20020163.pdfPERMIT EXPIRES
CITY OF EDMONDS
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CONSTRUCTION PERMIT APPUCATION
JOB SUITEIAPT#
ADDRESS
EINAME OF SUSIN as
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PLAT NAMEISUBDIVISION NO. I LOT NO, `�c NO*
MAILING ADDRESS
10 FEE Ir
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP S. P., a-1
ENEI-nd 8
EXISTING Ell
CITY ZIP ITELEPHONE
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— PROPOSED�
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AECLURED DEDICATION— FT
SIZE NO, OF 1IMUR11 PRY REQUIRED
NAME
METER SIZE I LINE
YES 0 No 0
ADDRESS
REMARKS
OWNEF
T�pe B or L vent connectors
CITY ZIP
required oil fuel -burning appliances i-±:�
ITILIPHONE
NAME
unheatetJ sp ces. UMC 815.7
1
I I H[ 3 1 1 1 ( x L'I 1k—V I ) I A I I FIRE RENnEWEDSY DATE
C ZIP 11TINLEPHINE
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CLI SHORELINE OR �Allff �IN BOND
EXPIRATIC14
.Kj; S�yIARIANCE
STATE LICENSE NUMBER BE POSTED
NEW RESIDENTIAL PLUMBING / MECH
LO COVERAGE REtl)JIRWttMtCft4WI.HOt'OSED SETBACKS (IT.)
ALL 11) PROPOSED FRONT 1111 RIAI FRONT L/R1IDE 'EAR
OW
OWT
0 ADDITION /Ei ........ L J5 C"P' N" OR
RANGE OF USE
I
REMODEL rl APARTMENT f—I SIGN
L1AjKIP...GY'.EG
RCOID Pnover
I LOT AREA PLANNING REVIEWED By DATE
PURSU To uPC 605.2
REPAIR 0 GRADING C,.S [:] F NICE
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REMARKS
A WAIEN. StA''vif,�b Ir1U1Uf'J`
DEMOLISH TANK 0 OTHER
—4-R;
T3�A_'S ITENITERSTIM BUILDING
GARAGE RETAINING WALL
RENEWAL
CARPORT ROOKERY
UYI OF USE. SUMO AT EXPLAIN!
�2�GROUP
OHEOIEDDY JTYPE�� C27Z OOCU ANT/
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CRITICAL
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SPECIAL INSPECTOR
JAREA OCCUPANT
BODDIE.
R Ely"
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
Inc CA
CIOIC"J, exEv.1;wrio tanks are
ay-)
I J)r)i tanks per
'
VALUATION $
Description
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FEE Description FEE
FEE Dedspdtgflo�n
I
"In Ch
Plan Check
SLOPE %
PLAN CHECK NO:
Plumbing
Plumbing
r..cha
rucat
Mechanical
THIS PERMIT AUTHORIZES ONLYTHE WORK NOTED. THIS PERINUT COVERS WORK TO
1: 8 CONECINPRIVATE OPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
Grading
ecording Fee
DOMAIN (CURBS, SIDEWALKe, DRIVEWAYS MARQUEES, ETCl, WILL REQUIRE
X SEPARATE PERMISSION.
Engr. Review
ity Surcharge
City Surcharge
PER ITAPPLICATImb 180DAYS
PERMITUM I YEAR - PROVIDED WORK IS STARTED WITHIN ISODAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
late Surcharge
State Surcharge
FTOta
'APPLICANT, ON 1EHAL (11 HIS OR HER SPOUSE, HEIII, A11111115 AND IUCCESTPE
. Traffic Mitigation
Plan Chk Deposit
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
-
Receipt III
ROD eipt #
EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF OATEVE NATURE ARISING DIRECTLY OR INDIRECTLY
]N R SHALL NOT BE
Fire Review
FROM THE ISSUANCE OF THI PERMIT SSUAN& OF THIS PERMIT
I
REDUCE OF ANY CITY ORDINANCE
0 AN
Fire Inspection
I Amount Due
Total Amount Due
DEEMED TO MODIFV� WAIVE OR ANY REQUIREMENT
N IN N P 'IS,
OR LIMIT IN ANY WAY THE CITY$ ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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Receipt #
I HEREBY ACKNOWLED E THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
I '
rINSPECTION
APPLICATION APPROVAL
GIVEN 16 CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
E ULAT'NG CONSTALIC.
THE OWNER I ABBE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONS
1
CALL
nee I. r. a ponen—fil signed by the
�Eorl WILL BE EMPLOYED
TION:ANDIN OINGTH WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
0
IN VIOLATION OF T HE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
I
dronsapplica
ding GROW., his De ty:.d ...Idpid,.nd
I_ or i—knoW,dged I-p— Provided,
FOR
WORKMEIIIB COMPENSATI A
OF1 1IGIi DATE
DATE SIGNE
(425)
'tIA11
771-0220 'DATF/
__&tENTION
EXT 1333
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-
ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
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INSPECTOR
DATE APPROVED
SETBACKS ...............
FOUNDATION:
Footing....................
wall .................
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Pier/Porch .... .............
do
Retaining Wall
Slab Insulation
PLUMBING:
M
Q�d d
rn 0
0
-40
Ao6gli-'In
0 a
Commercial Final
3: M
M Z,
10
HEATING:
GasTist . ....................
Gas Piping .................
Equipment
0 -n
M M
Commercial Final
EXTERIOR SHEATHING
0 Fn
NAILING ..................
C 0)
C C/3
ID
FRAMING ................
FIRST FLOOR FRAMING...
INSULATION ...................
z
Floor Insulation
Wall Insulation ...........
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Ceiling Insulation
SHEETROCK NAILING
m
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
vv\ 5
ca
OCCUPANCY ..................