20010913.pdf-1 DATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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C"'Su rE
PERMITAPPLICATI N: IAODAYS
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p,,Mff UMP, I YEAR - PROVIDED WORK IS STARTED WUNIN 100 DAYS
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SEE BACK OF PINK PERMIT MR MORE INFORIkUI0N
Engr. Inspection
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Traffic Mitigation
Plan Chk Deposit
ASSIGNS AND SUCCES.Os
-APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
ID HARMLESS THE CITY OF
IN INTEREST, AGREES TO It DEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
Receipt #
No AGEWS Mo. r a
EDMONDS. WASHINGTON. US OFFICIALS. EMPLOYEES. AND AGENTS MO. MY AND
'ITS REVIEW
Fire Review
'CLAIMS R DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
ISS N._B,_ RECT�y 2 P IN �.E�T �Y
THE FOUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Fire Inspection
Total Amount Due
FROM
DEEMED TO MODIFY, WWE OR REDUCE MY REQUIREMENT OF My CITY ORDINANCE
0 NCR LIMIT IN ANY WAY ME CrT)rS ABILITY 1. ENFORCE ANY ORDINANCE PROVISION *
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I HERESY ACKNOWLEDGE THAT I HAVE READ THIS API..I.N; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT AND THAT I AIM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER� I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
1, — F—ft-fil WgnW by
TION. AND IN MING THE WORK AUUI THEREBY. NO PERSON Will BE EMPLOYED
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IN VII-101 01 THE LABOR Cool OF THE S—, 0, WASHINGTON RELATIH. To
FOR INSPECTION
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WORKMENS COMPENSATIobLINSURANCE AND TIM 11 27.
OFFIC17SlGNATURE DATE
SIGNATURE DATE SIGNED
(425)
X771-0220
tLEAtlEDbY- DATE/
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221 1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI.
ORIGINAL - MILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK. OWNER - GOLD - ASSESSOR
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Beth, please prepare a refund check in the amount of $55.00. Uniform Building Code Section
8 percent
107.6 Fee RefUnds. The Building Official may authorize refunding of'not more than 0
of the permit fee paid when no work has be done under a permit issued in accordance with this
code. The permit #2001-0913 was issued 12/12/01. This is a duplicate permit. Please mail the
check to Blue Dot, 2320 1" Avenue, Seattle, WA 98121. 1 have enclosed a copy ofour receipt
#18768 for your records. Thank you.
City of Edmonds czR Community Services
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
Footing ......................
r
Wall..........................
Plejr/Porch .................
jn
p g Wall ...........
..........
PLUMBING:
Underground ..........
Rough -in ..............
Commercial Final
HEATING;
Gas Te t .................
a
'Gas Pipinit . ..............
Equipment ............
commercial FiniC.;
EXTERIOR FkXTHING
NAILING ............ ...............
FRAMING ........................ .
FIRST FLOOR FRAMING..
INSULATION ...........
Floor Insulation
Wail Insulation
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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#*'*VDATE RECEIVED
�) / I I PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS 'ONE 9-::-? 2- NUMBER Zo C) I — � V_�
CONSTRUCTION PERMIT APPLICATION 00 SUITEJAPT#
ADDRESS f3 Ll CC�
OWNER NAMEINAME OF BUSINESS
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STATE LICENSE NUMBER 11-IfOrl DATE
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REMARKS USC 1081FINAL I SPE C
PROGRESSINS DNS
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BE om" P P.
N (CU.RM all ALKS, DRIVEWAYS, MARQUEES, ETC.) WILIL REQUIRE
3 SEPAPATEPEftUMBIM
PateriarrualrEl PIERNITAPPLICATION:11101DAYS
YEAR - PROVIDED WORK 98 STARTED WITHIN IN DAYS
Engr. Inspection
SEX a&CK OF PINK PERMIT FOR MORE INFOFLMUGION
M "lauu, 01 Hi OR HER SPOUSE, HILBS, Allie"S AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS ME CITY OF
'P
Traffic Mitigation
D 0". WASHINGTON. OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
E MON ITS
Fire Review
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ANI DIRECTLY OR INDIRECTLY
MOM THE E OF THIS PERMIT. JSSUkNCE OF THIS PERMIT SNAIL NOT BE
13SDANC
Fire Inspection
DEEMED TO WAIVE OR REDUCE Alff REQUIREMENT OF ANY CITY ORDINANCE
MODIFY.
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
I HERESY ACKNOWLEDGE I HAVE READ THIS APPLICATION; THAT THE IIINFORIMATIO.
GIVEN 18 CORK" Me THAT I AM ME OWNER. OR ME DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE To 00 FLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
PLOYEO
TION, AND IN DOING ME WORK AUTHORUED TH'REffY. NO PERSON WILL BE EM ED
T
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELLATING TO
WORKMERS COMPENRATIO RCVV H1.21.
FOR INSPECTIC
(425)
0 SIGNED
1
IIIE
/2r,4,
771-0220
�
A4TTEIlITION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FIN4L INSPECTION HAS BEEN MADE AND APPROVAL 08 A CERTIFI-
CATreOF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
t d n Fee
arge
h.rg.
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r
C'I's.��c2larga
State Surcharge
Plan Chk Deposit
So
Racelpt III
Total Amount Due
Receipt #
APPLICATION APPROVAL
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OFFIC IG TURE DATE
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