20010531.pdfPERMIT EXPIRES 41
PERMIT
CITY OF EDMONDS ZONE NUMBER 3 1
CONSTRUCTION PERMIT APPLICATION 'A00BRESS
cl, �,EIA.E USINISS DIVISION NO. I LOT 00, LIU NO.
FEE
I VAIONGAQOR�SS EET MAP 0
PUBLIC RIGHT OF WAY PER OFFICIAL STR .... ... d 0
EXISTING � PROPOSED — I——
0 CI
ZIP Ep 0 E
s RECUIREDDEDICATION� FT XTURES . PAV REQUIRED
METER SIZ
YES 0 NO 0
NAME
ARKS 8
REM
A.D�E S OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY
NAME 'DATE
ENGINEERING
ADDRESS LA7� FIRE REVIEWED By DATE r
CITY IP T!!_EpHq�E 11
SHORELINE OR ADBf INSPECTION SON
VARIANCEORCU REO 'D POSTED
STATE LICENSE NUMBER IR NO E 0 YES ONO
oco SERA REVIEW SIGN AREA HEIGHT
COMPLI-11 I EXEMPT A OWED PROPOSED ALLOWED PROPOSED
PCT A OTT PARM EXP
REQUIRE SETS KS IFT- PROPOS D.El.AC-111
C"'AUS EUR SIDE REAR
'plpoLU.. 1: MECH ALLUXWED PROPOSE FRONT SIDE REAR FRONT
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C PL�A., ED
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0 ADDITION CNIMERCIAL 0 CHANGE OF USE G LOT wftwuva BY
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0 FENCE �MAR
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GRADING CYDS X
0 REPAIR 0
OTHER
TANK 0
0 DEMOLISH 0
t: RENEWAL
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(TYPE USINE5SUHlI- CHECKEDBY TYP 0 T C ON C OR UP
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:1 NUMBER NUMBER F SPECIAL IN PECTOR LOAD
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OF c
STORIES UNITS NUMBE
DESCRIBE WO rVL,,3 EMARKS PECTION REO'D
ROGRESS IN PECTIONS PER UBC 1081FINAL INS
AAS
VALUATION FEE
PLAN CHECK FEE
LOT SLOPE % BUILDING
FAT 0 CE GLAZING %
PLAN CHECK NO: V STED DATE PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLpyjHE WORK NoyjrfO HIS PERM"' COVERS WORK TO
SO R .NL,. A .6.T THEPUEILIC
STIUCTION ON GRADINOIFILL
DNE E P MARGUEES, ETC.) WILL REQUIRE
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BE GAIN ON PRIVAT EWALKS.OSIVE
0 (CURBS. SID WAYS S PC ARGE
3 SEPARATE PERMISSION.
PERMIT APPLICATION: HID DATYED
PERMIT LIMIT: I '. PROVIDED WORK IS STAR WITHIN 180 DAYS ENG. REVIEW FEES
" AR
SEE SAG�K OF ENG, INSPECTION FEE
-AP PLICA�STTOND3EEKALF 0 F HIS ONRI NER SPOU BE, HEIRS. ASSIGNS AND SUCCESORS LANDSCAPING
R EIiITOU4CEM DEPEND AND HOLD HARMLESS THE CITY OF INSPECTION FEE RECEIPT
1 PLAN CHECK DEPOSIT
1.713 15AT 'ON PPROVAL
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NATURE WNER OR 11, M 771-0220 R EASED BY
ATTENTION tzA 1 1333
IT IS UNLAVIFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTI,_ 771-0221 ORIGINAL -FILE - YELLOW. INSPECTOR
CATE OF NSPEC 'ONYHAS BEEN MADE AND APPROVAL OR A CERTIF FAX PINK -OWNER - GOLO,ASSESSOR �'V
A FINAL I..C. T . .
1A AS BEEN GRANTED. UBC SECTION 109
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall ..........................
Pler[Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground
Rough -in ......... ..........
':'.-Commerclal Final
',',,.HFATING:
de�i
Test
Oil
Gas Piping .................
Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ............
Coiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR VV\%
OCCUPANCY ..................
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CITY OF EDMONDS
F—cONSTRUCTION PERMIT APPLICATION
CITY ZIP
ADDRESS
... PERMIT
ZONE NUMBER tWi v� 3
PLAT NAMEISUBDIVISION NO.
LOT NO,
LIE NO.
11. FEE S
lUllIC RIGHT OF WAY PER OFFICIAL STREET MAP
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REOIJIREDOEDICATION— FT
METER SIZE
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PAY REQUIRED
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YES 0 NO 13
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FIRE REVIEWED BY
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EXP
SIGN AREA
ALLOWED I PROPOSED
HEIGHT
ALLOWED PROPOSED
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LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
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PROPOSEDSETBACKS(FT)
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FRONT UP BE A
COMPLIA CE OR
ADDITION COMMERCIAL 13 CHANGE OF USE
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PLAN CHECK NO: IVISTED DATE
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MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADiNGIFILL
8 TC.) WILL REQUIRE
DOMAIN (CURBS, SIDEWALKS, DRIVEWAY . MARQUEES, E
e'l
SEPARATE PERMISSION.
L k r
E SURCHARGE
PERMIT APPLICATI N: i3D DAYS
PERMIT LIMIT. 1 YEAR PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS A S ES
ENG. INSPECTION FEE
-LANDSCAPING
;APPLICANT.
N NTEREST. AGREES TO INDEMNIFY DEFEND AND HOLD H LE THE I F
.
2 EDMONDS.WASHINGTON. ITSOFFICIALS.EMPLOYEES.AND RENT A ANYAN
w U E T RIND1RECTLY
A LCtIMSFOR DAMAGES OF WHATEVER KATURE.ARISING
INSPECTION FEE
RECEIPT
FA M THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAIN CHECK DEPOSIT
M DEOEMEDT MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
ON.
0 JON."
0 N IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANYORDINANCE PROVIS
ORLIMIT -
TOTAL AMOUNT DUE
AEG IFT
I HEREBY ACKNOWLEDGE THAT I HAVE READTHIS APPLICATION; THAT THE INFORMATION
APPLI ATION APPROVAL
GIVEN IS CORRECT. AND THAT I A. THE OWNER. OR THE DULY AUTHORIZED AGENT OF
I, ppIjT, not a permit until Igned by the
THEOWNER. IAGREETOC MP WITH CITY AND STATE LAWS REGULATING CONSTRUC-
0 LY
CALL
0 Id, , Ohh,iml or hl�., D.qWy: end F ... ... ... d. end
TION. AND IN HE WORK AUTHORIZED THEREBY. NO PERSON WILL BE LOYED
DOING T TO
FOR INSPECTION ,plh. , k...l.dg.dh, p.. p—id.d.
LEMP
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RE ATING
WORKMEN'S COMPSNSATIOIV INSURANCE AND RCW 18 21,
P711"t
(425)
OF ALS IGN
SrNA7URE
�WE A 0 A
161
771-0220
A EASED BY DATE
Ex 1 1333
A17ENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSP ECTION 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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