20010708.pdfDATE RECEIVED
w
PERMIT EXPIRES
PERMIT
CITY OF EDMONDS
ONE 'LIMBER d&�Z-4
CONSTRUCTION PERMIT APPLICATION JOB
SUITEIAPT'
ADDRESS
0 ow INESS
"T%�;2�;'7_u
.7
PIT NAM EOSUBDIVI SION NO,
Ll NO.
-MAILING
7)
!"
t
LID FE
ADDRESS -
fl; "It e, A"kf r VIC-
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED —
00
0
SH...11 llq.l.d
CITY
TELEPHONE
REQUIRED DEDICATION— FT
IM�Ml'.�d.d
SIZE
LINE SIZE
NO. OF FIXTURES
REQUIRED
NAME
YEPRV
13 NO 13 5
ADDRESS
6WNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY
1�pe B or L ven connec ors
ml�ulrcu ul.—I-Ournuir, uppliall,
NAME
blbiefI9&E.ATE
ENGINE
nustcu ginues.
ADDRESS
/I 5-ey AIV 5,11;1. 10i
FIRE REVIEWED BY DATE
C IT
AAIANCE OR C SHOREUNEORADEM INSPEC BO 0
STATE tICENSE NUMBER 11111AIIIN
T
11
EaTION
R .1
POSTED
A P Vkl_rm 5-3 50
ONO
SEPA REVIEW
SIGN AREA
HEIGHT
-OMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO.
UP I
I
I
T OV F
LO C E AGE
REQUIRED SETBACKS (M.
PROPOSED SET ACKS(I.T.)
0 NEW
RESIDENTIAL
LUMBINGIMECH
ALLOWED PROPOSED
FRONT SIDE FEAR
FRONT UR SID E REA
0 ADDITION
COMMERCIAL
COMPLIANCE OR
C ANGE OF USE
PARKING NO REVIMED BY DATE
REMODEL
0 APARTMENT
C3 51GN
PEGG I PROVIDED.
El OR FENCE
E] REPAIR AGING CYDS ( _ _ FT,
P.MA.-
DEMOLISH TANK OTHER
oGARAGE RETAINING WALL 0_ RENEWAL
CARPORT R-KERY
(TYPEOFUSE.BUS ESSORACTIVITY)EXPILAIN:
CHECK ED
CON TRUCTION
01 SACTIl
OCR C
BLITYP�
OU
JCOD' P
I? U�AN
NUMBER N UMBER OF IRIETAIC I
CIALI� -------
OCCUPANT
OF WELL NG
AR
LOAD
0
NITS
EAR
DESCRIBE WORK TO BE DONE
REMARKS
INSPECTIONS PER UBC 1081FINAL INSPECTION FIEWD
ROGRESS
<
lbvwL-�-- 4w
VALUATION FEE
Wit 1 f.5 0 z
4�,
PLAN CHECK FEE
HEAT SO
�� I
BUILDING
hd 17 �
PLAN CHE9K NO:
VESTED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
T'ON ON THE PUB UC
E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
BOMAI"
GIADIN""LL
GRADINGIFILL
ETC I WILL REQUIRE
ICURBS. SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.1 WILL REQUIRE
SEPARATE PERMISSION.
-JAIZSURCHARGE
PERMIT APPLICATION: 180 DAYS
'T". ". DAYS
P MIT LIMIT. , YEAR . PlOVIDEDW RK IS STARTED WITHIN 160DAYS
R 0
END REVIEW FEES
AT'ON
SEE OACK OF PINK PERMIT FOR MORE INFORMATION
.N. AN. SU"-ESOR-
'APPLICANT ON BEHALF 0 HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
ENG INSPECTION FEE
HARMLESS THE CITY OF
N E E A EE INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY Of
'NT ' 'T OR S To
LANDSCAPING
AGEN,E,.OM ANY AN.
0 OD, . WASHINGTON 'AlS. EMPLOYEES. AID AGENTS FROM ANY AID
INDIRECTLY
'NE,-ECLY
INSPECTION FEE
�ITSOF"C _ NATURE. ARISING DIRECTLY OR
L .S'. AMA-E OF WHAT E R .,REC,LyOF
A E
A E OF THIS PERMIT SHALL NOT BE
F 0. THE ISSUANCE OF HIS P IT IS � T .
IT
PLAN CHECK DEPOSIT
'L NC
RECEIPT
FE.EIFT
GT..O "Y . WAIVE OF REDUCE ANYSURENOCUIREMENT OF ANY CITY ORDtNANC
E E-E -
C Ty S B'UTY
c N R AN HE A TO ENFORCE ANY ORDINANCE PROVISION.'
. LM"'N Y WAY T I
TOLTAL AMOUNT DUE
....
R E
I HEREBY L E ME READ THIS APPLICATION. THAT THE INFORMATION
APPLICATION APPROVAL
;HATT : A.A�,E
GIVEN S=T AND HE OWNER, OR THE DULY AUTHOR12ED AGENT OF
T"' .101-1— 11 - - P-1- M`I-I III P"
THEOWNER 1AGREETOCOMPL' WITH CITY AND STATE LAWS REGULATING CONSTRUC-
EMPLOYED
CALL
BuI lhlIDlPlIY ldF ... ... p,,d
TION AND IN DOING THE WORK A.TH RIZEDTHEREB'. NO PERSON WILL BE
THE OF WASHINGTON RELATING TO
FOR JINSPECTION
1011-P X1.1-god.P ... 11 P-1,11d
A STATE
IN VIOLATION OF THE LABO CODE OF
WORKMEN S COMPENSATION INSURANCE AND RCW 11127
02, IIGIAT DATE
N A T�
DATY
(425
(425)
S N
1 0
7 71-0220
RELEASED By
EXT 1333
NTION
LNL FUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
1
ITIJ CERTIFI- FIGI INSPECTOR
A F NAL INSPECTION HAS BEEN MADE AND APPROVAL OR A PINK -OWNER - GOLD -ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX
5�8
z
m
am
co
m
0
80
c
m
io
0 _n
m M
0
0
0 Fn
z
0
m
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Foatlng ......................
wall..........................
Pier/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 ..................
Zool 0 709v'
IN
z
0 M
lin
Z,
0,
rn M
0)
0)
Z
M
CITTOF EDMONDS
CONSTRUCTION PERMIT APPLICATION
0,
P=WT
MAILING ADDRESS
-F;rf e
CITY ZIP ITELEPHONE
10 F;;;�;;IRE
1-11.
USE
ZONE PERMMBIETR
7
JOB
SUITEJAPTN
ADDRESS '7
PLAT NAMEISUBDIVISION NO.
LOT NO,
LI NO,
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
WIPIZ1.117—
........ ..
EXISTING— PROPOSED—
._..2
0
REQUIREDDSIDICATION— PT
cl
METER SIZE
LINE SIZE
NO, 01 FIXTURES
REQUIRED
I
L
EPRV
SO NO 0 3.
ARKS
OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROU—N
T.. R nr L vent COnnectOrS
NAMAWVA,e
required on lu ei-ourglins -vv
ENGI VWheated sp
FIRE R BY DATE -
ADDRESS
1 57ig y 1kv ff, Y.,* /,D/
CITt4 zip
7
d%
TELEPHONE
M 51777
JEVIEWED
VARIANCE OR CU
SHORELINE OR ADB#
ON
p" N
P ED
RE.
NO
BOND
POSTED
STATEILICENSE NUMBER xFIIUN DATE
14.PV 3 o 14 NI
AgLr�.i
CHECKEDBY
&(./
1 dkl-
SEPA REVIEW
S
COMPLETE I EMEMPT
Exp
SIGN AREA
ALLOWED , PROPOSED
H61GHT
_= PROPOSED
PROPERTYTAX ACCOUNT PARCEL NO.
14�910044
0 NEW
RESIDENTIAL PLUMBING I MECH
LOT COVERAGE
OW
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE AFAR
PROPOSED SETBACKS I".)
FRONT �L/R SIDE AFAR
0 ADDITION
I& REMODEL
0 REPAIR
0 COMMERCIAL o C MPUANCEOR
CHANGE OF USE
0 APARTMENT 0 SIGN
0 FENCE
0 RADIN. YDS x FT)
A_ PARKING
EaD I PROVIDED
�LANNUNQ F& bF5 ATE
RENA.- E; 1112 a ka" U'L� lk &A cu
[j DEMOLISH
[:) TANK o OTHER
0 GARAG E
CARPORT
r-I RETAINING WALL
— ROOKERY
0 RENEWAL
TYPE OF USE.. �Us, EBB 0 ACTIVITY) EXPILAIN:
C"ICKEDRY
IT:YPOFACOIITRUCTION
&
ICODE I 11U I;tl
`?2 Group
ITICAL
EAS
MBER
0 _ir
A
S
REA UPANT
3
DESCRIBE WORK TO BE DONE
REMARKS
P ROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RECI'D
I
n��
"Utgo,
VALUATION FEE
Y_ j�la� *622
11-1 ,
H E K
PLAIN CHECK FEE
ILA N C c
HEAT SOURCE IN.
LOT SLOPE %
U 'L I N
7kP
A4 f. *13
B N G
PLUMBING
L U
PLAN CHEerk NO:
VESTED DATE
AN I c AL
MECHANICAL
M E C
THIS PERMIT AUTHORMES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN 5, SIDEWALKS, DRIVEWAY , MARQUEES. ETC.) WILL REQUIRE
(CURB S
SEPARATE PERMISSION.
A I L L
.AAD N."ILL
A
A C A A G
SURCHARGE
U
PIE IT.IP.CATI..: ll..AYS
PERMIT LIMIM I YEAR - PROVIDED WORK IS STARTED WITHIN 150 DAYS
SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION
EN A V w F E E S
E E
END REVIEW FEES
G
N.
N P E T I. FEE
ENO. INSPECTION FEE
END
3
'APPLICANT. ON BiHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
x EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
A CMMS FOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
LL
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PEr.IT SHALL NOT BE
E E
DEEMED To MODIFY. WAIVE OR REDUCE ANY A OUIAEMENTOFANYCITYORDMANCE
01 NOR LIMIT IN ANY WAY THE CITY*S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
S Ap I NO
LA NOSCAPING
LA. -
N ' EE
INSPECTION FEE
IN., E. T 0
K E S
PLAN C. C C PC IT
PLAN CHECK DEPOSIT
RECEIPT
T TAL AMOUNT DUE I-
T., NT CU
0 A A 0. E
cnm4:�/
75—
'ErE
I HEREBY ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION. THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT AM THE OWNER, OR T E DULY AUTHORIZED AGENT OF
Cl H C
T EOWNER. I AGREE TO COMPLY WITH TY AND STATE LAWS REGULATING CONSTRUC-
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE Or WASHINGTON RELATING TO
CALL
C L
P CTIC
FOR INSPECTION
APPLICATION APPROVAL
C -4.,g b,
011. F.Iy:,:PdFev,,d.,,d
—p—d.d.
Oa?IICNAT;"I� DATE
WORKMEN S COMPENSATION INSURANCE AND RCW 18.27
(425)
N R A
D ESI9fNED 1
'N ZT)
1 0 0
771-0220
EXT 1333
RELEASE. BY DATE
6
A*lNTION
T I?UNLAWFUL TO USE OROCCUPY A BUILDING OR STRUCTURE UNTtL
I 'T, LAw
771-0221
1
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
"B x
z
0
cl m
S
m
-4 0
0 0
C
� m ;..
In m
z
O"Al
m M
0
p Fn
z
z
9
0
m