20020079.pdfDATE RECEIVED
CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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ADDRESS
OWNER NAMEOYAME OF BUSINESS
PLAT NAMEISUBDIVISION NO. LOTHO. LID NO,
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LID FEE S
PUBLIC RIGHT Or WAY PER OFFICIAL STREET MAP 0
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REOUIRED DEDICATION W 0
NAME
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ECHANIrAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS. DRIVEWAY , MARQUEES, ETO) WILL REQUIRE
SEPARATE PERS
MISSION.
2 PERMIT APPLICATI N: ISO DAYS
STATE SURC14AR E
PERMIT LIMIT. I YEAR PROVID 0 WORK IS STARTED WITHIN III DAYS
SEEIIACKOI INK PERMIT FOR MORE INFORMATION
ING, REVIEW FEES
Wgjg�7t
'APPLICANT, ON BEHALrOr HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HAPIMLESS.THE Cl Y OF
LANDSCAP
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. ANDAGENTS F CIS ANYAND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
INSPECTIO'NNGFEE
- RE"I'l
'A M THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
DEEMEDTO MODIFY WAIVEORREDUCE ANY REQUIREMENTOF ANY CITYORDINANCE
0 NORL-T IN ANYWAY THE CITY�S ABILITY TOENFORCE ANIO-11ANCE lR--El.
TOTAL ANOUNT DUE
IHEnES ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
APPLICATION APPRO VAL
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.
ThnI IPPI-111 11 alt . Pal -I anna 119—d PVtII�
CALL
,ION AND IN DOING THE WORK AUTHORIZED THE REBY, NO P EFISON WILL BE EM P DYED
I N VIOLATION OF THE LABOR CODE 01 THE STATE OF WASHING ION RE L-NO To
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FOR INSPECTION —Pn--,—NPJq.d in space pnovidod
WOBiIMEWS.Cf"J�ENSATION INSUR NCE AND ROW 18.27
FIC DATE
TGRE DATE SIGNED
rl.NA—W �S-R AD
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771-022101 �RELEAS�DBY
ATTENTION
EXT 1333
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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-
'ORIJINAL-FILW- YELLOW-11,14PECTA
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX PINK -OWNER - COLD ASSESSOR
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OCT 1'7 2001
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Any
request for modificition, variance or o ther
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administrative deviation (hereinafter "variancer)
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must be specifically called out and identified.
Approval of any plat or plan containing
provisions which do not comply with city code
and for which a variance has not been
specifically identified, requested and considered
by the appropriate city official in accordance
with the appropriate provision of city code or
state law does not approve any items not to code
specification.
RECEIVE:
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OCT 17 266"
DEVELOPMENT SERVICES CT
CITY OF EDMONDS
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Height Cides
A=+95' 2 2 9.0. FT
B = +94' V, m
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D = +100'
Avc. Gmde= 97.751 eye (a
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CITY OF EDMU:,,,� 0
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SETBACKS:
FRONT 20'
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Top of SS Manhole Cover OTHER
llvd ST SW HEIGHT_a��—�
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Center OfRight-of-way
OFF. 1)(
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wait ....................... —
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Plar/Porch ...........
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Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
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Underground ..........
I'D
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Rough -in ............
0
-4
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Commercial Final
HEATING:
GasTest ....................
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Gas Piping ...............
0 -n
Equipment .................
Ill M
Commercial Final
EXTERIOR SHEATHING
0
NAILING ..........................
FRAMING ...........
FIRST FLOOR FRAMING...
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INSULATION ..................
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Floor Insulation
Wall Insulation
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Ceiling Insulation
SHEETROCK NAILING
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1711
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
Ins
OCCUPANCY ..................