20010925.pdfDATE RECEIVED _7
FPERMIT
EXPIRES L4121
us" PERM T
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CITY OF EDMONDS
ZONE NUMBER �96VI-
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ADDRESS
CONSTRUCTION PERMIT APPLICATION
O'FLIRIES1
OWNERiT
11. NAME1.U.DIVSI.N No
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'NAME
METER SIZE
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NO, .1 F...ES
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L.E.A.K�'
BE C3 NO 13
ADDRESS
WNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTRC
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ENGINEERING AEVIEWED/DATE
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REVI—ED BY DATE
:try ZIP
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VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
MYREG�o
ES [3 NO
I PBO D
OSTED
ITATE LICENSE NUMBER EXPIRATION -11
F? L L I i�' _35
SEPA REVIEW
COMPLETE I EXEMPT
CXP
SIGN AREA
ALLOWED , PROPOSED
EIGHT
ALLOWED PROPOSED
1
PAR
ROPEFIY TAX NO.
(0 nO o 0
11 NEW _E2:,,!EESIDENT`AL 0 PLUMBING I MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRON7 URSIDE REAR
0 ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
11 REMODEL 0 APARTMENT SIGN
I
PARKING
REO'D I PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
REPAIR GRADING (FENCE X FT)
REMARKS
DEMOLISH TANK
oGA GE RETAINING WALL
CARMPORT 13 ROOKERY RENEWAL
(ME OF USE. BUSINES�SAff�N:
CHECXJED BY
N
IC77
O.."PANT
GROUP Xll�;
NUMBER
OF
STORIES
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SPECIA LINSPECTOR [AREA
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DESC;�Z ZRKLOell..E DONE n 4Q,
REMARKS
PROGRESS INSPECTIONS PER UBC 109/FIRAL INSPECTION REG'O
IE
1 -4, _-_ , L— -L � - -7-,- r A.) I �, I U, 14 � III I
a' If 0.�_ I VALUATION $
___REATS6URCE
I GLAZNG %
LOT SLOPE %
1 din
Building
1 g
PLAN CHECK N!�.
VESTED DATE
Plumbing
.he mcal
Mechanical
Muic
"IS PERNIr AUTHKI ONLYTHE WORK NOTED. THIS PERMIT COVERS WORK 70
BE DONE ON PANATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBUC
'RE
Grading
Grading
DOMAIN (CURBS. SIDEWAI_K5. DRIVEWAYS. MARQUEES. ETC.) WILL. REQUIRE
SEPARATEPETIMISSION.
Engr. Review
rng ' .via_
PEROITAPPLICATIOW IWDAYS
PERMIT UMM. I YEAR-PROVID D WORK 18 WARTE.W171HIN INDAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Laton
T a III..
!— M L U0.
*APPLICANT ON BEHALF 11, HIS OR HER SPOUSE, "EIRI, ASSIGNS AND SUCCIS.RS
ali�
_
OF
IN INTEREST, AGREES TO INDEMNIFY, DEFE D AND HOLD HARMLESS THE CIV OF
ED DS,WASHINGTON, ITSOFFICLALS,E41NOYEES.ANDAGENTS MOM ANYAND
MON
F Rev�'W
'r. avi
F R a
LAIMS FOR DAMAGES OF WHATEVER �VUR5. ARISINO DIRECTLY OR DIRECTLY
ALL C IN CTLY
ISS 'T BE
FROM THE UANCI 01 THIS lEnMI. ISSUANCE 01 THIS PERMIT E.LL NOT -
he I Sp.ct,
Fire Inspection
C
0 IRMC
EBBED TO MODIFY, WAIVE OR REDUCE MY REQUIREMENT OF My CITY ORD . F
NOR UMff IN ANY WAY THE CITYS AB!LITY TO ENFORCE ANY ORDINANCE PRMISION.
LandscapaInsp.
I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN 0 CORRECT. AND THAT AN THE OWNER, OR THE DULY AUTrIORLZED AGENT OF
I
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONMUC
CALL
TION; MIT IN WING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
STATE OF WASHINGTON REUT14G TO
FOR INSPECTK
IN VIOLATi N OF THE LABOR CODE OF THE
WORKMENS COMPENSXI��CE AND ITCW 27.
SIGMWNE DA,TESIGNED
(425)
_I 9-0)
771-0220
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING 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
1010"
Description
777—
_!!S2±ng Fee
City Surcharge
State Su charge
Plan Chk Deposit
Receipt #
Total Amount Due
APPLICATION APPROVAL
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ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
.....................
FOUNDAMON:
Footing......................
wall....................... —
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final
HEATING:
GasTest ....................
Gas Piping .................
Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY
............
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J.ATE RECEIVED
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ERMITEXPIRES
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CONSTRUCTION PERMIT APPLICATION
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OWNER NAMEft"E OF BUSI EBB
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PLAT NAMEISUODIASION NO. LID NO.
LOT I'D FEE
MAILINKI ADDRESS
M4,41
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CITY ZIP
— PROPOSED —
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NAME
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A K
REMARKS
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WNERICONTRACTOR RESPONSIBLE FOR EROSION CORTROLMRANAGE
0 CTOR RE'
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CITY
NAME
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JET
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FIR AEVIEWI�D BY DATE
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INSPECTION
REG"'
BOND
POSTED
.:TE
STATE LICENSE NUMBER EXPIRATION DATE
1(77
[3YES E3NO
L f 1�' _01
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
A11OWID PROPOSED
HEIGHT
ALLOWED PROPOSED
PROPERTY TAX PAR EL NO.
EXP I
OT COVERAGE
L Lo C.V
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT)
L.
NEW PLUMIN. I EC.
V
ALLOWED PROPOSED
LLD . PROPOSED
FRONT SIDE REAR
FRONT URSIDE BEAR
0 ADDITION COMMERCIAL C MPLIANCE OR
CHANGE OF USE
I
PAR
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LOT AREA
P�NINGREVIEW ED By DATE
I-] REMODEL 0 APARTMENT SIGN
REaD
I PRO IDED
I
GRADING C S F NCE
REeAIR 1:1 YD 0 ( X Fn
REMARKS
DEMOUGH 0 TANK 11-IMIL9�—
.
GARAGE [I REMIND WALL RENEWAL
CARPORT ROCKERY
(TYPE OF USE. BUSINESSDR Ar
ST U ON
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-IC7
7
OCCUPANT
GROUP
MEER
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FIE IN."
CR ITICAL
AREAS
SPECIAL INSPECTOR JAREA
occu P W
LOAD
ITS
NUMBER
REOUIR ED[] YE a
REMA KS
PROGRESS INSPECTIONS PER USC 1(./F111AL INSPECTION REOD
t ey, r
VALUATION $
FEE
Doscription
FEE
HEAT SOURCE GLAZING % LOT SLOPE %
El ilding
U
PLAN CHECK NO:
Plumbing
mochanical
THIS PERNIff AUyHoRGaS ONLV IrKE WORK NOTED, THIS PERMIT COVERS WORK TO
T P E
t BE ON PRIVATE PROPEPRTV ONLY. AMY CONSTRUCTION ON THE PUBLIC
r
Recording Fee
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WIM REWIRE
8EPARATEPERM11SION,
Engr. Review City Surcharge
PERM11"APPLICATIOW 1"MYS
PRRWTUMMI YEAR. PROVIDED WORK [a UARTEDWTTHIM 10tIDAYS
P
'6
SEE BACK OF PINK PSRMff MR MORE IN ON
.H'a
"MCAMT1, COIN BEHALF F HIS Oil HER 1PO11E, HEIM, ASSIGNS AND IUCCEIORS
Plan Chk DOPOSII
IN INTEREST, AGREES INDEMNIFY. DEFEND AND HOLD HAR.LIESS THE CITY OF
ED MONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
Fire Review Receipt #
ALL CL4XS FOR DAMAGES OF WHATEVER NATURE ARISINGD]RECTLYORINDIRE-1
FROM THI;E ISSUANCE Of THIS PERMIT. ISSUAIICj OF THIS PERMIT SHAIA, NOT Iii
[INVI:OLAMON
on Total Amount Due INI&'��
Fire Inspection
DEEMSDI 0 MOG`Fy'WA`VE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
WM LIMIT IN ANY WAY THE CIT" ABILRY To ENFORCE ANY ORDINANCE 1ROVIII.W
L
Receipt #
I HEREBY ACKNOWLED43E THAT HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER I AGREE TO po, WRIT, CITY AND STATE LAWS REGULATING CONSTRUC-
COM
CALL
TION, AND IN D04NO THE WORK AUTHORUMD THEREBY. No PERSON WILL BE EMPLOYED
OF TH E LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
W... 8 CCMPEN!:2=NCE AND RM 10.27.
WORKMEN
DATE
...TUR' E SIGNED
BK`NA
7/
(425) 1 JD
ID
DAIrE
ATTENTION
FILE
'A3M BY
M 1333 Ll
/// I'IlWrl
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI. 3W -'INSPWCTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX PINK - OWNER GOLD - ASSESSOR
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