20020015.pdfDATE RECEIVED, _Z
:.ERMIT EXPIRES L2��
r--r USE ERMIT
CITY OF EDMONDS ZONE —NUMBER WN) - 0 1-5
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
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—PLAT NAMEISUBDAIISION NO, LI NO,
'4"
ING ADORES UG FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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E EXISTING — PROPOSED — 2"
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REQUIRED DEDICATION— FT —
E METER SIZE I LINE SIZE I No .1 F--U.EE PAY REQUIRED
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BESS REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDMINAGE
CITY
CITY ZIP
NUMBER
ADDITION COMMERCIAL C��UANpE0`F"USE
REMODEL
APARTMENT SIGN
REPAIR
0 GRADING CYDS
FENCE x FT)
0 DEMOLISH
0 TANK
OTHER
GARAGa
ARPO
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0 STAINING WALL
A
OCKERY
El RENEWAL
(TYPE OF USE. BUSINESS OR AC�,r�Z
-NUMBE
OF
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UMBER OF
DWELLING
NIT I
72 S
CRITICAL
I AREAS
N IT
UMBE
DESCRIBE WORK TO BE DONE
FIRE REVIEWED BY DATE
VARIANCE OR CU SHORELINEORADB# - INSFPEC�ONI No
JEO. �aO
—13YES 13NO STED
SERA REVIEW SIGN AREA HEIGHT
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ALLOWED PROPOSED
MPLETE I EXEMPT ALLOWED PROPOSED
XP I
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS D`T I
ALLOWED PROPOSED FRONT SIDE BEAR FRONT URSIDE BEAR
PARKING LOT AREA I PLANNING REVIE;�FD BY DATE
N PEIIm
3 r] YES
VALUATION $
Descirliation I FEE
"IT 1713GEE"'j GLAZIN.
LOT SLOPE %
u ,ld
Building
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PLAN CHECK NO:
VESTED DATE
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Plumbing
P In n g
M e c IT a
Mechanical
IT a I
THIS PERMIT AUTHORIZES ONLY THE W RK NOTED. THIS PERMIT COVERS WORK TO
'ad
Grading
G IT g
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CI HE DONE ON PRIVATE PROPIUM ONLY. ANY CONSTRUCTION ON THE PUBLIC
X DOMAIN (CUFtES, SIDEWALKS, DRIVEWAYS, MARQUEES, OC.) WILLREQUIRE
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Engr. Review
E .g a
SEPARATE PERMISSION.
PERUIT APPLICATION: IN DAYS
PERMIT LIM! . I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK Of PINK PERMIT FOR MORE INFORMATION
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Engr. Inspection
E n. I. p
'APPLICAW ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
T'. I'.. n
Traffic Mitigation
'I' g a I.
I"
"'. Gv
Fire Review
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS IHE C' ry OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, Me AGENTS FROM ANY ANO
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire inspection
FROM THE ISSUANCE OF THIS PERMM ISSUANCE OF THIS PERMIT SHALL NOT HE
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
DO NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscapeinsp.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
OiVCN Is CORRECT; AND ITIAT I AM THE OWNER, OR THE OU1Y AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STAF LAWS REGULATING CONSTRUC"
CALL
L
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATIO _R LA8,0R ODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPEC ' TION
WORKMEN 'A EATIO INSURANCE AND RCW 18,27.
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SKINATLI jOWNER4R'AGEN ATE SIGNED
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771 22
ATTENTION
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IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771 -0,22 1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTiFl-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
10101
LOAD
MIN
FdAA
Recording Fee
City Surcharge
State Surcharge
Plan Chk Deposit
Receipt #
Total Amount Due
Receipt #
PE�PASED BY DATE
ORIGINAL - FILE - YELLOW , INSPECTOR
PINK - OWNER - GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing
Wall .............
Pier/Porch .................
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Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough 4.
lt
-in .................
rn
0
Commercial Final
0
C
HEATING:
3: M
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GasTest ....................
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Gas Piping .................
Equipment
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Commercial Final
M M
EXTERIOR SHEATHING
NAILING ..........................
0
FRAMING
C
FIRST FLOOR FRAMING
M 0
INSULATION ...................
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Floor Insulation
Wall Insulation
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Ceiling Insulation
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3:
SHEETROCK NAILING
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SPECIAL INSPECTION
0
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MISCELLANEOUS
FINAL APPROVAL FOR 4Y)s
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OCCUPANCY .................