20010805.pdfI
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
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STATE LICENSE NUMBER EXPIRATION DIE
A'
PROPE AC NT PAR
gErRESIDENTIAL
PLUMBING MECH
C] AUDITION COMMERCIAL r:) COMPLIANCE OR
C
CHANGE OF USE
REMODEL APARTMENT SIGN
REPAIR Cl 0 FENCE
!yj CID. X ITI
0 DEMOLISH TANK 0 OTHER
—
B�GARAGE -.M,�E�I'Ny.WALL
CARPORT RENEWAL
C] 0
(TYPE OF �&SINESS OR ACTIVITY) EXPLAIN:
NUMBER NUMBEROI CRITICk_
OW LLING AREASR
STORIES UNITS NUMBE
DESCRIBE WORK TO BE DOME
R
HEAT SOURCE
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LOT Sl_��W
____ I
PLAN CHECK NO;,)1_2
IIESTIO DATE
THIS PERMIT AUTHO IZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
to BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
I
W
DOMAIN (CURBS, SIDEWALKS. DRIVE AYS' MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 VMS
PERMIT LIMIT, I YEAR - PROVIDED WOR K IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
"APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUC.EF.RS
D
IN INTEREST. AGREES TO INOEMNIF`Y. DEFEND AND ROL HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITSOFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND L
ALL CLAIMS FOR DAMAGES OF WHATEIERNATURE. ARISING DIRE TIORINDIFECILY I
FROM THE ISSUANCE 01 THIS PERMIT. ISSUANCE OF THIS FE RMIT SMALL NOT BE
a DEEMEDT MODIFY, M116 OR REDUCE AMY RECUIREMENT OF ANY CITY ORDINANCE
Z;j NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
T
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
GIVEN ISCORRECTANDTH I AM THE OWNER. OR THE DULY AUTHORIZED AGENT 01
THE60WNER IA R ETOCO LY WITH CITY AND STATE LAWS REGULATING CONSTRUC
G ` MPLY
TION AND HE WORK AUT CRIZIED THEREBY. NO PE SON WILL BE EMPLOYED
I IN VI IN ING T
A
N V'-LATI F THE LABOR C E OF THE STATE OF WAS INGTON RELATING 10 F
WOR
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PERMIT EXPIRES
PERMIT
NUMBER — L) 0 L-71)
jos SU I TEAFT.
ADDRESS 9
DIFEES
PUBLIC RIGHT OF MY PER OIFICIALSTFE6T MAP
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METER SIZE
LINE SIZE
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YES 0 No 0
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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REVIEWED BY DATE
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PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D a
VALUATION FEE
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BULGING 10, L124!3 52 (e 1,
PLUMBING
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ENG REVIEW FEES
ENG INSPECTION FEE
ANDSCAPING
NSPECTION FEE
RECEIPT
PLAN CHECK DEPOSIT
OTAL AMOUNT DUE 11ECEPT
PP ICATION APPROVAL
CALL T�.1111 �� I., . ., �,_ " _
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OR INSPECTION � p,
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771-0220 , hl�tfASED BI rk — ___ `t
ATTENTION . f EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING Oil STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI. 771-0221 L
CATE OF OCCUPANCY HAS BEEN GRANTED. U.0 SECTION 109 oRIGINAL-FIle YELLOW If
518 FAX PINK OWNER GOLD ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .................. s--
FOUNDATI ON:
yyl <_�
Footing .....................
wall.. ........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation . ..........
PLUMBING:
Underground .............
Sough -In
Commercial Final
HEATING:
GasTest ....................
Gas Piping ...........
Equipment ...........
Commercial Final
E)ITERIOR SHEATHING
NAILING..........................
FRAMING ....................
FIRST FLOOR FRAMING
ANSULATION,; ................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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PATE RECEIVED
PERMITEXPIRES i
USE PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION IAODB SUITEIAFT-
OWNER NAMIUNAM . E OF BUSINESS DRESS
PLA U ID140j,01 LID NO.
LID FEE I
A�BIDD&
n-jjq6 PUBLIC RIG HT OF WAY PER OFFICIAL STREET MAP
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EXISTING
CITY
— PROPOSED--
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REOUIREDDEDICATION— FT —
.."—
METER SIZE I LINE
SIZE
NO OF RX%REr
P V REQUIRED
YES 0 NO 0
Nu)
ADDRESS
Avc
REMARKS
OWNERiCONTRACTOR RESPONSIBLE FOR EROSION CONTAOLADRAINAGE
AX
ITY
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"ENGINEERING
FIRE REVIEWED BY DATE
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COVERAGE
ALLDWED PROPOSED
REQUIRED SETBACKS (Fr.)
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PROPOSED SE7&BACKS I".)
FRONT URP
COMMERCIAL
OMPLIANCE OR
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REQUIRED C] YES i
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RE ARKS
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0 ESS INSPECTIONS PER UBC JOB/FINAL INSPECTION FIEO'D
0
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THIS PERMIT AUTHORIZES ONLY THE WORK THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
L REQUIRE
GRADINGIFILL
OMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WIL
SEPAPU PERPISSION.
PE AMIT APPUCAnONAIld 06)
PERMIT LIMIT. I YEAR PROVIDED WORK IMS STARTED WITHIN 100 DAYS
ENG. REVIEW FEES
SEEBACK PINK PERMIT FOR ORE INFORMATION
0;
OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
I
;NAPpLIElRAElST,.lAl.1EHlLl
NT A ES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
a EDMONDS. WASHINGT% ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALLCLAIMSFORDAMAGE OFWHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
INSPECTI EE
L ON F�
RECEIPT
FR M THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
0
PI A N CHECK DEPOSIT
DEEMEDT MODIFY, WAIVE OR REDUCE ANY REOUIREMENTOF ANYCITY E
0
I. OR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVIS11 N.'
N
TOTAL AMOUNT DUE
IRECEIPT
I HEREBY ACKNOWLEDGE THAT; HAVE READ THIS APPLICATION: THATTHE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
- , p,,,.t 11,1 11,1d by thl
THEOWNER CRETE TO COMPLY WITH CITY AND STATE LAW�l RFlIb AT", C-STRUC-
I ANG " NOPERSONWILLSE EMPLOYED
CALL
b,lb.
10, AND IN H TH
IN E=rAUyooRFZTGE B'TFAT F WASHINGTON FILATIN. TO
'
T"'D T
FOR INSPECTION
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NDV��,M�VIMPTEI N NCEANDRCWI'8027.
W ATio
C146
SIGNAI,#
,fWN�A
I DATE SIGNED
(425
it'
i I
771-uzzu
EXT 1333.
ATTENTION
IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
CTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- OR
A FINAL INSPE I.INAI� �,d - Y,
ELL.- IN
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109 FAX PINK -OWNER - COLD - ASSESI.A
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