20020138.pdfDATE RECEIVED
) J,�- ell,� '-'2- 1 PERMITEXPIRES
OF EDMONDS
FCITY
NSTRUCTION PERMIT APPLICATION
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NAMEINAME OF BUM EBB
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CITY ZIP
HONE
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92:5. 672, 993/
ADDRESS
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CITY ZIP
L'fA)AJWOO,'-) �?0-20
11EILEPHONE
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NAME
B0011 VE C01J77ZVc77ot-J
ADDIEIS
600? o2/,-277:/ 557- 5--)
CITY ZIP
EZMO-AO,S
TELEPHONE
1125, 778. 2557
STATE UCSNSE NUMBER EXPIRATION DATE
CHECKED try
PROPERTY TAX ACCOUNT PA CEL NO.
00541,6(? 000 oo-6 o/
[3 NEW RESIDENTIAL JZ PLUMBING I MECH
COMPLIANCE OR
jo ADDITION 13
HANCE OF USE
0 REMODEL 0 SIGN
REPAIR Dvas 0 IINCI
, — x Fn
0 DEMOLISH [3 TANK ci OTHER
A 2 RETAiNING WALL
1:1 CGAARPGORT 13 ROCKERY [:3 RENEWAL
(ME OF USE, BUSINESS OR ACMITY) EXPLAIN:
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DESCRIBE WORK TO BE DONE
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I VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORKTO
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BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ONTH PUBLIC
OMAJN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEE S. ETC.) WILL REQUIRB
SEPARATE PERMISSION.
PIRMIIAPPUCATI N: 180DAYS
PERMIT Laliffe I YEAR -PROVIO 0 WORK IS STARTED WITHIN INDAYS
Ste 13ACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS 11011 ANY AN"
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE 01 THIS PERMIT. ISSUANCE OF THIS PERMIT $HALL NOT BE
DEEMED TO MODIFY, OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
VjAWAIHVEE
NOR LIMIT IN ANY YT CITYS ABILITY TO ENFORCC ANY ORDINANCE PROVISION. -
I HERE 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
THE OWNER. I AGREE TO COMPLY WITH C17Y AND STATE LAWS 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
WORKMENS =ENSATIO INSURANCE AND RCW 18,27.
SIGNATURJ���
DATE GNED
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REMARKS
OWNEFVCONTRACTOR RESPONSIBLE FOR EROSION CONTAOL/DRAINAGE
NGINEERING REVIEWEDIDATE
IRE REVIEWED BY DATE
VARIANCE OR CU SHORELINE OR ADS# INSPECTION 00 D
REQkN. POSTED
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EMARKS
VALUATION $ q,
Description
FEE
Description_
FEE
Plan Check
ff—:—
Building
/7*7
Plumbing
Mechanical
Grading
Recording Fee
Engr. Review
City Surcharge
Engr. Inspection
State Surcharge
,16212
Traffic Mitigation
Plan Chk Deposit
47
Fire Review
Receipt #
Fire Inspection
Total Amount Du
Landscapainsp.1
Receipt #
CALL
FOR INSPECTION
(425)
71 11-0M
APPLICATION APPROVAL
This applinflor, Is not a proardt until signed by she
Building Offlead., his/her Deputy: and Foes am paid. and
e,.Ipl I...ka—I.dg.d in space p—lo.d.
WIALS SIGNATUR DATE
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ATTENTION U EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL '77 Yff
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 111-0221 '45�n'
ORIGINAL -FILE YELLOW � INSPffGTC
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK -OWNER GOLD -ASSESSOR
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7171 COPY
DEVELOPMENT SERVICES CTR,
CITY OF EDMONDS
OTHER-
HEIGHT-
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ................
FOUNDATION:
Footing ......................
wall......................
3
z
Pier/Porch
M
4
Retaining Wall ...........
Slab Insulation ..........
-4
PLUMBING:
ITI
C
M
Underground ............
0
C
Rough -In ................
x M
Commercial Final
M Z
g) -q
HEATING:
Gas Test ..................
0 -n
Gas Piping .................
Equipment .................
M M
Commercial Final
0
0
EXTERIOR SHEATHING
C
M 0)
M 0
NAILING ......................
FRAMING ......................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation
441-110-4),
z
0Z
Wall Insulation ...........
MIS
-4- UDA4L_ KOF
R-45 �'IA
Coiling Insulation
I I
o
ITI
I SHEETROC K NAIL ING
SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY
..................
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