20020154.pdfATE RECEIVED
h
h PERMITEXPIRES
CITY OF EDMONDS
USE
ZONE
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
OWNER NAMEINAME OF BUSINESS
AD,740,4 qjT
PLAT NA 0.
JCS�JDIVISION NO. LOT No, L1
MAILING ADDRESS
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP OW
C" ZIP
anco—P—lensed
EXISTING — PROPOSED— c—o' a
X-11.
171111HONE
Ud,,—td
REQUIRED DEDICATION— R — g—l.
NAME
METER SIZE
LINE 1111
PAV REQUIRED
N/A
177711
or
YES C3 No 13
FORESS
REMARKS se
OW ER/CONITRACTOR RESPONSIBLE FOR EROSION CONTROLIDMINAGE
CITY ZIP
ITILIPHONE
1�ve B or L vent connectors
NAME
required on fuel -burning appliances in
I IN
ENGINE 10heated spaces. UMC afg.E71EDR)ATE
ADDRESS
A-)
FIRE REVIEWED By DATE ou
z
CITY ZIP ELEPHONE
9 i.
sy
STATE LICENSE NUMBER EXPIRATION OAT' CHECKED BY
VARIANCE OR CU SHO RELINE OR AD110 MISPECTI N PSOND
REOG
do CRIED
IT
ES 0 NO
E3Y C3 NO
or
PROPERTY TAX ACCOUNT PARCEL NO.
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
C04 1H60oqoi400L4
EXP , ,
M
N IN RESIDENTIAL IMECH
EW PLUMBIN
LOT COVERAGE REQUIRED SETBA KS (Fr. PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE C REAR) FRONT UR SIDE REAR
c:
ITT
0
ADDITION C MPLIAN E OR
COMMERCIAL
z 0
0 C
CHANGE OF USE
0 REMODEL APARTMENT SIGN
PARKING LOT A111 DATE
REGO I F._,.E. PLANNING 111111 BY
M
In
0 REPAIR CYOR F NCE
[3 GRADING
X Fr)
REMARKS
10
[3 DEMOLISH TANK OTHER
GARAGE RETAINING WALL
ISPECIAL
[:I CARPORT ROOKERY 0 RENEWAL
o
0 -n
(TYPE OF USE, BUSINESS OR ACTIV" EXPLAIN:
___1coDE
HECKEDBY J�P OF OCCUPANT
GROUP
NUMBER NUMBER OF 11IT11 I
L
A�GONSTRUCTION
71
MITI
1.
OF WELL N AREAS
I
INSPECTOR OCCUPANT
0
STORIES NITS NUMBER
U
URED [] YES JAREA
REQL LOAD
0
0
f
REMARKS
C:
PROGRESS INSPECTIONS PER UBC, 10811FINAL I NSPECTION REOD
(n
M C)
k or
So
X
.4- 1 Its, f--k-6a
(IR�- tud&dbe- ecrte e +-aL) fo-
VALUATION $
z
Description FEE Description FEE
z
Plan Check
LOT SLOPE %
Building
0
PLAN CHECK NO: STED DATE
Plumbing
IT
Mechanical
THIS PERMIT AUTHORIZES ONLY THE ORKNOTED. THIS PERMIT COVERS WORK TO
t HE DONEOM PRIVATE P OPERTY ONLY. ANY CONSTRUCTION ON THE PUSUC
2
Grading Recording Fee
0 OMVUN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review City Surcharge
Rg . ....... Is
M
PER ITAPPLICA71ON: IN DAYS
_MM. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection State Surcharge
ng'
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
AND
'APPLIC ON BEHA F OF HIS OR HER SPOUSE, HERS. ASSIGNS AND SUCCESORS
Traffic Mitigation Plan Chk Deposit
IN INTEREST, AGREES INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENT' FROM ANY Ater
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARVANG DIRECTLY OR INDIRECTLY
Lnpo,1,,,,on,
Fire Review Receipt #
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
Fire Inspection Total Amount Due
75—
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION�'
Landscape Insp. Receipt #
I
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT IN INFORMAn ON
APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
H CITY AND STATE LAWS REGULATIN
THE OWNER I AGREE TO COMPLY WIT 0 CONSTALIC.
CALL This application Is cal. pturaft UnIll signed by the
TION: AND 14 D:11NGJWWj1CAUDTE11OR,1ZED THENEBY. No PERSON WILL BE EMPLOYED
T, LA go
0, T ,a
IN VIOLATION 0 0 . THE STATE OF WASHINGTON RELATING TO
Building Official or hisfinu Deputy! and Fees are paid, and
FOR INSPECTION receipt Is acknDModged In space pno,lded,
TON I
WORKMEN'S COMP SAT ON I SURANCE AND RCW 18,27,
qED
DATE
(425)
771-0220
ATI NT ON
EXr 1333
IT IS U WFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE W
YELLO -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
:
FAX PINK, OWNE GOLD ASSESSOR
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall ...................
Pier/Porch .................
t
Retaining Wall ...........
Stab Insulation ..........
PLUMBING:
Underground
C C)
Rough -In ............
0
Commercial Final
IT!
171
HEATING:
z
-4
Gas Test ....................
'N)
Gas Piping ...........
Equipment .................
4;
Commercial Final
ID
EXTERIOR SHEATHING
0
NAILING ...... . ..................
(j)
FRAMING ........... ............
M 0
z
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
z
Wall Insulation
Cn
Ceiling Insulation
Z,
SHEETROCK NAILING
M
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..........