20010810.pdfDATE 11111111
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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�PERMIT EX�PIRES
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FLAT NAMEISUBDIVISION NO. LOT NO� LID NO.
LID EEE S
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PUBLIC RIGHT OF WAY PER 0 FICIAL =STREETMAP P—a R
EXISTING — PROPOSEO�
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REQUIRED DEDICATION _ FT
17E�� IIIE NO. OF FIXTURES PRV EQUIRED
YES 0 No 0
DDRESS
CITY ZIP TELEPHONE
REMARKS [ON CONTROUDRAINAGE
OWNERICONTRACTOR RESPONSIBLE FOR EROS
GINEERING REVIEWEDIDATE
0. ADDRESS
FIRE REVEWEDBY DATE
MARS
iCITY
PAFSE F
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EC!0N I IOND.
VARIAN POST.
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STATE LICENSE NUMBER
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C3 NO
SERA REVIEW SIGN AREA
PROPERTY TAX ACCOUNT PA RCEL
ell 0j/
0
Co, PLETE I EXEMPT ALLOWED PROPOSED
LOT COVERAGE REQUIRED SETBACKS (FT)
SIDE REAR
0 NEW
PLUMBING t MECH
ALLOWED PROPOSED FRONT
0 ADDITION
COMPLIANCE OR
0 CHANGE OF USE
LOT AREA LANNING REVIEVIED BY DATE
C] REMODEL
C3 SIGN
REG D I PROVIDED
0 REPAIR 0 GRADING CY.S
0 'FENCE X FTI
REMARKS
KN
OTHER
C] DEMOLISH U,;
0 ARA E 0 RETAINRING WALL
GARPG.FT
C] RENEWAL
(TYPE OF USE. BUSINESS OR AC7Y) EXPLAIN:
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AREA OCCUPANT
LOAD
OF
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UNITS
NUMBER /AV/
REQUIRED E] YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 110SWIFINALINSPECTION R-EQ
as
VALUATION 'BE
HEAT SOURCE GLAZING I LOT SLOPE %
PLAN CHECK NO: VESTED DATE
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
AT PROPER I CONSTRUCTI.14.141H�PU.LIC
E Sl
=AA
GRADING"'LL
. MAR...ES, ETC.) WILL REQUIRE
3 080EDONEONPRIV
D YALKS
MAIN (CURBS. SI El
3
t:
ST� SURCHARGE
2 PERMIT APPLICATION: 180 DAYS
.1 PERMIT LIMIT: I YEAR - PROVIDED WO RK IS STARTEDWITHM 180DAYS
ENO, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENO INSPECTION FEE
0 ' LF 0 SOPS
A I AN N ERA F"ISORRER� IE E1.1.1�A.S"111AIDSUC I
P PL C T CITY OF
S;l �N`
22
RA THE
D . F.LE S
N NE EST - AGREES To INDEMNIFY, DE
I R FROM ANY AND
LANDSCAPING
FEE
'F , ALS EMPLOYEES. AND AGENTS
ED N.SS WASHINGTON ITS. IT"
OR INDIRECTLY
INSPECTION
- G" R NATURE. RISING DIRECTLY
A FOR AMA S FWRA EVE
LL SHALL NOT BE
DEPOSIT
NCAO PERMIT
.IS PERMIT E THIS
0 . THE ISSUANCE OF ISSLA
ANY CITY ORDINANCE
PLAN CHECK
FEF
EE A E.FFEDUCEA NYPEOU MENT OF
ME. TO MODIFY W IV E ANYORDINANCE
NOR LIMIT IN ANY WAY THE CTY.SAE'LITY TOtI,IFOlC
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICEATICN, THAT THE INFORMATION
AGENT OF
GIVEN IS CORRECT AND THAT I AM THE OWNER OR T 0 LyAUTHOPtZED
AND STATE LAWS EGULATING CONIIRUC
CALL
T"E—NIR I AGREE 10 COMPLY WITH CITY
TION. AND N 00 NG TH AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
ON TO
FOR INSPECTI(
IN VIOLATION F THE LABOR CODE OF HE STAT OF WASHINGTON RELATING
T e
WORKMEN S COMPENSATION INSURANCE AND ROW 18,21.
(425)
JE
SIG�VER= DAi�JNED
771-0220
EXT 1333
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPEC ' rION HAS BEEN MADE AND APPROVAL. OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
APPLICATION APPROVAL
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ORIGINAL -FILE YEILOW.INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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MEMO TO: PERNUT COORDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DATEZQ:::�--c
FROM:
ENGINEERING DIVISION DATE—
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PLANNING DIVISION DATE—
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DESCRIPTION OF WORK TO BE INSPECTED
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RECORD OF INSPECTIONS
SETBACKS .....................
FO��RATION:
qlng .............
..........
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final
HEATING:
GasTest ....................
Gas Piping .................
Equipment............
Commercial Final
E)CrERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
- ----------
LPERMITEXPIRES
USE PERMIT
Z.k
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION 'A'DO R E S S SUITEJAPTN
7
DIVA NAMETM' OF SUSt�ESS
_ I. PI -AT NAMEISUBDIVISION NO. LITHO. LID NO.
C. a LID FEE S
MAILINGAD RESS PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TE9rP;;;7"_C3
0 ct- 0
CITY =T�L.��.OHE EXISTING __ PROPOSED� a—. R.I.-
U..
REQUIRED DEDICATION— FT —
7966 'd
NAME METER SIZE I LINE SIZE I NO.OFFIXTURES YES 0 NO C3 il
REMARKS i
ADDRESS OWNERICONTRACTOR FESPONSIBLE FOR EROSION C.�TII.LIDRAIIA.E 21
CITY ZIl JTEL.1�.NE
NAME
3 1 �- D e
FIRE REVIEWED By' DATE
,ITY ZIP
TELEPHONE
S _A 0
;2a �ci 7 (33,t -7
VARIANCE OR CU
SHORELINE OR ADB.
1
"ECTION
INFIR
REO'D
BOND
POSTEC
STATE LICENSE NUMBER IN DATE
CHECKIDBY
1
E3YES 0 NO
COMI—E E-11
EX'
--- -SIGN AREA
ALLOWED I PROPOSED
HEIGHT
ALLOWED PROPOSED
prt"r'K_ r-'gp#?L4 10 10/0
IROPERTY TAX ACCO TPAFICEL�� 601 0�
'Q1
L. COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (Fr.)
0 NEW EVIDENTIAL 0 LUMBING / MECH
ALL OWED PROPOSED
FRONT SIDE FEAR
FRONT LJRSIDE REAR
0 ADDITION 0 COMMERCIAL C MPLIANCE OR
CHANGE OF USE
P I
AlK NO
AREA
PLANNING REVIEWED BY DATE
0 REMODEL C] APARTMENT 0 SIGN
I I PROVIDED
E] FENCE
0 REPAIR I X FT)
[REOG E,___T_L0T
EMARKS
OTHER
C] DEMOLISH Q;-�NK
0 IAG E C] REOTAJNIN�GWALL RENEWAL
G4ARP.RT R CKER
(TYPE OF USE. BUSINESS OR ACYY) EXPLAIN:
CHIECKEDBY
TYPE O�',CONSTAU N
TYR
0 CUPA
f
IC 1
77 GROUP
NUMBER NUMBIR OF
DWELLING
S
/V A-
R
C.U-NT
LOA
OF
STORIES UNITS
NUMBER
E
1.
DESCRIBE WORK TO BE DONE
ITSIARKS
DNS PER UBC 1081FINAL INSPECTION RED
k
PLAN CHECK FEE
HEAT SOURCE GLAZING I
LOT SLOPE *4
BUILDING
PLUMBING
PLAN CHECK NO:
IVESTID DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
9 E DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PU BLIC
GRADLNG/FILL
13 DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SPRE SURCHARGE
- — SEPARATE PERMISSION.
A PERMIT APPLICATI N; 15D DAYS
5
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
P
ENG. INSPECTION FEE
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
ANDSrAPING
I EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANYAND
X F WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
ALLCI-AIMSFORDANUGESO
INSPECTION FEE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
LAN CHECK DEPOSIT
DEEMED TO MODIFYWA'VE.R IIEDLCE ANY FE..IFE.ENT OF ANY CITY ORDINANCE
PROVISION
NOR LIMIT IN ANY WAY THE CtTY'S ABILITY TO ENFORCE ANY ORDINANCE
TOTAL AMOUNT DUE
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
GIVEN I CORRECT: AND THAT I AM THE OWNER. OR THE DULY AUTHORII EO AGENT OF
S
THE OWNER AND STATE LAWS FEGUITIN. CO�STRUC
CALL
'� DAGREE.TEOWC.�.KPLYUWIT.HRCITY
TICK AND 'NG A T. 'ZED THEREBY, NOPERSONWILLSE L11LOYE D
01 THE STATE OF WASHINGTON RE ATING TO
FOR INSPECTI(
IN VIOLATION OF THE LABOR CODE
0 N S COMPENSATION INSURANCE AND ROW 18.21.
W RKME
DATQNE
_SQ�V�R
(425)
tff�� I
96/o/
771-0220
EXT 1333
ATTENTION
IT IS UNLAWFULTO USEOR OCCUPYABUILDING 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
VALUATION I FEE
APPLICATION APPROVAL
TNI Pplll-'--n m 1 . annit un,11.1p.d by Ina
S�i'd.no Off,,i,l *I hitne, Dop,ly: and F.09 am "'d—d
m-p- �Cwlmdoad In spao pmvid.d.
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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