20020164.pdf.1 D E RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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JOB 11.11 TE/APT#
ADDRESS
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PLAT NAMEISUBDIVISION NO.
LOT NO,
L�D NO.
L D FEE It
PUBLIC RIGHT OF WAY PEA OFFICIAL STREET MAP
EXISTING — PROPOSED
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at'.
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REQUIRED DEDICATION— FT
— 'T
13
METER SIZE
LINE AIZ.�
PAV RECAARE.
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YES 0
REMARKS
OWNEIVOONTRACTOR RESPONSIBLE FOR EROSION CONTROL1.11XINAGE
CITY
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FIRE REVIEWED By
DATE
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STATE LICENSE NUMBER
EX N DATE
VARIANCE OR CU SHORELINE OR ADD#
INSPECTION
I
ID
r3YREG'D
ES ONO
PBOND
OSTED
PROPERTY TAX ACCOUNT PARCEL No,
SEPA REVIEW
�TE EXEMPT
SIGN AREA
ALLOWED PROPOSED
"EIGHT
P,
ALLOWED O"O"D
c� -7
U'yj 614
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EXP I
19 NEW
RESIDENTIAL
LUMBING I MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.) PROPOSED SETBACKS IFT.
FRONT SIDE HEAR FRONT LIR SIDE REAR
0 ADDITION
C..PLIA... OR
2
REMODEL
APARTMENT
CHANGE OF USE
PARKING
LOT AREA
PLANNING REVIEWED BY DATE
SIGN
SED, PROVIDED
0 REPAIR
F NICE
I
( _ X FT)
REMARKS
E] DEMOLISH
TANK
0 OTHER
o BARAD
CARPORT
0 RETAINING WALL
ROOKERY
0 RENEWAL
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EXPLAIN:
-17
CHECKED 71-mcoNsTrIUCTON
NUMBER
N.MBER OF
CRITICAL
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GROUP
OF
STORIES
j D ELL'N.
UNITS
A SAS
NUMBER
&11A
SEPECIALEINSPECTOR
R UR OES JAREA
OCCUPANT
LOAD
DESCRIBE WORK TO BE DON!
PRO
BESS lNe
BESS INSPECTIONS PER UBC 108/FINALINSPECTICiN
REO'D
(10,
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Pla n Check
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HEAT SOURCE 7.... �WIIGI
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PLAN CHECK NO:
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
V ER Wo K To
M a
Mechanical
C harn..'
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
HE PUBLIC
2 DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS MARQUEES, EaTC.) WILL REQUIRE
'LL
-mcfm.
Grading
SEPARATE PERM; $SION,
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ER.T .view
Engr. Review
A
0
PERNITTIL111i PE* PM'RTOAVIPPEUDCAWTOIRKN:ISISMTADRATYESD WITHIN INDAYS
'a
Engr. Inspection
____SEE BACK OF PINK PERMIT FOR MORE INFORMATION
- -
'APPLICANT ON BEHALF OF a OR HER SPOUSE, HEIR$, ASSIGNS AND SU CES AS
O—F
I
Traffic Mitigation
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS ...
. T.
Z! EDMONDS, WASHINGTON, 17S OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
- 0
Fire Review
ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE, ARISING DIRECTLY On INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
H
DEEMED TO
'Ire Inspection
F
MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
21 , " 'Y 0. CE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscapainsp.
I HERSEY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION� THAT THE INFORMATION
GIVEN Is CORRECT AMD THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
TION; AND IN DOING
CALL
THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTII
WORKMEN'S COMPEN$21RANCE TrD RC� 1 .27.
SIGNED
(425)
771-0220
ATTENTION
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
10/01
FAX
FEE
Recording Fee
City Surcharge
State Surcharge
Plan Chk Deposit
Receipt #
Total Amount Due 614�_
APPLICK ON APPS DVAL
U.'dt,g OffiCial or Inelho, Deputy; and Fees am paid, and
mo0JP1 13 aalmledged I, space pkmd.
ORIGINAL,FILE - YELLOW. INSPECTOR
PINK,OWNER - GOLD,ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
f
SETBACKS ...............
FOUNDATI ON;
Footing......................
Wall..........................
Pier/Porch .................
z
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground
M
C
Rough -In ...................
M
0
0
Commercial Final
C
171
HEATING�
M
Gas Test ..........
'04
Gas Piping
Equipment .................
n
Commercial Final
M M
EXTERIOR SHEATHING
NAILING .....................
0
0
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ..................
Floor frisulation
>
z
Wal(Insulation
Ceiling Insulation
fj)
SHEETROCK NAILING
z
SPECIAL INSPECTION
IT1
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..................