20020062.pdfr6ATERECEIVE,
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
WNe" MMEINAME OF BUSINESS
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LING ADDRESS
ZIP TELEPHONE
CITY ZIP
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US' PERMIT
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SUREJAPT#
ADDRESS Z.-S
PLAT NAMERIUSDIVISION NO, I LOT NO. L
L�D N
D FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP .1.
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EXISTING — PROPOSED — I. -con Race-
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REQUIRED DEDICATION— V—d
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METER SIZE I LINE al!j� "I I REQUIRED
a E3 NO 0
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ADDRESS —
CITY ZIP
TELEPHONE
FIRE REVIEWED BY
DATE
STATE LICENSE NUMBER
EXPIRATION OAT a 0 BY
VARIANCE OR CU
SHORELINE OR ADS#
INSPECTION
RE."'
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'OSTE1
0 0-
i3yes 13N.
PROPERTY TAX ACCOUNT PARCEL NO,
BE REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
I
,
,
Exp
NEW
PLUMBING
LOT COVERAGE
REQUIRED SETBACKS (Ft.)
PROPOSED SETBACKS (Fr.)
I MESH
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE BEAR
ADDITION
Ei C MPLIANCE R
CHANGE OF USE
R MODEL
E
11 SIGN
PARKING
HEOrD PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
[3 REPAIR
[3 GRADING
0 FENCE
I
CYDS
I — I — Fn
REMARKS
[j DEMOLISH TANK
11 OTHER
nGARAGE [3 RETAINING WALL
CARPORT ROOKERY
...........
[3 RENEWAL
OWE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY
OF CONMN
0 OUPAN;p
se
2 NUMBER
OF
GROUP
' OF
or
0 ELLING
'0
OOCUIANT
STORIES
UNITS
LOAD
DEOI,��WO=DONE
REMARKS
4PECT, TIS PER UBC 1081FINAL INSPECTION REaD
1T2Ha"2`N,
71 0� IAJjA:j
Ln I PJA 142�-
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Description
FEE
Description
FEE
Aeat —
Plan Check
BEAT SOURCE -91GLAZING % 'or SLOPE %
Bit kfing
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE RK NOTED, THIS PERMIT COVERS WORK TO
1: BE DCNE ON PRIVATE PROPER"'WOLY ANY C
ON 61,18TRUCTION ON THE PUBUC
2 DOMAIN SIDEWALKS, DRIVEWAYS
Grading
Recording Fee
(CURBS, MAR USES, ETC.) WILL REQUIRE
t: SEPARATCPERMiSSIONO.
I
PE MITAPPUCATION'. INDAYS
Engr. Review
City Surcharge
PERMIT LIMIT I YEAR - PROVIDED WORK 19 STARTED WITHIN I So DAYS
Engr. Inspection
State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS
OjASSIrNs AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY DEFEND AND H 0 HA-1-- I'll -11 1 -
Traffic Mitigation
Plan Chk Deposit
2 EDMOND S' WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
Receipt #
I ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
E
FROM THE ISSUA CE OF THIS PERMIT ISSUANCE OF THIS PERMIT $HALL NOT E
!3 DEEMED To MODIFY, WA VE OR REDUCE ANY REQUIREMENT
Fire Inspection
Total
OF ANY CITY OADINANCHE
21 NOR LIMIT IN ANY WAY THE CIrYS ABILITY 70 ENFORCE ANY ORDINANCE PROVISION.-
R771-0220
----pi
Landscapansp.
#
I HERESY ACKNOWLEDGE THAT I HAVE REM THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGRE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONST -
EHE
CALL
This application Is not a ponalt rellitigned by pro
TION; AND IN DOING WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLORYUECO
III VIOLATION OF THE E STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENEA;=Cuc-�,— TH . . Say IS
FOR INSPECTION
Resent; Official or leader Deputy: and Fees are paid. and
SIGNATURE N R
(425)
0 FICIA I ILL DATE
111-1 D*E
ATTEKTION
EXT 1333
ILI-3
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI.
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
ORIGINA FILE - YELLOW - INSPECTOR
PINK OWNER - GOLD - ASSESSOR
10101
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ......................
FOUNDATION:
Footing ........... ..........
wall .................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
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PLUMBING:
Underground ..........
Rough -in
Commercial Final
M
m
0
HEATING:
0
C
Gas Test ........ . ....
ITI
Gas Piping .................
Equipment ..........
-4
Commercial Final
EXTERIOR SHEATHING
NAILING ................... .
FRAMING .........................
cla ?
M IT!
13—W
0
0
FIRST FLOOR FRAMING...
C
INSULATION _ .................
M 0,
Floor Insulation
Wall Insulation
Ceiling Insulation
-4
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S C,9
7-
SHEETROCK NAILING
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SPECIAL INSPECTION
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0
9
ITI
E41SCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................