20020083.pdfWWR4 MRNbViL-LP—:
CATE RECIIVII,,,�
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NESS
�LING ADDRESS
R,
�y ZIP 11IL1110"
ID EBB
'IP
g�40 1 TELEI�ql
r-at"6"a,c) c ) _I U _ C, 7�i�n
US' PERMIT
ZONE N U M B E -)(Y)
ADDRESS C) SUITE,APTQ
57 to
PLAT NAVEiSUBOIVISION NO,
LOT NO-
LID NO,
LID FEE S
PUBLIC RIG HT .1 WAY 'Ell Clll�ML STREET MAP
T`
�XISDNG- PROPOSED-
12 *,1", A
REOUIPEDDEOIKATION-- FT --
u
SIZE
PFV PEOUIRED
YES 0 NO 0
REMARKS
OWNERICONTRAC70R RESPONSIBLE FOR EROSION CONTROUDRA
ENGINEERING REVIEWEDIDATE
ADDRESS
FIRE REVIEWED BY DATE
0 2
ZIP
0
TELEPH NE
STATE �ICENSE NUMBER EXPIRATION IATE
'Sty, 10, c- s I
�IY
y
V�RIANCE 08 CU
SHORELINE OR ADS.
INSPECTION
RED 0
Y ES 0 NO
I 'BO D
OSTED
I PROPERTY TAX ACCOUNT RCEL NO,
U
SERA REVIEW
COMPLETE EXEMPT
EXP
SIGN AREA
ALLOWED , PROP01111
HEIGHT
ALLIANED PROPOSED
0 IN 0 RESIDENTIAL LUMBING MECH
,6 0
ALL LOT C VERAGE
OWF� D PROPOSED
REQUIRED SETBACKS (PT)
FRONT SIDE REAR
PROPOSED SETSACXS (FT.)
FRONT L/A SIDE REAR
C
0 ADDITION t4,10MMERCIAL 0 C MPLIANCE OR
CHANGE OF USE
ocREMODEL 0 APARTMENT 0
DATE
0 REPAIR 0 GRADING CYGS 0 1 X FT)
REMARKS
0 DEMOLISH 0 TANK o OTHER
2ARP.�T RA8TAINING WALL
0 CA'AG' 0 0 RENEWAL
CER
0 -
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY
TYPE O:IWUC ION
O�COUP,ANT
GROUP
-25,i
NU BER
M OF
0 STORIES
UMBER OF I
DWELLING
UNITS
CRITICAL
A lAl
NUMBER
SPECIAL INSPECTOR [AREA
REQUIRED E:] YES
OCCUPANT
.5Vrl_ LOAD
DESC=TO
K-a5vcvca— Y, v(o cld-j-
REMARKS Sp T,
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECT14ON RE-'D
()(z-k-)czIeckr`% Clf\ck�lo
fe'dCLco— kn--�kck arky'n' dtoo(-,
0,-,a 0(4�1
VAL UATION
FEE
PLAN CHECK FEE
HEAT SOURCE GILAZI101, LOT ILOPI I
BUILD'..
PLAN C"?%-� IVISTED DIE
PLUMBING
MECHANICAL
THIS PERMIT AUTHO IZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t 8 E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
GRADINGIFILL
SEPARATE PERMISSION,
STATE SURCHARGE
PER.ITAPILICATI N; 190 DAYS
PERMIT LIMIT, I YEAR - PROVIDED WORK IS STARTED WI 80 DAYS
SEFBAC AMTHIN I
K OF PINK PERMIT FOR MORE INFO TION
fi��PEES-
�AP LICANT, ON BEHALF F HIS OR HER SPOUSE, H EIRS, ASSIGNS AND SUCCESORS
L
E�, NSPECTION FEE
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
2 E MONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
INSPECTION FEE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRE TL ORINOIRECILY
X C
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0 Y
, DEEMED TO MODIFY. WAIVE OR REDUCE ANY REOUIREMENT Or AWYCIT ORDINANCE
PLAN CHECK DEPOSIT
R CEtPT
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY OnDINANCE PROVISION.'
TOTAL AMOUNT DUE
073
I HERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
T EOWNER� I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTFUC
TION AND IN DOING THE WORK AUTHORIZED THEREBY NO PERSON WILL BE EMPLOYED
CALL
D", Ti,.� I� - . 1.1-1 -11 �11- b, 11.
-0 Offic"ll ., -1- Dq: I—
IN VI LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RMATIN. TO
FOR INSPECTION
WORKM ENTS COM PENSATION INSURANCE AND nCW 18,21
OF�� DATE
SIGNATURE W R 0 AGENT DATIaNIEQ
(425)
V,6 �2-
, /
0
RK DA11TE
A
EXT 1333
STRUCTURE UNTIL
,;2
IT7EN UT.1 ..IA.R.O.CUPY A BUILDING OR
771-0221
Pr
,P
A FINAL ION S EEN ADE AND APPROVAL OR A CERTIFI-
Nr
IN
CATE OF PANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
ORIGINAL 'ILE YELLOW INSPECTOR
PINK OWNER GOLD ASSESSOR
5199
z
0
a m
c
MO
0
80
c
mz
jo -4
co
0
n
m m
cl 65
0 r-
0 M
C co
9 ch
m 0
z
74
;u
z
co
z
m
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ....................
Wall ..........................
Pier/Porch ................
Retaining Wall
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final
HEATING:
Gas Test ....................
Gas Piping .................
Equipment ...........
Commercial Final . .......
EXTERIOR SHEATHING
NAILING ...........
-0 -7-s-oz
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...........
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
z
0
0 M
i,
a
MID
0
80
C
M
ITIZ,
0 -n
,n
M M
0
o Fn
C 0)
M 0
z
IT