20020165.pdf11
DATE RECEIVES
are PERMIT EXPIRES
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CITY OF EDMONDS 12T), �Z_q NUMB'ER,�2�,�,,��- '&16
CONSTRUCTION PERMIT APPLICATION jo SUITFIAFTO
IER NAMEINAME OF BUSINESS ADDRESS 21117 77 PI W 15
Rr.Uge Murubey
PLAT NAMEISUBDIVISION NO. T7�T�_
11 NO.
MAILING ADDRESS
LID FEE $
21117 77 P1 W
#15
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
CITY
ZIP
EXISTING — PROPOSED—
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-I—Edmonds
ITELEPHONE
98026
425-776-4852
REQUIRED DEDICATION— FT
AME
METER SIZE
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LINE 1111
NO, OF FIXTURES
PRI REQUIRED
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1
YES 0 No C3
REMARKS
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FIRE REVIEWED BY
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1 425-814-3124
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TATE LIGEAS� ER
EXPIRATION DATE
VARIANCE OR CU
SHORELINE OR ADB#
FASTWjiC052DF
2-16-03
PROPERTY TAX ACCOUNT PARCEL 110.
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED P7 ED
00835874501500
EXP
0 NEW
RESIDENTIAL
PLUMBING I MI:GH
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ALLOWE PROF.
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ARPORT ROOKERY RENEWAL
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STORIES
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NUMBER
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DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS I�SPECTIONS PER UBC 108/171
Remove/ret:ilace gas water h t
,000 btu's
DATE
NO
OCCUPANT
LOAD
LU
VALUATION $
449.00
FEE
Description
FEE
"B""Pt"an
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Plan Check
HEAT SOURCE 11—ING 10-T 11OP,
E.AT.' jPlumbing
Building
PLAN CHECK NO: T .
SO
. . ice,
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I: BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
r
Grading
Recording Fee
ONLAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL I E
a REOU R
SEPARATE PERMISSION.
Engr. Review
City Surcharge
PS RMITAPPLICATION: 100DAYS
PERMITIUMMIYEAR, -PROVID D WORK IS STARTED WITHIN ISODAYS
Engr. inspection
State Surcharge
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
_
-PLIC . ON 81-LI OF "IS OR HER 1PO11E. H1111, AISIGMS AND SUCCESCAS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
IDMONDI, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Review
Receipt #
ALL CIUMa FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE S PERMIT ISSUANCE
MIT P NOT
OF OF THIS ERMIT $HALL NOT E
ER HA BE
OF ANY CITY OROINAN
E A REDUCE ANY REQUIREMENT OF AN 01 ORDINANOE
ci�
9 D EMED TO MODIFY, WAIVE P Y Ty C
Fire Inspection
NOR LIMIT IN ANY WAY THE S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,
Y — 'E --- - ---
Landscapainsp.1
Receipt #
1 A/W_
I HERE ACKNOWLEDGE THAT I HAVE AM THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
R
THE OWNE . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
This appll�.I.a harm . in-11 trill 11pird
by Me
A L . MPL.YE.
TION; AND IN DOING TH WORK AUTHORIZED THEREBY, NO PE]ASON WILL BE EMPLOYED
VIOLATI are
IN ON OF THE LABOR CODE OF THE STAT OF WASHIN A RELATING TO
GTO
Oulkliho Officiel ., his/her DarrWy: and Fees are paid, and
FOR INSPECTION reaha Is ackroaledged karrala pmIded.
WORKMEN'S COMPENSATION INSURANCE AND AGIN MET
OFFICIALS 1A I
DATE
DA E SIGNED
a G
(425)
_11�2
'le
771-0220
RELEASED BY
DATE
ATTENTION
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
WAX
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Milk
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ................
FOUNDATION:
Footing......................
Wall ................
Pier/Porch .................
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Retaining Wall ...........
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Slab Insulation ..........
PLUMBING:
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Underground
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Rough -in ...................
0
0
Commercial Final
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HEATING:
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Gas Test ..............
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Gas Piping .................
Equipment .................
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n 23
Commercial Final
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EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ..................
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FIRST FLOOR FRAMING
INSULATION ...........
Floor Insulation
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Wall Insulation
Ceiling Insulation
V)
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SHEETROCK NAILING
SPECIAL INSPECTION
m
MISCELLANEOUS ..........
FINAL APPROVAL FOR
22- r"
OCCUPANCY ..................