLYOR;NDIAECTLY
FROM THE ISSUANCE OF THIS PERMIM ISSUANCE OF THIS PERMIT SHALL NOT BE RECIIII
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE PLAN CHECK DEPOSIT
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,' C
7�5
TOTAL AMOUNT D
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLCATION� THAT THE INFORMATION
GIVEN IS COAAECT.'AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF ICATION APPROVAL
THE OWNER. I AGREE TO C MPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. Tl�pppp"�I �� P.1 . -in �'Do l,' ro.
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL S..Id,,,g Officiml or h1sthe, Depwy� ,d FOIS — Plol. Ild
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION o.p .�kl.d,d r, �lro. pl—d.d.
WOPIMENS COMPENSATION IN URANCE AND RCW 18,27, T RE DATE
f STGNATAIOWNER (425) mz�� /Azejd
L771,0220 RELEASED BY I DAW
ATTEATiON EXT1333
ITISUNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILE YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR
5198
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ...............
FOUNDATION:
Footing......................
wait..........................
Pier/Porch .................
Retaining Wall ...........
Slab insulation ..........
PLUMBING:
M
Underground .............
Ma
0 C
Rough -in ...................
-4 C
commercial Final
ITI Z
10-4
HEATING:
a
>
Gas Test ....................
0)
Gas Piping .............
Equipment ..................
MM
Commercial Final
0)
tg
EXTERIOR SHEATHING
NAILING ..........................
fj),
RI 0��
FRAMING........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ..........
Z
'W;
Ceiling Insulation
SHEETROCK NAILING
fj
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .... .........
9
1 0
ATE RECEIVED PERMIT EXPIRES
E T
V/
'NlM'B'ER
CITY OF EDMONDS
CONS-1] ION PERMIT APPLICATION JOB SUITFJAPT,
ADDRESS p) 0
T UC_ 5 r
OWNER NAMEINAME OF BUSINESS PLAT NAMEISUBDIVISION NO LOT NO* LION
I
L 0 FEE S
C FMAILINGAOD.E 5 P AR
0 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP m P.,
00 `Aw 00
EXISTING — PROPOSED 0
ZIP TELEPHONE 0
a
REQUIRED DEDICATION— FT
-7 r�a u 7
NAME
METER SIZE
LINE SIZE
N OF FIXTURES
FRV REQUIRED
YES 0 NO 0
ADDRESS
M S
OE�NERKICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP TELEPHONE
NAME
Ik v"177"
REVIEWEDIDATS
AODRIII
DATE
j
CITY ZIP
TELEPHONE
FIRE REVIEWED By
z
0
1"JI 1 0 4,
q;" 7741— o?
CU SHORELINE
OR ADS#
INSPECTION
BOND
S ELICENSENUMBER
CFKEDBY
VARIANCE OR
0 YRED'D NO
BE (71
POSTED
-4 �.<s 44,11/
REVIEW ____;tGN
—AREA
HEIGHT
��i
SERA
COMPLETE EXEMPT ALLOWED
PROPOSED
ALLOWED PROPOSED
NO.
pFlo;Flo__�2 1-917
EXP
I
m
i��
_jEL
Lo COVERAGE -7EQk
IRED SETBACKS (Fr.)
PROPOSED SETBACKS (FTI
FRONT UR SIDE REAR
rl NEW
PLUMBING I MECH
ALLOWED PROPOSED FRONT
SIDE REAR
C,
0
0
C] ADDITION
o C MPLIANCE OR
DO
HANGS OF USE
3:
PARKING
LOT AREA
PLANNING REVIEWED
BY 7ATE
0 REMODEL
[3 SIGN
REDD I PROVIDED.
m
FENCE
0 REPAIR 0 GRADING CYOS 0 X FT)
REMAHK5
E] DEMOLISH TANK OTHER
RAGE INING WALL RENEWAL
0 G.AAP.RT C] FIETAM P,
0
'n
0
OPUS 1;USIN111 OR ACT11ITY'l EXPLAIN:
`TYP:i
CHECKEDBY
TYP F CONS;,�UcMTJON
OCCUPA
ROU
NU� A
SPECIAL INSPECTOR
AREA
OCCUPANT
IN
OF
REQUIRED YES
LOAD
STORIES
o
DESCRIBE WORK TO BE DONE
REMARKS
C
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG-D
0
We -J
z
VALUATION
FEE
cl)
z
PLAN CHECK FEE
HE SOUrE GLAZING
I SLOPE
BUILDING
0
m
PLAN CHECK NO:
OAT'
PLUMBING
VESTED
MECHANIC L
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
L BE DONE ONPAIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
GRADINGIFILL
N DOMAIN (CUhBS.SiD L�,
SEPARATE PERMISSION.
A RGE
PE M IT APPLICATION: 180 DAYS
I ITHIN ISO DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK S STARTED W
ENG. RE FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Y OF
ENG, INSPECTION FEE
A EF�NG AND HOLD HARMLESS THE CIT
IN INTERES�TA�G"INGTIQN) NOOEMMICI:Y FROM ANY AND
:I
LANDSCAPIN
" M
ED BS S L E PLOYEES. AND AGENTS
MON , S. .
ALL CLAIMS FOR DAMAGESOFWHATSVER NATURE, ARISING DIRECTLY OR INDIRECT LY
INSPECTION FEE
RECEIPT
X FROM THE ISSUANCE OF THIS PERMIt ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
DEEMED To MODIFY.WAIVE OR REDUCE ANY REQUIREMENTOF ANY ITYORDINANCE
NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANYORDINANI.
TOTALAMOUNTOIJE RECEIP
I HEREBY ACKNOWLEDGE THAT I HAVE REA. THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN CORRECT, AND THAT I AM THE OWNER� OR THE DULY AUTHORIZED AGENT OF
INS
T IppillIlOn I' 'It I POrmit -I �g
E LAWS REGULATING CONSTRUC-
THE OW EA. I AGRE To COMPLY WITH CITY AND STATE
CALL
E.itj,�hil
, OIj,.II .1 N.1h., D.,Ill: III P---
D THEREBY, NO PERSON WILL BE LOYED
TION; AND IN DOING THE WORK AUTHORIZE FAMIPNG TO
OF WASHINGTON RE
FOR INSPECTION
,pl I, nk-w-10 m p —vid-
IN VIOLATION OF THE LABOR CODE OF THE STATE
RE DATE
WORKMEN'S COMPENS SUjANCI AND ROW"Z'*
(425)
0 PALSSIGNATU
ffi,
ER:2
3NEO
;g
771-0220
A`E L'E A
EATION
EXTP333
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 YELLOW - INSPECTOR
- ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD
5,98