20010285.pdfI
D-TE FECEIV�Q,
ul
lol,
U_
[ PERMIT EXPIRES
PERMIT 2 ji
_(y
/Bp�r
_ _
CITY OF EDMONDS 'a
-NUMBER
CONSTRUCTION PERMIT APPLICATION 'AoD`0 4 E S S gUITEIAPT-
lw ��ll AS 4 ,
m
OWNER NAMEINAME OF BU NESS PLAT NAMEISUBDIVISION NO I LOT NO, LC NO.
LID FEE S
MAILING ADDRESS 0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP F P. .,
0
EXISTING — PROPOSED
C y
ITY _.4TELIPHONI FT
REQUIRED DEDICATION
FRV REQUIRED
NAME YES 0 No 0
R MARKS
ADDRESS OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY
2 a
A"
NAME
ENGINEERING REVIEWEDIDATE
a ADDRESS
3
REVIEWED BY DATE
FIRE
CITY ZIP TELEPHONE
0 2 3
Q VARIANCE OR CU SHORELINE OR ADEN INI�PEE.0!1019 PBCO'TE.
EWE LICENSE NUMB R EXPII�A ION ATE CH G
14-lig co W4 4 412 oc SEPA REVIEW SIGN AREA i HEIGHT
PROPOSED
COMILITI I EXEMPT ALLOWED PROPOIED ILLOWED
p OPERTY TAX ACCOUNT PI
0
EXP
LOTCOVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (M.
PLUMBING I MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UPSIDE REAR
NEW
C MPLIANCE OR
ADDITQ� CHANGE OF USE By DATE
C] REMODEL C3 SIGN
0 REPAIR GRADING CYDS F-LEf..' X ITI REMARKS
0 OTHER
DEMOLISH TAN , K
GARAGE FETAKJNIN�G WALL RENEWAL
CARPORT' ROC ER C]
,PCTtV[TY) EXPLAIN
(TYPE OF U E. BUSINESS O�� CHECKED BY TYP=
STRUCTION
coo 0 CUPANT
G OUP
NUMBER
MEER OF CRITICAL
NU SPECIAL INSPECTOR
OCCUPANT
EILLING AREAS IED
A FEDUlf E] YES
JAIIA
LOAD
OFOWNI
STORIES
T_S NUMBE
...
.1
DESCRIBE WORK TO BE DONft
KS
REMA
mcN,l.9Qq INAPECTIONS PER UBC IOBIFINAL INSPECTION REgD--,g
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE
BUILDING
PLAN CHECK NO:
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTIO N ON THE PUBLIC
U
GRADING""'
W , I E
2 DOMAIN (CURBS. SIDEWALKS. DRIVE AYS. MARQUEES, ETC) W LL R 0 IRE
:3 SEPARATE PERMISSION.
STATE SURCHARGS
PERMIT APPLICATION: B81I DAYS WITHIN '80 0
LIMIT'. i YEAR ' PROVIDE) WORKI STARTED AYE
ENG. REVIEW FEES
PERMIT
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
;A LICANT. ON BEHAL F S OR HER SPOUSE. HEIRS, ASSAIGNS AND SUCCESORS
FEES 0 INDEMNIFY. DEFEND AND HOLD H RMLESS THE CITY F
ENG. INSPECTION FEE
AND CAP'NG"
T.
IN INTER" AD
WA N.TQN� TS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANYAND
17
INSPESCTION
.M.NGE
E OFWHATEVER NATURE. ARISING DIRECTLY OR INDIP
IF NOT BE
ALL C_',ME,F.0' DAMAOE,'lNIS
RECEIPT
FROM T LANC PERMIT. ISSUANCE OF THIS PERMIT SHALL
OF ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
EANYR UIREMENT
DEEMED TO MODIFY. WAIIE OR REDUC ED
ANY ORDINANCE PROYI—N.
RECEIPT
T
0 WORUMIT IN ANYWAYTHE CITY SABILI Y TO ENFORCE
TOTAL AMOUNT DUE
THAT THE INFORMATION
APPLICATION APPROI I Ill
T I HAVE READ THIS APPLICATION;
Ill RIBY A N G HA4, U F
C' 0 12
WLD NHA AM THEC,,,TWNER6 ORATHE LYRAUTHOR ZED AGENT 0
AN.
T ,t lKlld by IhG
p
.,&N IS, :OR ECT.
W
TH Y AN ST LADLE C
THEO NE IA REETO 0 LYW !UI_ATINGCONSTRUC
NO PERSON WILL BE EMPLOYED
CALL
d.' p,lyl :,,d F111 d. I.d
0",_, D
TON,,ANDND ING THE OlK AUTHORI ED THEREBY,
OF WASHINGTON RELATING TO
FO R INSPECTION
IN VIOLATION OF THE LABOR CODE OF'THE STATE
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
0 . FFICIA .. ATV E
0
SIGNATU GENT) SIGNED
(425)
-3.142--1
771-0220
ELEAS 0 Y
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
YELLOW-INSP TOR
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE
PINK OWNER GOLD - ASSESSOR
A FINAL
HAS BEEN GRANTED. UBC SECTION 109
FAX
-
CATE OF OCCUPANCY
5198
z
m
3:
,,a
0 c
m z
c: 2
>
0 -n
-n Lo.
mm
a 5
0
0
C w 1
rn C., -
z
z
z
0
m
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
J�
wall..........................
z
Pler/Porch .................
ft
;q
Retaining Wall
SA
Idb Insulation ..........
cn
am,
PLUMBING-
6�
..Underground
0,
Roug -in ...................
h —17
M.
qommercial Final
M Z!j"
4
HEATI NO
Gas Test ............
Gas Piping .................
0 -ni
EculpmeW ............
m m;
10
COMIMorclat Final, I
q
C.)
EXTERIOR SHEATHING
NAILING .....................
FRAMING ..........
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
&
Wait Insulation ...........
Z
Calling In sulation
IT!
SHEETROCK NAILING
p ERMIT EXPIRES
.. PERMIT
CITY OF EDMONDS ZONE NUMBER
IV SUITEIAPT#
CONSTRUCTION PERMIT APPLICATION 'AODRESS 4,i57�
OWNER NAMENAME OF BUSINESS FLAT NAMEISUBDiVISION NO. I LOT NO* LID NO.
04-f� IID FEE S
MAILINGADDR SS 11 Als—
PUBLIC RIGHT OF WAY PER .11KNAL STREET MAP � P—h Roq-d
14 SI-1 us. P—s s'.ko
EXISTING — PROPOSED I-.. oF"--
CITY LEPH NE
REQUIRED DEDICATION— IT — u
,—d
IAZ/ ,*M t4
WDRESS
V-7, 02 IU
NTY ZIP
c-
TELEPHONE
PRV REOURRED
ETER SIZE i LINE YES 0 No El
REMARKS
Ow NERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
REViEWEDIDATE
ENGINEERING
ADDRESS
6
FIRE REVIEWED BY
DATE
ZIP
TELEPHONE
r
—2
No
)(-Zl 01/ L
12 C/
VARIANCE OR CU
1100
IV60RELINE OR ADBN INSPECTION
FE2� OSTED
SqYS LICENSE NUMBER
0
7). 7ATE CH K
tli H A:R E3 YES
Al/19 C .4 AIX k, 6 4 p p
SERA RVIEW
SIGN AREA HEIGHT
TM ACCCU�T PAF
'17V-
COMPLETE EXEMPT
ALLOWED PROPOSED ALLOWED PROPO ED
ozb
ou
EXP
3:
LOTC VERAGE REQUIRED SETBACKS III R.pl)S.D SETSACKS III
C] NEW �
RESIDENTIAL
0 PLUMBINGIMECH
ALLOWED PROPOSED
FRONT SIDE R EAR FRONT URSIDE REAR
m
.
MPLIANCEOR
c:
m 0
AODITIO�
to ,�
ci C
CHANGE OF USE
—1 0
PARKIN 0
LOT AREA J��IIIG REVI EWED vy DATE
0
0
M REMODEL
r-1 APARTMENT
0 SIGN
E.1
a
REPAIR
DEMOLISH
C3 &RAGE
CARPORT'
—E7RZF-�.
TANK
C] PETAIN�NLGWALL
ROCK5
a 'IE� �t X
0 OTHER
E] RENEWAL
IT) REMARKS
(rYPE 0 SINES CTIVITY) E—N.
CHEC1108y C04
0 CUPANT
riz)
JTY)�UCTION
_7
FOUR
NUMBER "
— I NUM ER OF
CRITICAL
SPEC;ALINSPECTOR
I OCCUPANT
OF
STORIES
LUNG
DWES
LIN TS
AREAS
NUMBER
JAIIA
R
REOL M YES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER USC 1081FINAL INSPECTION F
TL
m
-n-gggl
VALUATION
FEE
PLAN CHECK FEE
PLAN CHECK F E
L 0 T L 0 P E
HEAT SOURCE GLAZING % :��LOT SLOPE %
BUILDING
D A T E
...... ....
T D
PLAN CHECK NO: ..... .
PLUMBING
S
MECHANICAL
E R M I T C 0 V E 6 W 0 n K To
THIS.PER.M.IT ^UT.H.ORIZES ONLY THE WORK NOTEO, TH S PERMIT COVE16WOFIK TO
H' `ERM' AUTHORIZE S 0 N'
U L C
E ON PRIVATE PROPERTY ONLY. ANY CONSTLCTION ON THE PUBLIC
T E
E 0 0 '
S B N N A 'D
GRADINGIFILL
E T W I L E U I E
N ICU S. WAYS, MARQUEES, ETC.) WILL REGUIRE
SIDEWALKS. DRIVE
DOMAIN C 'n S *' T D E W A
:2 SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: ISO DAYS
I I N I B A
PERMIT LIMIT-. I AR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
YE
ENG. REVIEW FEES
SEEBABKOFPINK FAIT FOR MORE INFORMATION
C PE
I
ENG. INSPECTION FEE
U S IS
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
T S, S HARMLESS THE IT' OF
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
AND
LANDSCAPING
2 EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY
I I G I
1. ALLCLAIMS FOR DAMAGESOF WHATEVER NATURE. ARISIN DIRECTLY OR INDIRECTLY
INSPECTION FEE
It
A S R L NOT BE
FRO M THE ISSUANCE OF THIS FERMIt ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
0 C T 0. 1 C
DEOEMEDTO MODIFYWAiVEO REDUCE ANY REQUIREMENT -FANYCITYORDMANCE
R
N 0.
N OR LIMIT ION ANYWAY THE CITY'S ABILITY TO ENFORCE ANY 011ul--I 1-1--
TOTAL AMOUNT DUE IR
N; T T '0 TI
I HEREBY ACKNOWLEDGE TH AT READ THIS APPLICATIO HAT THE INFORMATION
:HAVE
I, NT
GIVE ISCO E IA DIFIAT AM THE OWNER, OR THE DUtY AUTHORIZED AGENT OF
N FR C N
, LA
THEOWNER. AGREETOC MPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
E PLOY ED
TION. AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
FE ATING TO
L T, G
I Sp
FOR INSPECTION
IN VIOLATION OF THE LABOR DE OF THE STATE OF WASHINGTON
Co
WORKMEN'S COMPENSATION INSURANCE AND RCW 18,27,
SIGVVf RA F('AGE T) A IS BIG .
(425)
(
'NE
771-0220
EXT 333
A�TtNtiON
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI.
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
------- ------
—�PPLICATION APPROVAL
This
�in,, 0166.1 ., Wsoh.r Dopll: od Foes ,, P,,d.
,pt I I 1—owlodgoP io -Pso- P—lo-1
AA _19NATU
x
A
m z
(in
0 -n
m rn
-0
��15
D
0
c:
M 0
z
71
;a
z
z
0
m
D Y
D
ORIGINAL FILE YELLOW INSPECTOR
PINK - OWNER GOLD - ASS�SSOR