20010776.pdfffTi RECEIVE. I Z, I ol PERMIT EXPIRES
ZONE 17S_1 Z PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB ITE.PT.
ADDRESS QdGc4_A C =
PLAT N-11SU111111111 11 1 LOT 10. _) LION I
CIL �4 LID FEE S
MAILING ADDRESS TE.cPA,P.1
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP m P
,)_vv)� SIl-U_.NR.-,q=%.q1
EXISTING — PROPOSED— `H1....
ZIP R., "d
FE.UIAEDoED,CAT,ON— FT V.
NAME TELEPHONE %Eiiwsim I LII,IESIZ�_j MO.OFIIXTURES PRVAEOUIRED
E3 AD 0
-na,
ADDRESS REMARKS
-I*"* O..E.I..HlRACT.. F.P�1111_1 FOR EROSION CONTROUDRAIMAGE
ENGINEERING REVIEWEDIDATE
ADDRESS
E 304 U
FIRE REVIEWED By DATE
ZIP
1�;a u
TELEPHONE
5
�NRA`E--o-R—U
IARIAIIE CIR CU
SHCIELINI 01 AOBI
INSPECTION
RED D
'YES N.
80 D
STATE LICENSE NUMBER EXPIRATIOWDAT
9JQLT.0DQ 16DA
c
SERA REVIEW
COMPLETE EXEMPT
Exp I
A
N REA
ALLOWED PROPOSE.
I
ALLOWED PROPOSE.
-
'EL NO
71,TMACAff 0
E
E] NEW A �ISIDTIAL PLUMBING/MECH
COMMERCIAL C MPLIANCE OR
D CHANGEOFUSE
APARTMENT SIGN
GRADING CYDS FENCE
REPAIR X FT)
*-EMOLISH 0 TANK ci OTHER
GARAGE RETAINr WALL [3 RENIWAL
c 0 CARPORT
CAR ROD
LOT C VE AD
ALL.E. o PRR.POSED
REQUIRED SETBACKS (FT)
FRONT SIDE FEAR
PROPOSED SETBACKS(
FRONT UR SIDE REAZA
PARKING
RED D I PROVIDE.
LOT All EA
PLANNING REVIEWED BY DATE
_9E.AFKS
(TYPE OFUSE. BUSINESS OR ACTIVIT
r TYPE OF USE BU"N
A.
C"C
OcCUPANTD.2
F.Up
UMBER
OF
TOP, S
E
NUM Ell OF
D IN LLING
U NIE
TS
11TICAL FQ
REAS
NUMBEA
PEC JAREA
RED Al. INSPECTOR
RED
-E IRE 0 YES
OCCUPANT
LOAD
Q.E_1FU1P -
REMARKS
MA
PROGRESS INSPECTION$ PER UBC 1081FINAL INSPECTION REG'
iz c3rA % iv",�
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE GLAZING % LOT SLOPE
BUILDING
PLAN CHECK NO: ED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY ANY CONSTRUCTION ON THE PUBLIC
GRADINGfFILL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
—
SEPARATE PERMISSION.
P. AF�E
:;��
MiTAPPLICATION: 18GDAYS
YEPE
P. PERMIT LIMIT'. I All - PROVIDED WORK IS STARTED WITHIN 10 DAYS
ENG REVIEW FEES
SEE BACK OF PINK PE AMIT FOR MORE INFORMATION
ENG INSPECTION FEE
PPLICANT ON BEHAL AN. SUCCESORS
A F OF HIS OR HER SPOUSE. HEIRS. ASSIGNS
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY F
LANDSCAPING
EDMONOS.WASHINGTOH, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANYAND
A L CLAIMS FOR DAMAGESOF WHATEVER NATURE. ARISING D
L
INSPECTION FEE
FROM THE ISSUANCE OF TIAIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
IRECEIPT
I EEMlo T01O11FY.WAI1E OR RE1U11AN1 IEIUIIEIEITOF A"Y11TY11111AICI
. K.RL,.,TNA.y WAYTI11 CITY 1ADILITY TO ENFORCE ANYOIDIIANCE PROVISION'
.1
TOTAL AMOUNT
42
I HEREBY ACKNOW EDGE T. I HAVE READ THIS APPLICATION. THAT THE INFORMATION
APPUICATION APPROVAL
GIVEN IS CORRECT, AID THAT I A. THE OWNER, OR THE DULY AUTHORIZED AGENT OF
-1. P.1-1.1111 �11 b, —
THE OWNER I AGREE TO COMPLY Willi CITYAND STATE LAWS REGULATING CONSTRUC.
CALL
D,Iul, IF- .1. P.NI
TION. AND IN DOING THE WORK AUTHORIZED THEREBY. NO PE ONWILLBEEMPLOYE
I VIDL S'S L D
N AT`C` LABOR CODE OF THE STATE OF WA HiNnTON RE ATING To
FOR INSPECTION
_:p P--d
WORKMEN, ANON INSURANCE ANCRCW 18 27
DATE
SIGNATU WN ORAG9N I TE S GNED
(425)
771-0220
RELEASEDBY DATE
EXT 1333
A NTION
12 0/
I U'
L'WFLIL TO USE 08 OCCUPY A BULOING OR STRUCTURE UNTIL -0221
T N 771
A FINAL INSPECTION HAS BEEN A0E AND APPROVAL OR A CERTIFI-
IFIGNAL - 'ILE -
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK OWNER GOLD, ASSESSOR
911
z
0
om
c
M 0
0
c
'0
JOE
Om
m M
0 F_n
J
M n,
z
0
m
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pier/Parch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final
HEATING:
GasTest ....................
Gas Piping .................
Equipment .................
Cornmerclal.Finat
E)CrERIOR SHEATHING
HAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING
ff"S
Q-9 I
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Calling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
13 M
C)
a
M
Z.
to
0 n
171
Cal
0
Z
M
101
PEZIT EXPIRES
Lp.
lz
'94
CITY 0 FtDMONDS Z
/j7—/
PERMIT
Z NUMBERZDI—otr�&
p1l, L t:AITI
ADDRESS
CONSTR '60-11ON PERMIT APPLICATION JOB
OWNER"A"llN ME011USINESS
NA"EISUBDIVISION NO.
LOT NO.
LID NO.
v c Ck q 's
PLAT
LIDFEES
M
MAILINGAODRESS
s,-
PU BLIC A IGHT OF WAY P ER OFFICIAL STRE ET MAP
EXISTING � PROPOSED
AP—.d
P 0
13
ZIP
y6l -,,,ITILEPHONE
A
REQUIRED DEDICATION—
PT
R-
NAME
NO. OF FIXTURES
PAV REOUIRED
YES C] NO 0
,ADDRESS
EMARKS
OWNEWCONTRACTOR 51BLE FOR EROSION CONTROUDRAINAGE
ZL)6 r
CITY ZIP TEL�l
NAME
S"M \r
NSA=
ENG,
REVJEW�IDATE
ADDRESS
E F6 &y 1 5o9 (i
DATE
Fl.
CITY
HONE
425 5
m
z
VARIANCE OR CU
SHOREUNE O� ADE! INS�P�E.C!101 BOND
STATE UCENSE NUMBER
N.
POSTED
REVIEW
FlN AREA
HEIGHT
rp
COMPLETE EXEMPT ALLOWED
PROPOSED
AULOWEDol PROPOSED
OIL 1�
;7MACAM JOS D
E.,
LOT COVERAGE REQUIRED
SETBACKS (7)
PROPOSED SETBACKS,(M.
0 NEW.-
RE IIAL
PLU.SING�MECH
LOWED
AL PROPOSED
FRONT SIDE REAR
FRONT UPSIDE REAR
m
CE OR
0
COMIMER. AL
COMPLIA
c3 CHANCE OF USE
IT!
0
E3 SIGN
PARKING
0,
RE D I PROVIDED
LOT
AREA
PLANNING REVIEWED BY, DATE
80
c
0 FENCE
0 REPAIR 0 GID111 CYDS ( X FT)
-REMARKS
m
rn
�
OTHER
*DEMOUSH 0 TANK ci
I of
0 �
92
0 ARAG' E] RETAINING WALL RENEWAL
OARPORT
%f
v
C ROCKERY
(TYPE OF USE, BUSINESS OR ACTiVIWIM
CHECKED By
TYP
0
om
UION
JCJ" GCCUPMA3
ROUP
-n
,�,.,,NUMBEP
OF
W LLIN
D G
CRITICAL
ECIAL INSP C A AREA
OCALIPANT
Lo
Cm
0 TOP.
UNITS
T
D E
E RISEW R
EBB INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
0
cr) 'm
0
I ffir7l
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE
LCTSLOPE,
z
PLAN CHECK NO:
PLUMBING
c
MEC ICAL I
m
THIS PERMIT AUTHORIZES ONLY THE W RK NOTED, TH S PI TCOVEIIWO K TO
0
BE GONE ON PRW ATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLI C
rRAOING�FIL�
t:
..AN 'CUR.S. SIDEWALKS. DRIVEWAYS ARQUEES, ETC.) WILL REQUIRE
SEPARATE PER�ISSION.
URXAFGE
PERMIT APPLIC 'IW _iO"kS 'Z)
PERMIT LIMIT.- I YEAR - PROVIDED WORK IS STARTED WITHIN 80D S
EVNG.. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
12
-APPLICANT ON BEHALF OF HISOR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
ENO, INSPECTION FEE
1�
IN INTEREST, AGREES TO NDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF'
:TS ANY AND
LANDSCAPING
2
E MONDE. WASHINGTON� OFFICIALS. EMPLOYEES. AND AGENTS FROM
AULCLAIMSFORDAWGES FWHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
INSPECTION FEE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
IREC111T
PLAN CHECK DEPOSIT
T ". WAtVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
DEEMED OMODI
I N09 LIMIT IN ANY WAY THE CITY S ABILITY TO EN FORCE ANY ORDINANCE PROVISION.'
TOTAL AMOUNT DUE
RED
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER� OR THE DULY AUTHORIZED AGENT OF
CONSIOY�E%
-illip 1�1
THEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING
WILL BE EMPIL
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON
OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
0N.pt I, ,knowlIdgId 1. 'PIN P—ld0d.
IN VIOLATION ` THE LA 0 CODE
WORKMEN IENNSATQ. NSURANCE AND RCW 18.27.
D C
SIONATU WN OAAGE�T),
D E SIGNED
(425)
/1) J7_
771-0220
REL ASED BY DATE
ATTkNTI0_N---
EXT 1333
o
IT IS UNi[AWFUL TO USE OR OCCUPY A BUiLDING OR STRUCTURE UNTIL
771-0221
'
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI.
ORIGINAL - 'ILE IE OW - INSPECTOR
G LD,ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER -