20001014.pdfDATE RECEIVED
12
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMENAME OF BUSINESS
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NAME
Milli, PERMIT EXPIRES 4��, n
USE PERMIT
NUMBER ;W-61T
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Pt.U.1 R
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EXISTING - PROPOSEC� le.p.-h
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METER SIZE LINE SIZE I 10.01FIDITURES PRV REQUIRED
YE No
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DATE
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VARIANCE 09 CU SHORELINE OR ACE.
INSPECTI N BOND
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UM�
STATE LICENSE NUMBER
S SS�
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0 YES 0 NO
0
REVIEW SIGN AREA
HEIGHT
SERA
COMPLETE EXEMPT ALLOWS PROPOSED
ALLOWED PROPOSED
PROPERTY TAX ACCOUNT 1ARD-11IJ.
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I
_:�13 /.,of rn ---� r) EXP
LOT COVERAGE RIQUIRED SETBACKS (FT)
SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT UPSIDE REAR
NEW LUMBINIGIMECH ALLOWED
PROPOSED FRONT
ADDITION COMMERCIAL ci COMPL ANCE OR
OF US.
CHANGE OF USE
PARKING UOTA REVIEWED
BY DATE
EAFLA.NIN.
C] REMODEL [3 APARTMENT F SIGN RE OVIDED
F
GRADING ENCE
REPAIR CYDS cl - x FT)
E3 DEMOLISH E] TANK ci OTHER
ARAGE 0 RETAKININYG WALL RENEWAL
Cl GA.PORT C 'R
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NUMBER OF
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sPECiALINSFECTOR
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LOAD
0 OF
STORIES
DWELLING
UNITS
NUMBER __VA
REQUIRED 0 YES
I
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTKW REQ
a
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE "I"No I LOT SLOPE I
BUILDING
�15TED DATE
PLAN CHECK NO:
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I�j BE CONS ON PR.IVATE PROPERTY ..Ll. ANY C.NBIRU.".. ON THE PUBLIC
GRADINGIFILL
DOMAIN I CURB SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION,
t=
STATE SURCHARGE
PERMIT APPLICATION: 180DAYS
W R
PERMIT LIMIT. I YEAR -PROVIDED ORKISSTA TEDWITHIN 180DAYS
ENG. REVIEW SEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
La
-3 IN INT.FESWT TO �T.EMNIFY. DEFEND AND HOLD HARMLESS THE CITY 01
'LANDSCAPING
AWI.EtES
2 'EMONGS A H T.N. S OFFICIALS. 5M PLOYEES. AND AGENTS 'ROM ANYAND
INDIRECT'
INSPECTION FEE
1. ALL CL,IlMS FOR DAMAG OFWHATEYER NATURE. ARISING DIRECTLYOR
T SHALL NOT BE
RECEIPT
IEFS
____. RP�RMIT. ISSUANCE OF THIS PERM
F ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
RDINANCE PROVISION,-
TOTAL AMOUNT DUE
HAVTEHIII EAD THIS APPLICATION� THAT THE INFORMATION
APPLICATION APPROVAL
IHEREBY
,=TLEADNG.E TTHHAAT :
GIVEN I A. E OWNER, ORTHE DULY AUTHORIZED AGENT.'
ThIl IPPI-111- hel , pe1 0 eghld ey the
PLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
'AGR.T.TE`WCoM
CALL
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.AN 'IN .KAUT.ORIIECTHEFE.Y D E PSON WILL BE EMPLOYED
,T,H.E�?�N,S','� 'N P INGTON RELATING TO
,Fj,� Ilk-Ildg,d III �pac. phovid0d
FOR INSPECTION
IN VIOLATION 01 THE A CODE OF THE STATE OF WASH
WORKMEN' om E T;2 SURANC Rcw 1827.
SE
OFFICIALS TURE DATE
DATE S GNED
(425)
1
01) 0
-Q %\ o-
771-0220
RELEASED BY
EXT1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERI IFI-
ORIGINAL - FILE YELLOW m INSPECTOR
GOLD ASSESSOR
A FINAL
BEEN GRANTED, UBC SECTION 109
FAX
PINK OWNER
CATE OF OCCUPANCY HAS
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION;
Footing ......................
wall..........................
Pier/Potch .................
Retaining Wall ...........
Slab Insulation
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final
HEATING:
L!
Gas Test ....................
Gas Piping ...........
Equipment ...........
Commercial Final
EXTERIOR SHEATHING
NAILING, ........................
FRAMING ............... .
FIRST FLOOR -FRAMING.....
ANSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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