20010397.pdf.DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
IER NAME/NAME OF BUSINESS
CITY J ZIP TELEPHONE
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NAM
ADDRESS
CITY ZIP TELEPHONE
NAME ytif
CITY
0111611
❑ NEW
❑ ADDITION
❑ REMODEL
❑ REPAIR
❑ DEMOLISH
GARAGE
❑ CARPORT
ITYPE�
NUMBER
OF . '1 /
221 PERMIT EXPIRES
USE �� 5 n PERMIT pJ 0 i
z°NE cx � NUMBER �,I✓V 1 V
JOB SUITEIAPT.
ADDRESy&,1/o,/ `J ,7Gy4t � U� • . l
PLAT NAMEISUUBDIVISION NO/. LOT NO. LIO NO,
0 FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
B �.I U.. P-11 R.Q a
FXIST ING PROPOSED
vne
REQUIRED DEDICATION FT �j°�'!'O "!
METER SIZE I LINE SIZE I NO.OF FIXTURES PRV REDUIREO
ES O NO Cl
',Cl
\'
REVIEWED/DATE
ENGINEERING
44"1
x/
IRE.REVIEWED BY
DATE
ZIP
TELEP ONE
.y '
/VARIANCE
0
-7V oUlO�
OR CU
SHORELINE OR ADBM
INSPECTION BOND
R
EXPI ATION DATE CHECKED BY
NA
NA
❑ REOQ/ POSTED
YES �^IO
J�
e0g16'
// "1 Q
IV
SERA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSE
NT PARCEL NO.
-000 -0/6
EXP •QI�I
LOT COVERAGE
REQUIRED SETBACKS (FT)
ROPd5E0 SETBACKS I"..)
ESIDENTIAL
❑ PLUMBINO/MECH
A�LLIOWED`1 PROPOSED
SIrE REA
ROI�IT VR REAR
COMMERCIAL
COMPLIANCE OR
❑
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c.�l I7.r �� 1�V
L�DE
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❑
CHANGEOFUBE
PARKING LOT AREA PLANNING REVI V
Y DATE
APARTMENT
❑ IGN
REO'D I PROVIDED -
L _
c/ I
m
❑
S
FENCE
❑
❑GRADING
CYDS
1 _ X/_ FT)
❑ TANK
$4 A.p- YNlUc-
❑RETAINING WALL
ROCKERY
❑ RENEWAL
OR ACTIVITY) EXPLAIN:
NUMBER OF
nwFll lN[, I
CRITICAL
AREAS
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
UOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REOUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 1 BO DAYS
PERMIT LIMIT: 1 YEAR • PROVIDED WORK IS STARTED WITHIN ISO DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
'J IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
S EDMONDS,WAEHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANYAND
,4LLCLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
[CHECKEDBY ITYPEOF AUNSTFUCTf�N I�� I GROUPANT N
PECTOR AREA
❑ YES
OCCUPANT
LOAD
REMARKS
S INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D c
r
VALUATION
FEE
PLAN CHECK FEE
BUILDING
PLUMBING .
MECHANICAL
GRADING/FILL
-9F SURCHARGE
ENG. REVIEW FEES
•'
ENG. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
RECEIPT'-
TOTAL AMOUNT DUE
RECEIPT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
PO WITH CITY AND STATE LAWS REGULAT ING CONSTRUC
CALL
TH.ia epplica, ie Rol a pormll v.I,l signed by the
Fees an0
THE OWNER. I AG FEE TO COM
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
RELATING TO
FOR INSPECTION
Builtlin 011icielor hWher Deputy: end aee paid,
go ipl is ack wlBdged y:.pecp prp— d.
IN VIUUTION OF THE LABOR CODE OF THE STAVE OF WASHINGTON
WORKMEN 'SC SATION INSURANCE AND ROW I8.21.
AT
SIGNA UR :OWNER AGENT)
DATE SIGNED
(425)
_
771 -O2GO
DAT
EXT 1333
REL ED BY
,
ATTENTION
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-
ORIGINAL FILE YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX -
PINK - OWNER GOLD- ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Fcoting ......................
Wall..........................
Plot/Porch ................. - -
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ...................:
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation - --
Wall Insulation ..........
Ceiling Insulation ......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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