20010597.pdfI
CiTY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
WNER NAMENAME OF BUSINESS
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PERMIT EXPIRES
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FILAT NAMEI$UBDIVISIO� NO.
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REOUIRED DEDICATION FT
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YES 0 NO 0
R MARKS
NERIGONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
tanks are
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City rode, FQQQ 19.30 .020 (I�
CITY ZIP
VARIANCE OR CU
SHORELINE OR ADB#
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INSPECTION
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0 ADDITION C3 COMMERCIAL o CHANGE OF USE
REMODEL [3 APARTMENT SIGN
GRADING FENCE
C] REPAIR 11 CYDS E3 I X FT)
DEMOLISH 0 TA- o OTHER
C CARGE RETAINING WALL RENMAL
GAPPORT QQKF
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED ETBACKS (I't)
FRONT USR S109 REAR
PA9XING
RED G I
LOT AREA
DED
PRO" PUJS TIANI
PLA NING REVIEWED BY DATE
FO ECDC 19.30.020
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REMARKS ==ULATORVALvE(mv)
Typ OF USE. BUSINESS OR A TY, P I
S=A —, I J�g._
C.E.KE. BY _jIYPEp
IS -1
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, ING N SEE
STORIES NITS U.BE
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GLACE GLAZING % LOT SLOPE %
PLAN CHECK NO: IVESTEDDATE
THIS PERMIT AUTHORIZES ON" HE WORK NOTED. THIS PERMIT COVERS WORK TO
!Z BE DONE ON PRIVATE PROPERTY ONLY, AN' CONSTRUCTION ON THE PUBLIC
n OMAIN (CURBS, SIDEWALKS, DnIVEW4YS* MARQUEES. ETC.) WILL REOUIFUE
SEPARATE PERMISSION,
PER.ITAPPLICATI A' 18AYS
YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
PERMIT LIMIT'. 1
C
SEE BACK OF PINK PERMIT FOR IAORE INFORMATION
'APPLICANT. ON BEHALF 01 US OR HER SPOUSE, HEIRS, ASSIGNS AN. SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
M NO AS N I OFFICIALS, EMPLOYEES, AID AGENTS 110" ANY AID
M , 0 1 5 W "' GT ' , 'IS WHATEVER I
A FORDAAG OF ATU E. ARISING DIFECTLYOR INDIRECTLY
'L - -S EU N. I.' S FEF_,T ISSUAZC E OF THIS 1.01 SHALL NOT a'
FRO. THE IS A E 0 GE 0 CE
I. MODIFY F ANY.EQ HEMENT OF ANY CITY ORVIIAN
DEEMED WAIVE D EDU
NOR L, ,I INANY W Y THE CITY ABILITY TO ENFORCE ANY ORDINANCE IFOVISIO
PPP ICATION THAT THE INFORMATION
SPECIAL IN P
YES R'. LOA.
FE.LR, I ?Y
oat
REMARKS lypw
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VALUATION
FEE
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PLUM51NG
MECHANICAL
GFADINGIFILL
5;ATI!IURCHARGE
END REVIEW FEES
ENG INEPEcriON FEE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
71�_CEIPT
TOTAL AMOUNT DUE
__I
I
I HEREBY ACKNOWLEDGE THAT I EREADTHISA L
I HAT
GIVEN E IT D TV THE OWNER, OR THE SILLY AUTIlORIZED AGENT OF
DEC Uc
G 'i CALL
IS ""A CITY AND STATE LAWS REGULATING CONSTR
T.E.-NE. I G F E 'IT'
T,EW THE E . FEES I WILL BE E.Illyll IF
A.
ICI,ANG IN. IN. L41H.-T P E.Y41 WASHINGTON RELATING TO FOR INSPECTION p"
GO
IN VIOLA ION OF THE L HS E OF TH E STAT
WORKMEN S CoMPENS RANCE A NO RCW 18 27 FFI IAL RE CATE
_777_111R�IOWN�; 9/( ih
(425) —
771-0220 E, I DAIL'
EXT 1333
,Z7EN
LA91.'LTO 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 GOUD-ASSLSSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .... . ...............
'POUNDATION:
Footing ....................
wait .................
Pier/Porch .................
p
"Retaining Wall
4 Slab Insulation ..........
M
PLUMBING:
Underground .............
M
Rouh-In ....................
rn
Commercial Final
C)
HEATING:
I
M
Gas Test .................... 1(y)s
10
Gas Piping .................
Equipment ........ . .......
(Sal
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
G
FRAMING ........................
r
FIRPTtwORFRAMING
U N .............
Floor Insulation ......... .
Wall Insulation ...........
Calling Insulation
Co
SHEETROCK NAILING
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SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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EXPIRES
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PERMIT
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CITY EDMOhiDS
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CITY ITELEPHONE
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ADDRESS
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PMSUANT TO UPC 605.2
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WATER SM-ILM 511UTOFF
NAME
SHAU B L 111-c
ENGINEERING Lm ENTIMSTF&ROW
ADDRESS
FIRE REVIEWED BY DATE
pURSUANT TO ECDC 19.30.020
CITY ZIP
TELEPHONE
'/AS X?6
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BOND
POSTED
STMLIC 1;" 11T
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SERA REVIEW
COMPLETE I EXEMPT
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ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
ERTY TAX ACCOUNT PARCEL NO.
60o
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0 ADDITION 0 COMMERCIAL CHANGE OF USE
ARKIN per DATE
0 REMODEL APARTMENT SIGN
REoD P e. E C 19.ao. 0 (c)
GRADING F N E
E] REPAIR 0 CYDS 0 X FMT))
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OTHER
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bDEMOLISH 0 TANK
0 GA RETAIJINEWALL1 I RENEWAL
=E 1:1 ROCKERY
CA POIRT
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(TYPE O�SE, BUSINESS OR ACTIVITY) 69
CHECKED BY
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VALUATION I FEE
I FEE
=LOPE I
_��CK
PLAN CHECK NO'.
IVESTED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHO R91ES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
GRADING/FILL
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS. MARCUEES. ETC.) WILL REOUIRE
SEPARATE PERMISSION.
RCHARG5
PE MIT APPLI`PA`X �80 15AN
PERMIT LIMIT. I YE K IS STARTED WrTHIN 180 DAYS
ARRIPROVID DWO
SEE BACK Oi PINK PEnMIT FOR MORE INFORMATION
ENG. REVIEW FEES
PECTION FEE
ON BEHALF 0 HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
;APPLICANT,
N NTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
ANY AND
I-ANDSCAP NO
I EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM
Z ALLCLAIMS FOR DAMAGES OFWHATEVER NATURE. ARISING DIR —
INSPECTION FEE
CEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAIN CHECK DEPOSIT
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REGUIREMENT OFANYCITY ORDINANCE
E NOR LIMIT IN ANY WAY THE CITY S ABILITY TO ENFORCE ANYORDINANCE PROVISION'
TOTAL AMOUNT DUE
R
[HERE ACKNOWLCDGET AT I "E READ THIS APPLICATION: THAT THE INFORMATION
'A I
By H
GIVEN IS CORREC D "AT - THE OWNER. OR THE DULY AUT.ORIZED AGENT OF
'T AN T T
T,
7 E OWNER. I AGREE To C. WITH CITY AND STATE LAWS REGULATING CONSTRU C.
C. V
CALL
TIO�. AND IN E YWA.U"l HORIZED THEREBY NO PERSON WILL BE EMPLOYED
W
0 IN RELATING TO
FOR INSPECTION
IN VI OLATIO' CODE OF THE STATE OF WASHINGT
Won KMEN*SI AND RCW 18.27.
OFFICIAL
ZNCE
(OWNER d4GE�
NED
(425)
771-0220
RELIAS
EXT 1333
IT IS LIN W 0 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
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so ATURE DATE
ED 84' D
ORIGINAL -FILE . y,jICW.INSPECTOR
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