20020121.pdfDATE RECEIVED
PERMIT EXPIRES
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CITY OF EDMONDS ZO'Es R:�, 12— N
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
_�WNER NAMEMAME OF BUSIN...
S
dLICATION
IPLAT NAMEISUBDIVISION NO, LOT NO. 110 NO -
MAILING ADDRESS LID FEE S
PUBLIC SIGHT OF WAY PER OFFICIAL STREET MAP TEsGP We
snorser,
sue....' seats
CITY ITELEPHONE EXISTING — PROPOSED— In,-. lue-
13
Pz 0-?7/ Z. REQUIRED DEDICATION— F1 — Undulesund
.'surteadoase,
METER SIZE I LINE sll�_] No. .1 11.U.. PRV REQUIRED
YES C3 No 13
ADDRESS REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUTRAINAGE
so ADDRESS
i�ow '�
FIRE REVIEWED BY DATE
CITY ZIP
0
ILI &I.;W3
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STATE LICENSE NUMBER
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
RE 10
1PBOND
OSTED
1 1,
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—
—
0 ED E3NO
PROPIRMTt ACCOUNT RCE-4—
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SEPA REVIEW
COMPLETE I E3ZPT
EXP
SIGN AREA
ALLOJED P101
1,5ED
HEIGHT
ALLOWED PROPOSED
2r, I 1-2G,
INEW git_RESIDENTIAL pLumBINa, MECH
ADDITION 0 COMMERCIAL [3 COMPLIANCE OR
B HANDS OF USE
LO COVERAGE
AL ROPO ED
16y,
REQUIRED SETBACKS (Fr.) PROPOSED
FRONT SIDE BEAR
2,61 1z), aiss,
SETBACKS (FT)
FRONT
,WRIDE 11AR
I F
3087 01
lot (
th
PARIONG I LI IT AR
BE 0 �- j��
=0
I 50;__
0 REMODEL 0 APARTMENT [71 SIGN
0 REPAIR [3 GRADING CY.S [:] F NCE
I _ X FT)
0 DEMOLISH 0 TANK OTHER &e
o GARAGE 0 RETAINING WALL RENEWAL
CARPORT ROOKERY
REM ;r MN 1\tM1L)
It) F
OWE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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UMBER
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UNITS
CRITICAL
AREA 8
NUMBER
SPECIALEI.NSIE.T0.
R OUR [] YES JA.EA
OCCUPANT
LOAD
DESCRIBE WOFI'X'&,o ,
PROGRESS INSPECTIONS PER UBC 1OS/FINAL INSPECTION REO'D
VAWATION
HEAT SOU I -��
I LOT SLOPE %
Building
PLAN 41HECK 140�� _ 0
VESTED DATE
Mechanical
THIS PERMIT . ... WO K NOTED. THIS PERMIT COVERS WORKTO
-
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTIR CTIONONTHEPUBLIC
a QUALM (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION,
Engr. Review
PER 'TAPPUCATIOM: 180DAYS
PERMITLIMM I If - PROVIDED WORK IS STARTED WITHIN ISODAYS
SEE RACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
'APPLICAM. N SEIIAIF F HIS OR HER SPOUSE, HEIRS. ASS.rI. AND SUCCESORS
I gNT"
N EST. AGREES INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
1!!11., M!IIL.11on
1-tre Review
D
EDMON S' WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND A13ENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
FRO, THE I SUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF NYCITYORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Landscapoinsp.
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I HEREBY 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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAW REGULATING CONSTRUC.
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, No PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
CALL
FOR INSPECTION
WORKMENS COMPENSATPR71NIS4�11ANCE AND RcW 18.21.
DATE SIGNED
(425)
771-0220
ATTIENVON
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
771-0221
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
1010,
Recording Fee I
City Surcharge
State Surcharge
Plan Chit Deposit
Receipt #
Total Amount Due
—t7e..v —#fflpTT
"PLICATION APPROVAL
ppil araw 11 a.'. Part until sigerd by th,
iflfic�al of his/her Deputy; and Fees ans Palo, and
wipti,eak ... lodged In space p-Idod.
SIGNATURE
By DATE
2 /1 :3h,;L
IIGINALI�-Fd . YELLOW - INSPECTOR
PINK - OWNER - GOLD - ASSESSOR
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0
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0
0
0
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9
0
1711
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ...........
wall......................
Pier/Porch ................
0
Retaining Wall ...........
Slab Insulation
rp
PLUMBING.
=5
Underground
M
C
Rough -in ...................
M
Commercial Final
0
HEATING:
M
10--i
GasTest .....................
z
Gas Piping ..........
Equipment ..............
0
Commercial Final
M M
EXTERIOR SHEATHING
NAILING ............... ..........
0
0 Fn
(y) T—)` —0
FRAMING � ......................
IT 0
FIRST FLOOR FRAMING
INSULATION
;a
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
z
SHEETROCK NAILING
SPECIAL INSPECTION
0
M