20010772.pdfFc�TE FIECEIV�,
I
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER VAME�NAME OF BUSINESS
S �N Zk,� -
MAILING ADDRESS ?:3 N ID
CITY ZIP ITILEI"ONE
CITY ZIP
NAME
PERMIT EXPIRES Qhl�
USE
ZO PE
NE U T
N MM.E 112001 — q -7
JOB SUIMAPT,,
ADDRESS Kb
PLAT NAME'SU5DIVI SION NO I LOT NO. LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL S1 REET MAP
111*1111,
U.. I.- F.,
EXISTING — PROPOSED—
=g,11271*1
FEQUIREDDEOICATION-- FT
-"IDI'l C)"411 ENII
IF ADDRESS
2 Type B or L vent connectors
'_A-2-104 NE 17—LA IRE F Ereqidmd on fuel -burning applianew in
4�
q 8z'Ph4 20 — 5"g44 B unheated spaces. UMC 815.7
STATE LICENSE NUMBER EXPIRATION DATE C= IN !ANCE OR CU SHORELINE OR AGE, I INSPECTION
-N.
P 11 ... j"
-3� I-PoldiK
PROPERTY TAX ACCOUNT PARCEL NO.
Z:?Q-.7�z_4
SEPA REVIEW
COMPLETE EXEmPA I
EXP _SHAT'7_0BEfI
CSTA
RESIDENTIAL PLUMBING / MECH
COMMERCIAL C PLIANCE OR
ANIE)WDITION F CHANGE OF USE
REMODEL APARTMENT 0 SIGN
REPAIR 0 GRADING .,.B 0 FENCE IT)
C] DEMOLISH C:] TANK [3 OTHER
ARPORT .110TAKIN.Myr WALL
C] 'GARAG' El RENEWAL
C
LOT COVERAME
ALLOWED PROPOSED
PRR
-A.Mrs � -
FRONT SIDE
1
q
PARKING
RED 0 1 PRCA
I f 9 F"
PLANMN
ULAA
HIMA-P
nffl WATER S
(TYPE OF USE. BUSINESS OR ACTIVITY)
CHECKEDDY
JTYPE��
0 OF
STORIES , -
N M BER OF
DWELL NG
I UNITS I
A."MA"AL
NU...
ER IV
S1E.IA1E1D.EPECT.F
R E.0 F 0 YES JARIA
DESCRIBE WORKTOBE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC
C5TVftA6Jk_T 'gr-7 e
ITAi-rn
VALUATION
NO CI
IPOSTED
IT
PROPOSED
IYAPMUZU DATE
VALVE nv)
' '�AR
4-4'
rOFF
OCCUPAII�
GROUP
OCACDUPANT
LO
FINAL INSPECTION REO'D 5
IF
FEE
%J
PLAN CHECK FEE
HEAT SOURCE GLAZING I LOT SLOPE
BUILDN.
PLAN CHECK NO: rESTED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
z: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
a0MAIN (CURBS. SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
OTADING"ILL
SEPARATE PERMISSION.
A
PERMITAPPLICATI N: 16DDAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'A PLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
ENG INSPECTION FEE
IN INTEREST. AGREES TO INDEMNIFY. DEF END AND HOLD HARMLESS THE CITY OF
ANDSCAP NG
EDMONDS.WA HINGTON. ITS OFFICIALS, EMPLOYEES ANDAGENTS FROM ANYAND
I , PECTION FEE
IF ALLCLAIMS FOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE 01 THIS PERMIT SHALL NOT BE
DEEMEDT MODIFY. WAIVE OR REDUCE ANY REOUIREMENT 01 ANY CITYORDINANC E
ILAN CHECK DEPOSIT
N OR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION
CE111
TOI AMOUNH DUE
1� )j�q�'D I
I "11E1Y ACKNOW EDGE THAT I HAVE READ THIS AIPL CATION, THAT THE INFORMATION
[CATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AU1 AORIZED AGENT OF
THEOWNER I AGREE TOCOMILY WITH CITY AND STATE LAWS REGULA INGCONSTRUC
CALL
T= �.P
TION, AND IN DOING THE W ORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LAB F THE STATE OF ASHINGTION RELATING TO
30-g DIPIF" I., PJIP1 D-1, - F F-
FOR INSPECTION
WORKMEN SCOIMPENSAT E AND RCW 18 27
RE
.,c4&W—
jOW 0 GENT) DATE SIGNED
(425)
C, lZold j
��ATUFE
mvwl
_1U44%j
'DATE'
1 1 1
iELEASEDB'f
ATTENTION
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
IN SPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL nLE YELLOW -INSPECTOR
XAINAL
TE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK OWNER - GOLD ASSESSOR
0
In
a m
a
IT!
0
0
In
10
c:
0
n
m IT!
a
0
6
C
ma)
m
z
(j)
z
0
IT!
C)l 10
RiCORD OF INSPEanONS
INSPECTOR DATE APPROVED
SETBACKS .............
FOUNDATION:
1 Footing , ........... ..........
'Wall
PlerIPOrch ...........
Retaining Viall
Insulation'
Underground .............
Rough -In
...........
CommerclsjFInaI'�;----.
HEATING:
GasTest'..; ..........
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 ..................
t7a
El,
8
m
r
In
-1
0
m
m
a
'n
m M
Fn
z
0
0
M
:!j*jqATE RECEIVII6,
W �611k
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
III
MAILINGADDRESS
CITY ZIP ITELEPHONE
r___ r-) PA:F2n -1 v7 --I, K.-L-
:74
[PERMIT EXPIRES
US' IT
ZONE PERM
NUMBER 200- 0
JOB KbSUIT&APTS
ADDRESS I��Iq L_ ��a
PLAT NAME'SUBDIVISIONNO. LIONO.
-�FEE I
T%gCO ljv*Eft%r syst _A- .1 a
OWNearmpwmb - a P-1. 0
IMF 015 ... .. a
Aug "enO 69ffsWATJlfteeA_4sAks_ 0 e4" R-q"` 0
0 ICATIO e7 wm-w 0
"dod t=Ejqt 0 f.M TURES
�REOIIRED
No 0
REMARKS _R
OWNE
6; DRAINAGE
CON it connedors
"Mitred on fuel-WrIting IlIppIllinces In
NA.1,
OA' L Ak
VJP'VV-� kAeM-e�S UL 1AIC
ING, junmawu op--
N
"GIN
z
0
FIRE REVIEWED By DATE
4
LEPHONE
14
'.q'AT.A
VARIANCE OR CU
V A
641"DoN
8 OND
POSTE
STATE LICE BE NUMBER I-1-11ON DATE
cH Y
_0
6cmuw V�05-��Df 1-2-31 01
A
WATER SERVICE!
Humm..
SERA REviEw 5kij
COMPLETE E.EVPftq
ILL .811bINWALLE
&I ff
I [PWHPTROPDSED
�ROPERTY TAX ACCOUNT PARCEL NO.
IN?
rn
Zz_;�:7 CO) a 00 2-\214-00
FXP
I
C
rn 0
0
C.)
PLUMBING
NEW RESIDENJTIAL PLUMBING MECH
IV
LOT OV A
ALLOLoEDC ER GE
W, PROPOSED
LOW
I IFr.
REOUIREDSETBACK I
FRONT SIDE FEAR
PROPOSED ETBACKSEA(FT)
FRONT UR SIDE R R
1
0 C
0 ADDITION C3 COMMERCIAL COMPL ANCE OR
CHANGE OF USE
:2 r,
Fn
DPA RKING
RED PAovIDEJ rfdj
'WE
*M.30 .06
NT
REMODEL E] APARTMENT 0 SIGN
0
REPAIR GRACING CYQS C] I _X FT)
1
REIGULAMRVALVEMV)
R NbAR
o OTHER
C) DEMOLISH 0 TANK
0 GARAGE 1ITA.11ING WALL
CARPORT P C FRY 0 RENEWAL
0
n
rn M
a
0
0 rn
C 0)
(TYPE OF USE. BUSINESS OR Ac
cHECKEDBY ITYPEOM
I C77 [FPA T
N IZ:?
:;)
7 UMB E�R
IT Fl ,IS e
SIR OF
UL NO
�WME
UNITS
OR T CAL
AREA'
u ER /*
SPECIAL.INSPECTOR JAREA OCCUPANT
FE.0 R LOAD
0 YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS ER UBC 10871NAL INSPECTION REO'D
0
I,. e p I'Acie- (--7p6 Vo f�E� V\Epmr;�
e-N e-- 17
S 'B.
jlft� la
VALUATION FEE z
P C4GKfES
HEATSOURCE GILA21NG % LOT SLOPE % BUILDING m
PLAN CHECtfL_______ IVISTED CATS PLUMBING
MECHANICAL
lM"E=IrAUTHOFII2EE_C5_NLY THE WORK NOTED. THIS PERMIT COVER WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
no MAIN (CURBS. SIDEWALKS. DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
:3
SEPARATE PERMISSION.
�T�URCHARGE
PIRMITAPPLICATI N; ISODAYS
PERMIT UNIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. INSPECTION FEE
PLICANT ON BEHAL OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
-aN—DSCAPING
;A
NPINTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
D NDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
I Mo
ALLCLAIMS FOR DAMAGES OFWHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
INSPECTION FEE
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
DEEMED TO MODIFY. WAIVE OR REDUCEANY REQUIREMENTOF ANY CITY ORDINANCE
0 NORLIMIT INANYWAYTHE CITY'SABILITYTO ENFORCE ANY ORDINANCE PROVISION.-
CEIPT
Tc TAL AMOUNT DUE IR
lHERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
APPLICATION
APPROVAL
TA D THAT IA. THE OWNER OR THE DULY AUTHORIZED AGENT OF
GIVENBSCORREC ' THO R Z
N
I uMiI.19,Ibl
C
EGULAT,N. oNSTRU.
THEOWNER. I AD FEE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
Su"c
I N WILL E PLO, E,
TION, AND IN DOING THE WORK AUTHORIZED THERE By. NO PE RSON WILL BE EMPLOY
T'N. T_
T.N R L 74�
INGTON RELATING T
I
FOR INSPECTION
..k..wI.c9 pace pr—ded..
INVIOl_ATiO OFTHELAB QDDE OF THE STATE OF WAS.,
WORKMEN I COMPENSAT SUNNCE AND RCW IEL27.
OFlICI IA
ra" ME'
TIE 1
(425)
�LSSII BUIE
L4
RELEASED BI DATE
ATTENTION
EXT 333
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-
_"`7;rCuPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
ORIGINAL -FILE YELLO
PINK -OWNER - GOLD