20010671.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME.AME OF BUSINESS
MMZ,
� F�- A
CITY q?
El NE
ITI I PERMIT EXPIRES
use
'ONE
P RMIT
2-
NEUMBERMN-067,
ADDR
,Do 2V4d
SUIT -IT,
FILAT NAMEiSUBDIVISION NO.
LOT 10,
Ll N
I
FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
_LID
7� R.100
I,1 A.,
EXISTING — PROPOSED
—
RE UIRED DEDICATION—
FT
NO-OF111TURIS
VIIIIU18ED
I YESC3 No
R MARKS
Gw�ONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
FIRE REVIEWED BY
DATE
-
LOT FO—VERAGE
I REQUInEDSET.rlB,11
PROPOSED STSACK&A(FT)
• NEW
[jr<EWIDENTIAL
PLUMBING I MECH
ALLOWTID PROPOSED
FRONT SIDE REAR
FRONT UR SIDE F R
I
• AUDITION
C3 COMMERCIAL o C MPLIANCE OR
CHANGE OF USE
I
PARI
ING
LOT AREA
PLANNING REVIEWED BY DATE
• REMODEL
0 APARTMENT 0 SIGN
RED
FLO
PROVIDED
I
I
I
0 REPAIR
0 FENCE
X FTI
X FTJ
MARKS
0 DEMOLISH
0 TANK
0 07HER
IWAILL
0 REN—WAAL
oGARAGE
CARPORT
0 %�KIN
F
(TYPE OF USE. BUSINE=L,UN:
�A
CHECKEDBY
ITYPE;tWXN
1C E OCCUPANT '7
7 1 GROUP k-7
NUMBER
OF
NUMBER.
D
IT S A.
AR —�H
CA.
SPECIAL INSPECTOR
P
OCCUPANT
OF
STORIES
UnELLING
"EAS
UMBE 11I)tj
N MBE
JAPEA
REQUIRED 0 YES
LOAD
PER UBC
VALUATION I FEE
PLAN CHECK FEE
GLAZING %
LOTSIOIJEIIUI
LD' NO
PLAN CHECK NO:
IVISTED DATE
PLUMBING
PLUMBING
i i
MECHANICAL
C
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK 70
US
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
3 DOMAIN (CURBS. SIDEWALKS, VEWAYS MARQUEES. ETC) WILL REQUIRE
URI U
SEPARATE PE0115sioN.
V-'j'U ... AF.E
U
PE MIT APPLICATI N: 180 DAYS
PERMIT LIMIT. AR. PROVIDED WORK IS STARTED WITHIN 1411 DUB
I YE
END, REVIEW FEES
SEE BACK OF PINK PERMIT FDR MORE INFORMATION
ENG. INSPECTION FEE
ON BEHALF OF HIS OR HER SPOUSE, HEIRS� ASSIGNS AND SUCCESORS
—LANDSCApiNG
;APPLICANT
1� N NTERE ST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS SHINGTON, ITS OFFICIALS. EMPLOYEES ANDAGENTSFROM ANYA411
ALLCLA FO E. ARISING DWECTLYORINDIRE
lMiWAR DAMAGES OF WHATEVER NATUR C
INSPECTION FEE
�RECEIPT
III FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
DEEMED TO MODIFY� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY S ABILITY TO ENFORCE ANY ORDINANCE 'oV'SK`N
CEIIT
15V
T' TAL AMOUNT DUE IR
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
APPLICATION
APPROVAL
T. A D T AT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
GIVEN IS CORREC T
N " A.
I AGREE TO COMPLY WIT. CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
T
THEOWNER
.y .
T ION, AND I N DOING THE WORK AUTHORIZED THE REBY, NO PERSON WILL BE EMPLOYED
DOp,IY I'll,
, I G .
IN VIOLATION OF THE LABOR CODE OFJHE STATE OF WASHINGTON RJELATINGTO
FOR INSPECTION
focelP!IsacknowIodQ.dFp.
WORK�ENSCOMPEN=SURAN ANDRCW18,27
E TE
sl I (OWjr
DATE SIGNED
(425)
GFI6N
I
"AG
771-0220
RELEASED By DATE
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
I NSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
771-0221
1
ORIGINAL - FILE - YELLOW - INSPECT R
A FINAL
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
Else
z
0 j
m
m a
-1 0
0 0
m
O'n
nj
r M
n
0
0
0 F,
O�
z
rj)
z
m p
, M
"J -W, I
r
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
66 I*irisulation
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final
HEATING:
LO (2.
Gas Test ....................
0 L&tga_
Gas Piping .................
Equipment .................. .
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
_07 -
FINAL APPROVAL FOR
OCCUPANCY ..................
joo /a, 064 71pe
"'N
M
M 0 !,
0
171
to -4
C Z
co)
0 n
n
M M
8 rn�
C
z
8
11111
0
PERMIT
EXPIRES
I I
CITY OF EDIV16fbs
USE
ZONE 2-
PERMIT
NUMBER
2Z/ 067/
JOB
ADDRESS 6120
4A�TO
ITEIAPT*
5�s_ —
CONSTRUCTION PERMIT APPLICATION
OWNER NAME�IAME OF BUSINESS
Pi -AT NAME/SUBDIVISION NO.
I LOT NO*
11 0.
LID FEE I
I MAIL
PI1.11. R ,-IT OF Way PER OFFICIAL
STREET MAP
Tedaae
P II'd
=Rae-aw
EXISTING � PROPOSED�
REQUIRED DEDICATION—
FT
0
In
N
METER SIZE UNE SIZE
NO.OF1I-URES
PR1V'F!;.UIRED
NAME
I
YES C3 NO 0 .3
ADDRESS
KS
REW ARKS
NER-ICONTRACTOR RESPONSIBLE
OW RA
FOR EROSION CONTROUDRAINAGE
CITY, '21P.
ITELEPHOtf
NAME
TELEPHONE
41�7c—_ -,
LICENSE
DATE
IF Xp
'P
M
c-
a
I MECH
TT zAGE
V
REQUIRED SETBACK$ (Fr.)
FRONT SIDE REAR
PROPOSE SETBACKS(FT.)
FRONT URSIDE R R
0 NEW LUMBING
(3--.E.I.ENIIAI
ALLOWED PROPOSED
PR
0
C MPLIAN E OR
0 ADDITION 0 COMMERCIAL CHANGE OF U E
LARK
C)
PARKING
PROV
RED D PROVIDED
I
EA
JPILANNINGREVIEWFOSY DATE
I I
E3 REMODEL C-] APARTMENT SIGN
m
GRADING C] FENCE
X PT)
REPAIR CYDS x PT)
10
ARKS y
S
— —
0 DEMOLISH 0 TANK o OTHER
0 RENE
Ap� RETAINING WALL FIENE
G.A9eGRT
't-JA
_XgRy
03
r"ICKE05Y
OCCUPA.T"e
(TYPE OF USE. BUSINESS OM) EXPLAIN:
a
gN
ITYPE=;W
GROUP
m M
at UMDER
NUMBER I OF
WELL NO
OF 6jr,�
A!AL
TIC L
ITICAL
CR EA
AREAS
SPECIAL.INSPE.TOFI
COCU PANT
LOAD
N T.'
NUMBER
JAR�A
EGLI R
R C] YES
-
0
0
0 Fn
1
DESCR;EW 2-5 rL)
BE D��Ej
i
REMARKS
PROGRESS INSPECTIONS PER UB I 081FINAL INSPECTION REOM iS
0
VALUATION
FEE
PLAN CHECK FEE
z
_70
HEAT SOURCE GILAZING I LOT SLOPE %
jTHS
BUILDING
PLAN CHECK NO: [ITE11111
PLUMBING
m
MECHANICAL
THIS PERMIT AUTHOFIdES ONLY THE WORK NOTED. PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
D L REO IRE
OMAIN (CURBS. SIDEWALKS. DRIVEWAYS. MARQUEES ETC.) WIL
SEPARATE PERMISSIPM j
GRADING/FILL
ER ITAPPLICATION! IMIDAYS
P M
PERMIT LIMIT: I YEAR, PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. REVIEW FEES
V
AIPUCANTjON BE"ALFOI HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
;NNTERES . AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY .1
M EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANYANO
ALLIC-AIMS FOR DAMAGESOF WHATEVER NATURE.ARISING D
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
GEEMED TO MODIFY. WAIVEOR REDUCEANY REOUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISI ON.'
ENG. INSPECTION FEE
LAND A NO
'C P'
INSPECTION FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DL
RECEIPT
I
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
GIVEN Is CORRECT. A D THAT I AM THE OWNER OR THE DULY AUTHORIZED AGENT OF
THEOWNER. I AGREE TO COMPLY MT. CITY AND STATE LAWS REGULATING CONSTAUC
TION. AND IN DOING THE ING RK AUTHORIZ ED TH ERESY, No PE ASON WILL BE EMPLOYE D
IN VIOLA71ON OF THE LABOR CODE OF�JHE STATE OF WASHING70N RELATING TO
WORKMEN S COMPENS �I�NSURANCEIkND RCW 18 2 1 GAII SIGNED -
SIGNA,16AE CWNE�
/.;( , I VVI I 1
APPLIC&ION APPROVAL
CALL 'ng an add
8u0,"3OHp,',,I e, ne, Deputy: and Fees na F.Id. and
FOR INSPECTION "".Pt p. Fdod.
OFpF
(425)
, 5 � & �/,
-0220 DATE
771 RELEAS(FO By
ATTENTION
EXT 1333,
IT IS UNLAWFULTO 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
ORIGINAL FILE YELLOW -INSPECTOR
PINK - OWNER GOLD - ASSESSOR
,I).