20010738.pdfI
i , " , " , EI, '.'-Z
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
6
CITY
cc� --ck-
NAME
&'1 14
ZIP 1111EPHONE
A S4 L-i
:ENSE NUMBER EXPIRATION DATE 0
CW,4HP9��1)4 G� &A (
PERMIT EXPIRES
USE PERM T
ZONE Alm i
Joe
ADDRESS T a 0
PLATNAMEISUDDIVISIONNO. LOT NO. 111) NO -
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
U.:
EXISTING — PROPOSED
REOUIREODEDICATIO�_ FT
I REQUIRED
NO 13
REMARKS
OWNERICONTRACTOn RESPONSIBLE FOR EROSION CONTROUDRAINAGE
PURSUANT TO ECDC 19.30-021)
APREZbUlmRbuMMftVlk9ffik'"
QuAl I RE Aij.ED NEAR
Tm WATOltli=FF
ENGINEERING EVIEWEDiDAT
FIRE REVIEWEDBY DATE
VARIANCE OR CU I SH20MRSWMEC W:!!$!# 41INSPECTI.N 801
NEW
NT'A L
ESIDENTIAL
S
>� -
'D E
MEIN
PL BING f MECH
U "'MICH
X—
T
LOT C
L o
A L' D
ALLOWED
o W E
ADDITION
AL
COMMERCIAL
C o M E RC,
I CE OR
C.L PL.NCE .11
MPL AN
E OF USE
CHANGE OF USE
CH N
Co
PA
REQ D
'A
A RA T EN T
REMODEL APARTMENT 0 SIGN
E
R ON
0
G
E] REPAIR
OR A .I No
GRADING .,B.
FIE C
PENCE
N
X FT,
I X FT)
I
-A.
MAR
[3 DEMOLISH
0 TAN
C:] OTHER
ciGARAGE
CARPORT
M R BAINING WALL
E] RENEWAL
TY
ITYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN
j
[L
CH c
NUMBER
OF
LJ
R
E OF
�E NG
`u L,
ICAL
A
cN RUE'NAISE
SPECIAL
STORIES
ITS
R
F E.UFE
REQUIRE
DESC RlBE WORK TO
BE DONE
RKS
r A.,
11 lj� /I,
olle
cl 1)
P .
R
% 'w OYES 0�0 �
IN ARIL v HEIGHT
J.!�O.SAEO ) ALLOWED PROPOSED
BACK I_
_ PROPOSED SETBACKS (Fr.)
R R FRONT UP SIDE REAR
PLANNING REVIEWED BY DATE
MT �m f1pr 605 9
SEVICR SHUTOFT
PER
GROUP ,
OCCUPANT
LOAD
PLAN CHECK FEE
PL A C H C K
HEAT SOURCE GLAZING %'44144111
U 'L D N G
PLAN CHECK NO:
N
PLUMBING
LU M G
-A N "A L
MECHANICAL
E C
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THI ...... T C. ERE WORK To
CT.. ON THE .. U.
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GAADINGIFILL
AD N LL
DOMAIN (CURBS. SIDEWALKS. DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
3 SEPARATE PERMISSION.
URCHARGE
T
PE MITAPPLICATION: NIQDAYS
IT
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PEnMIT FOR MORE INFORMATION
ENG. REVIEW FEES
END. INSPECTiON FEE
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
T
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
a EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANYAND
INSPECTION FEE
E ALLCLAIMSFOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
4 T PERMIT SHALL NOT BE
z FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PF
PLAN CHECK DEPOSIT
RECEIPT
To ANY CITY ORDINANCE
DEEMED To MODIFY. WAIVE OR REDUCE AN' REOUIRFMENTO
NOR LIMIT IN ANYWAY THE CITY S ABILITY TO ENFORCE ANY ORDINANCE PROVISION�
TOTAL AMOUNT DUE
IREC7)?&,,g
I HEREBY ACKNOWLEDG6 THAT I HAVE READ TMSAPPLICATION� THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
CONSTRUC
bpy Ilhd'
THEO NER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING
W BE EMPLOYED
NO PERSON W11
CALL
,d
T ION. ANDIIN 00' NG THE WORK AUTHORIZED THEREBY.
IN VICLAT ON OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING To
FO R INSPECTION
WORKMEN S COMPENSATION INSURANCE AND RCW 18.21
ATURI DATE
s.
(425)
WICIALSSI
771-0220
RELEASEDBY IATE
ATTENTION
EXT 1333
ITISUNLAWFULTOUSEOR 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. LEG SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
5198
z
0
4 - I
0
M
0 m
c a
m 0
0
m m
_z
ca
O.m
mm
p R,
c ca
rj)
0
z
m
MEMORANDUM
Date: November 13, 2001
To: Beth Duvall, Accounting Assistant
From: Marie Harrison, Building Departme
Subject: REFUND
Beth, please prepare a refund check in the name ofNorthwest Permit in the amount of $55.00.
The permit #2001-0738 was issued 9127/01. The applicant has requested the permit be
withdrawn. Per Uniform Building Code Section 107.6 Fee Refunds. The building official may
authorize refunding ofnot more than 80 percent ofthe permit fee paid when no work has been
done under a permit issued inaccordance with this code. Please mail the check to Northwest
Pemiit,23201"Ave#250,Seaftle,WA98121. I have enclosed a copy of our receipt #18402 for
your records. Thank you.
Sincerely,
*a.Uiekiison
Development Services Division
City of Edmonds cza Comm,
nity Services
0 , 16
77 i
.10
W
rni:.
m
C",
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
7".;
SETBACKS .......................
FOUNDATION:
Footing .............
wall ...............
Pier/Porch .............. 7....
Retaining Wall . ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...............
Commercial Final
HEATING:
Gas Test
Gas Piping .................
Equipment .................
commercial Final
E)(TERIOR SHEATHING
NAILING .................
FRAMING ............... ...
FIRST.FLQQ f.RAMING
INSULATION ....... . ..........
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
.1 i R,
z
0
lom 1
0
ITI
C
0
M
C
M
PIP
10F
AECEIVED,,/
e
r�2
Cj/�2
r
r
.1
P ERMIT EXPIRES
CITY OF EDMONDS
USE E PER 'To
ZON Ml
NU BE
CONSTRUCTION PERMIT APPLICATION
SUIT
IDS FIESS F,/ft
ADD 5 vo v) lo !� -r got
OWNE,L!�7AME OF BUSINESS
I 6 1
1
PLAT NAMEISUBDIVISION NO
LID NO.
UO
LID FEE 5
X
MAILING ADDRESS
-�- � �, 5-4
(
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
P—m_ 13
._V,.P_j 14.
C
; ",
CTY ZIP
ONE
EXISTING — PROPOSED
o— 0
ITELIP
I.
d
10 �' 7
REOUIREDDEDICATICN— FT —
==. n
METER SIZE
LINE SIZE
NO,OFFIXTURES
RV REQUIRED
NAME
1,J)
I
I
IE: 0 NO 0
ADDRESS
HEMARXS
OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROL(DRAINAGE
a
PURSUANT TO ECDC 19.30.020
CITY ZIP
ITELEP ... E
APRMURER ULAIURVALVE(PRV)
'if
Tm WkTER SHMFF
ty 0141f k114
ENGINEERING FEVIEWE—E
'ADDRESS
" '
13o3 5'
NE
ZIP TELEPHONE
tj)� -o',
It 7�-7 _
�oo(l cla - �l q-OL/
T
STATE LICENSE NUMBER S.I.—II.N.ATE CH CKI
A6 cwo HF`9�2 Q CH
0;
PROPERTYTAX ACCOUNT PARCEL NO.
00scl C"g 000,,)o loe
NEW >( RESIDENTIAL COLU.
P:,..
NO
ADDITION COMMERCIAL 0 CHANGE OF USE
0 REMODEL 0 APARTMENT 0 SIGN
C] REPAIR 0 GRADING CYDS F NCE
C] DEMOLISH 0 TANK OTHER
ciGARAGE M RETAINING WALL RENEWAL
CARPORT LI ROOKERY
Is
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPILAIN:
IL
NUMBER
OF
STORIES /
E. OF
�ILI'ICF
jLLIN.
r �/ZAS
C�IITICA
IT'
CAR -
MBE
IUM�
DESCRIBE WOOK TO BE DONE N,
— rl.tm 10 AM
FIRE REVIEWEDBY N DATE
ELI OR ADBN INSPECTION I BON"
F'ANC 'C REO-D POSTED
= HEIGHT
CO.FLETE EXEk D PROPOSED ALLOWED PROPOSED
:xp IL I L
ED SETBACKS (FT.)
LIR SIDE FEAR
LOTAREA 11.NING_ DATE
B F
jTlP.F/ij;7 -7Z I . .....
1�41N 1
GROUP
NSPECTOR
)0 JAREA LOAD
YES O,OU
WjqjjVWAL INSPECT]
RegarcMess of whether the water systen
I is open or closel, expansion lanks are
PLAN CHECK FEE
BUILDING
PLUMBING
PLAN CHECK NO: ED DATE
THIS PERMIT AUTHORIZES ONLY ORK NOTED, IS PERMIT COVERS WOn TO
PER ANYCON UCTION ON THE PUBLIC
BE DONE ON PRIVATE PROPER
GRADINGIFILL
DOMAIN (CURBS. SIDEWALKS, DRI MARO S, ETC.� WILL REQUIRE
3'
SEPARATE P SIGN.
PERMIT APP LICAnON; 180
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STA T ITHIN 190 DAYS
SEE BACK (IF PINK PERMIT FOR MORE INFORMATION
NO. REVIEW FEES
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
IN INTERESt AGREES To INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
NDSCAPING
2 EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMSIORDIIMAGESOFWHATEVER NATURE.ARISING DIRICTLYOR INDIRECTLY
I SPE TION FEE
SH 8
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT ALL HOT E
LAN CHECK DEPOSIT
DEEMEDTO MODIFY. WAIVE OR REDUCE ANY REOUIREMENTOF ANYCITY ORDINANCE
NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANYORDINANCE
TOTAL AMOUNT WE
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGCKT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
TION, AND IN DOING TH E WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
OF WASHINGTON RELATING TO
FOR INSPECTI(
IN VIOLATION OF THE LABOR CODE OF THE STATE
WORKMEN'S COMPENSATION 1 NSURANCE AND RCW 18.27.
,
0
(425)
ME�_ 0 1
771-0220
*fTENTION
EXT 1333
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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
Sao
_UATION FEE
APPLI ATION APPROVAL
permil unlil.g.edbytre
Wdd�q Oftiml �l h,�., O.puly! IxI F... — ;M d. And
,pti—k ... Ildgld , sp— p—ded.
qICIALS SIG)4ATURE _ DATE
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
- ----- ---------
z
0 m
m
c
m
0
m m
a _c
0
C)
c
z
0
m