20010850.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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CITY ZIP
ADDRESS
CITY ZIP
NAME
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ADDRESS
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PERMIT EXPIRES
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ADDRESS
SUrTEJAPT#
PI -AT �FJSUBDPVISION NO.
I LOT NO,
LID NO.
LID FEE S
PUBUG RIGHT OF WAY PEA OFFICIAL STREET MAP
EXISTING- PROPOSED-
U.. P_ W'I
REOUIRED DEDICATION-
FT -
U�
MUEA SIZE
LINE SIZE
No- OF FIXTURES
'RV RE.UHRED
YE SO NO
A MARKS
OWNERICONTRACTOR RESPO�SIBLE FOR EROSIOICONTROUDMI"aE
19- __
C ZIP
TELEPHONE
FIRE REVIEWED BY DATE 1.
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I
STATE LICENSE NUMBER EXPIRATION DATE
VARIANCE OR CU
SHORELINE OR ADBI
INSPECTION
REQ-0
OSND
I 'Bo
TED
k'Q
d
C31ES
'ROPERTY TAX ACCOUNT PARCEL No.
SERA REVIEW
EXEMPT
SIGN AREA
ALLOWED 11OPCI11D
HEIGHT
ALLOWED PROPOSED
,413-41Y-a 9-#i9-oo6_i
,COMPLETE ,
XP
EN
,
,
O-Z& [ErSESIDENTIAL ILU--IA-
LO COVERAGE
REGUIRED SETBACKS (FT.) PROPOSED
SETBACKS (FT)
A -WE. PROPOSED
FRONT SIDE A-
F..NT - SIDE REA.
C] ADDITION COMMERCIAL COMPLUBAC6)
CHANGE
OF USE
0 REMODEL 0 APARTMENT SIGN
... PARKING I
D I PROVIDED
LOT AREA
PLANIANQ REVIEWED BY DATE
REPAIR GRADING FENCE
CYDS ( _ X FT)
REMARKS
DEMOLISH TANK E] OTHER
GARAGE o RETAINING WALL
0 RENEWAL
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'ARPORT ROCKERY
(rYPE OF USE. BUSINE88 OR N:
Co Aj 1) 6 m I �WZm
CH1CKE0!r=N
jCq-jj.R.UP
OCCUPANT
NUMBER
OF
DUMBER F
A 0
AS
CRITICAL
AREAS Id-7-
SPECIAL INSPECTOR
A [:] YES JAREA
EQUIRED
OCIUPANT
LOAD
STORIES J
UWELL
NITS
NUMBER
DESCRIBE WORK TO BE GONE
REMARKS
5-Fm
PROGRESS INSFIFICTIONS PER UBC 111111/171NAL INSPECTION REO'D
tu /A f-1- - J .2 <
Plan Check
HEAT SOURCE
C.4,5 I GLAZING LOT SLOPE %
Building
FILM CHECK NO: "'T", DATE
E
PILanbing
Mechanical
_ -
THIS PERMA, AUTHOR— Ly THE WORK NOIAED. THIS PE COVERS .."
BE DONE ON PRAVATE PROPEM DAM A� WNSTIRUITAOM 04 THE PUBLIC
2
Grading
E C) our
,t DOMAUN (CURBS, SIDEWALKS, DRIVEWAn MuUt U ES, ETC.) WRI. REOLARE
Eng, Review
PERUTrAPPLIQUA N: 1W DAYS
PCIA.n.I.I.A, , YEAR - PROVI WORKIBSTARTEDWITHIN ' IKI DA"
Eng, Inspection
Z BACK OF PINIK PERMIT FOR MORE INFORMLATION
*APPLIOANT, ON 1E1Ik_F 01 HIS 04 HER SPOUSE, HEIM, AS1IGN1 -0 SUCCIIOM
Tf-ffic Mitigation
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD A MLESSTHECITYOF
EDMONDS, WAS INGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
Fire Review
FROM THE I UA,NCE OF TIVS PEAMM ISSUANCE F THIS PERMIT SHAlL NOT BE
Fire Inspection
DEEMED TO MODIFY. WAIVE OR REDUCE ANY EGUIREMEWOFANYCITYORDINANCE
NOR UNIT N ANY WAY THE CITY8 ABILITY TO ENFORCE ANY ORDINANCE PR ISION -
Landsrapoinsp.
1 HEREBY ACKNOWLEDGE THAT � HAVE READ TH THAT THE INFORMATION
.W� I' CO% IS t"P"'A"M
CT; THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
AND
THE _,. BE T. Go.
TION. AND IN D04NO THE WORP Y WITH CITY AND STATE LAWS REGULATING CONSTRUC.
K AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
CALL
IN VIOLATION OF THE LABOR THE STATE OF ARINGTON RELATING TO
FOR INSPECTII
aCOF
WORKMEArS COUPEN
DATE SIGNED
(425)
11-�3-01
771-0220
ATTENfl—OW—
EXr 1333
IT IS UNLAWFUL TO USE On OCCUPY A BUILDING OR STRICTURE UNTIL
NAL SP,
A FI ECTION HAS BEEN MADE AND APPROVAL 08 A CERTIFI-
771-0221
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
1010,
FAX
I _0zW 4 If
FEE I Description I FEE
Recording Fee
City Surcharge
SateSurcharge
Plan Chic Deposit
""C"'p,
let Amount Due
Receipt #
kPPLICATION APPROVAL
2 OgIXI . h[,A_ D.P.,Y: d F .. P.W.
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(�SIIGIIU�R, 1 04�
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ORIGINA�-FALE YELLDW-INSPECTOR
PRIK-OWNER GOLD.ASSES$OA
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I'D
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall I ........... I .............
Pier/Parch .................
Retalnlng Wall ...........
Slab insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final
HEATING:
GasTest ....................
Gas Piping .................
jol
Equipment ............... .
.
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING; .......................
FIRST FLOOR FRAMING
INSULATION ...................
Floor insulation
Wall Insulation ...........
Calling Insulation
SHEETR06K NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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