20001004.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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9TY ZIP ITELEPHONE
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NAME
CITY
EXPIRES
700
PERMIT
USE PERMIT
ZONE NUMBER
Joe SUF7VAPI'N
ADDRESS &,31,7 ZIP' fAl '30) —
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PI -AT NAMEISUBDIVISION NO.
LOT NO
LID NO,
I
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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RE UIRED DEDICATION— FT —
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METER SIZE
LINE SIZE
No, OF FIXTURES
I REQUIRED
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S El NO 0
YEP
REMARKS
nWNVRdCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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'TATE LICENSE NUMBER E.1I.AI KIN -Al I CHN By
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p�ICC NO.
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0 NEW It RESIDENTIAL 0 LUMMNG/MEC.
ADDITION C] COMMERCIAL ci C MPLIANCE OR
CHANGE OF USE
C] REMODEL APARTMENT SIGN
0 PENCE
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DEMOLISH TANK o OTHER
GARAGE ING WALL
RETAINI 0 RENEWAL
ARPORT F_._
NUMBER NUMBEROF,
OF DWELLING A
STORIES UNITS N
DESCRIBE WORK TO BE DONE
required on all lic, i
ji-Li-E E.I.AT.
-NGINE Hy Code. ECDC 19.10)=�020,jc
FIRE REVIEWED By DATE
VARIANCE OR CU
SHORELINE OR AD5#
INSPECTION
RED 'D
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OSTED
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SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
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LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SSTBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
— PARKING
L.TAREA
PLANNING REVIEW ED BY DATE
REDD I PROVIDED I
I
CHECKED By T
SPECIALINS 70
REQUIRED j[T3yES'
Iff '7 1 GROUP K
OCCUPANT
LOAD
PER UBC 1081FINAL INSPECTION
VALUATION I FEE
PLAN CHECK FEE
HEAT SOURCE GLAZING LOT SLOPE I
U 'L.ING
PLAN CHECK NO: VESTED DATE
PLUMBING
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
L T MIT E PUBLIC
11 B.E.0A,NljO" PR�IIATE PROPER Y ONLY. All' CONSTRUCTION .
N C.. . SIDEWALKS, DRIVEWAYS , MARQUEES, ETC.) IN ILL REQUIRE
SEPARATE PERMISSION.
MECHANICAL
GRADINGIFILL
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
A. PERMIT LIMIT., 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
ENG. REVIEW FEES
;A F HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
PPLICANT, ON BEHALF
0 Y. OF
M INTEREST. AGREES TO:NDE. N"' DE FEND AND HOLD HARMLESS THE CITY F
EDMONDS, INA HINGTON, TS OFFICIALS, EMPLOYEES, AND AGENTS PROM ANY AND
S RE. ARISING DIRECTLY OR INDIRECTLY
ALL CLAIMS FOR DAMAGES OF WHATEVER NATU
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REOUCEANY REQUIREMENTOF ANYC TY ORDINANCE
Q, 'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
io. NOR LIMIT IN ANY WAYTHE CITY
ENG. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT UE
RECEIPT
El - PT
HERES ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION'. THAT THE Mp RMATION
GIVEN SCORRECT�ANDT ATIANITHE OWNER . OR THE DULY AUHO RIZED AGENT OF
T E OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
EMPLOYED
TION, AND IN DOING THE WORK AUTHORIZED THEREBY. No PERSON WILL BE L T
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RE ATING 0
WORKMEN'$ COMPENSATION ll� I SURANCE AND RCW 18.27 —
MIINEI
APPLIC �TION APPROVAL
TIa—pla-11(ad a, . p. dal -.1 �19.ld by and
CALL Blldalg Oillc--:,O.f O,ty. and F plal. and
"'Iapi
FOR INSPECTION —1—ang6d an space pcovidod,.—
(425) (TLS SIGNATURE,��> DATE
-,g
,0 mtm�dyl
771-0220 RELEkSED By DATE
ATTENTION OR STRUCTURE UNTIL
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING
HAS BEEN MADE AND APPROVAL OR A CERTIFI-
EXT 333
771-0221
ORIGINAL FILE - YEILOW�INSPECTOR
A FINAL INSPECTION
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK OWNER - GOLD - ASSESSOR
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RECORD OF INSPECTIONS
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DATE APPROVED
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Wall..........................
Pier/Porch .................
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Retainirig Wall ...........
Slab Insulation
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PLUMBING:
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Equipment .................
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EXTERIOR SHEATHING
NAILING ..............
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FRAMING ........................
ca
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FIRST FLOOR FRAMING
INSULATION ............ ......
Floor Insulatiorf
Wall Insulation ...........
—1
Ceiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
0
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
rK
OCCUPANCY ..................
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E RECEIVED
—7
PERMITEXPIRES
USE
PERMIT
CITY OF EDWND�3 ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUlTE/APTa
ADDRESS 15LWk)
IROL4
OW ERNAMEN CrOANES
PI -AT NAMEISUBDIVISION NO.
LOT NO_
LID NO.
FEE S
MAI INGADU E55
P RIGHT OF WAY PER OFFICIAL STREET MAP
UXISSLTICING
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at I a
CITY
E — PROPOSED—
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REQUIRED DEDICATION— FT
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NO. OF FIXTURES
PRV REQUIRED
NAME
YES M NO 0
REMARKS
ER ONT
OWNERICONT
ADDRESS
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n emer the water system
CITY ZIP TELEPH HE
is open D. clowd. uVanglorl TanKS are
aquired no all
NAME
IN E 9 ISI
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ADDRESS
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REVIEWED By DATE
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CITY ZIP
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OR ADS# INSPEC I N BOND
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VARIANCEORCU
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STATE LICENSE NUMBER
OYES 13 NO
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S 5N9
SEPA REVIEW
SIGN AREA.
HEIGHT
COMPLETE ExEra PT A
LLOWED 15RO OSE
ALLOWED PROPOSED
M 0
PRO ME L NO. 4� 2� oc
UP
-4 0
OC
C ERAGE REQUIRED
OypROpOSED.
SETBACKS (Fr.).
PROPOSED SETBACKS (Fr.)
SIDE REAR
NEW. F16SIDENTIAL
. PLUMBINGIMECH
ALLOLIOTED
FRONT SIDE FEAR .
FRONT UR
M
AUDITION COMMERCIAL
COMPLIA CE OR
El CHANGE OF USE
10
c
LOT
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AREA
PLANNING REVIEWED BY
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0
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(TYPE OF USE.
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GROU
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1.
1.3"NUMBER NUMBER OF ITICAL
SPECIAL INSPECTOR AREA
OF
Wo
DWELLING
HIT
AREAS
NUMBER
REQUIRED [3 YES
LOAD
20,
STORIES
DESO (BE WORK B DONE ---A _�_
-7
PER uou juWFINAIL INSPECTION REO'D
PER UOU lUwrlm
I
PROGRESS INSPECTIONS
z
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VALUATION FEE
0
PLAN CHECK FEE
BUILDING
HEAT SOURCE
LOT SLOPE %
PLAN CHECK NO:
PLUMBING
MECHANICAL
r'.
IS PERMIT COVERS WORK TO
THIS PERMIT AUTHORIZES ONLY THE WORK NbTED. TH CTION ON THE PUBLIC
PROPERTY ONLY. ANY CONSTRU
ORA NO FILL
t: BE DONE ON PRIVATE
z DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
:1 SEPARATE PERMISSION.
A E URCHAAGE
STT S
PERMIT APPLICATION: IBO DAYS WITHIN 180 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED
ENG. REViE FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
UCC'SOFS
'APPLICANT NEE LF HIS OR HER SPOUSE, HEIRS. ASIIGNSA.N.0 E.
NAR.LE
A ST INDEMNIFY, DEFEND AND HOLD I E CITY OF
E F
ED
ENG. INSPE TION FEE
L ANPDS, A, PI NO
ININTEREST
'S NO
2 ED 0 ITSOFFlrIA AGENTS FROM-AN'�AW
Nj
F HATiVE�NATPU',',Ey,'AEllSlilAN.DI RECTLYOR INDIRECTLY
5 ON FEE!.
ALL I A N
OFENTS PERMIC,TSYHAOLLD OT
SSUAN E F THIS PER IT. ISSUAN R
FRC . INANCE
. ANY
_AN CHEC K DEPOSIT
PLAN CHECK DEPOSIT
... ... ....... .
OCE
IFY. AIVE AREDUCEANYRE UIREM
9 DEEMED FORCE ANY ORDINANCE PROVISION..
EN
0 NORUMUTINANY AYTHE CITY'S ABILITY TO
TC )TAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATUOLNY. THAT THE INDFOIMATI N
LICATION APPROVAL
GIVEN IS COPRECT�ANO CIHAT I A. THE OWNER, OR THE . AUTHOPn AGENT OF
OWNER N. CONSTRUC
TO OMPLY WITH CITY AND STATE LAWS
By-
Pa ald. and
CALL Tlil 1=11D, IV: and Fee"M P
BE .,A.. A BE
TION; AND IN DOING THE WORK AU HORIZED THEREBY. HOPE='= :EMPLOYED
CODE OF THE STATE OF WASHINGTON RELATING TO
no,,ipI I, - pn—dl.d..
FOR INSPECTIONJ _di-P.
IN VIOLATION OF THE LABOR
WORKMEN-. CO.lEllSATI.N INSURANCE AND ROW 18.27.
OrTLS SIGNATURE . DATE
(425)
DATE SIGNED
771-0220 RELEASED BY D.E
EXT 333
ATTENTION
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNT11 771-0221 FILE YELLOW. INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
109
ORIGINAL - j
FAX PINK - OWNER GOLD - ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION