20020006.pdf0 ;'A DATE RECEIVED
PERMIT EXPIRES
USE PERMIT
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CITY OF EDMONDS
NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
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F.AILING
OWNER "�Ar�Alhl Ill IISI ESI
PLAT NAMEISUBDIVISION NO, LOT NO. L�D NO.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP W."'.1
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NAME METER SIZE LINE 1111 NO� OF ".RES PAV REQUIR D
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ADDRESS REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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SEPA REVIEW SIGN AREA HEIG14T
— PROPOSED ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL — 11.1. EXEMP, Al OWED
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RV RESIDENTIAL LOT COVERAGE REQUIRED 1E1BAOKS R".1 PROPOSED IIT-11 -1
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NEW PL .. INS (... ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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G.MPUANCE�j
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ADDITION 1:1 COMMERCIAL El CHANGE OF USE I
H A No, 0 F U E
PARKING I LOT AS FA PLANNING REVIEW ED BY DATE
REMODEL 0 APARTMENT SIGN REDD I PROVIDED
SIGN
PENCE
0 REPAIR [3 GRADING CYOR 0 F NCE
( X FT) REMARKS
X
OTHER
0 DEMOLISH [3 TANK [3 OTHER
o GA AGE (i RETAINING WALL aw L
CARPORT ROOKERY [3 RENEWAL
(TYPE OF USE, BUSINESS ACT nY) EXPLAIN: CHECKED BY ITYPErry 0 OU
SIM " �'�N GCROLIT�3
CRITICAL
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NUMBER NUMBEIR OF ;." a A In OCCUPANT
DWELL I].EA SPECIAL INSPECTOR
OF AREAS
JAREA
UNITS �UM.. LOAD
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STORIES NUMBER REOU'REDO YES
DESCRIBE WORK TO as DONE
REMARKS
PROGRESS INSPECTIONS PER USC 10S/FINAL INSPECTION REGO
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VALUATION $
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FEE
Description
FEE
Description
Plan Check
HEAT SOURCE GLAZING LOT SLOPE
LOT -'0
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Building
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PLAN CHECK NO: 'ESTS. A
I n.'ON
Plumbing
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Mechanical
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Ta
0 DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
"T
adng
Grading
Recording Fee
WILL R
DOMAN (CURB., SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. —
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Engr. Review
City Surcharge
PERMITAPPLICATION: TOO DAYS
PERMIT UM . I YEAR - PROVIDED WORK IS STARTED WITHIN IN DAYS
gr Inspect
Engr. Inspection
State Surcharge
I
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICAN7. ON SEHM. Of HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
R
I', It.. atioc.
Traffic Mitigation
Plan Chk Deposit
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IN INTEREST, AGREES To INDEMNIFY, DEFEND AND HOLD HARMUESS THE CIWTI OF
AGENTS
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDISECTLY
r)
0 OF THIS PERMIT. SSUANCE OF THI PERMIT SHALL NOT HE
FROM THE ISSUAN I B
DEEMED TO MODIFY� WA VE OR REDUCE ANY FEGUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
TotalAmountDue
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Landscape Insp.
Receipt #
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC�
CALL
ThI 11-1. "Et '"'IM,inedbythe
oty:
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATI N OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
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WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
OFIr IONATUFIE
SIQMNAT21NNE,R,� 5�) 1 DATE SIGNED
(425)
15/0,ATE
U U
771-0220
17ASto By DATE
-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-
OF,NAL,L9 - YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER - GOLD -ASSESSOR
10/01
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ...............
Wall ; ....................
Pier/Porch ... . ........
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Retaining Well
?5
Slab Insulation
v'
PLUMBING:
Underground
M
C
IT
Rough -in ............
Commercial Final
HEATING:
M
�i
Gas Test ....................
GasPiping .................
Equipment .................
0 n
-n
Commercial Final
IT!
EXTERIOR SHEATHING
0Fn i
NAILING ..........................
C co
FRAMING ........................
0
FIRST FLOOR FRAMING
7
INSULATION ...................
Floor Insulation
z
Wall Insulation ; ..........
CA
Ceiling Insulation
z
SHEETROCK NAILING
0
SPECIAL INSPECTION
ITI
MISCELLANEOUS ..........
FINAL APPROVAL FOR
4
OCCUPANCY ..................
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