20020194.pdfe- DATE RECEIVED
CITY OF EDMONDS
F CONSTRUCTION PERMIT APPLICATION
FAI
PERMIT EXPIRES
us' P E R MIETR
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NUMB
JOB E/APT#
ADDRESS 5��/ UIT
PLAT NAMEISUBDIVISION NO
LOT NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
IF —
..a Nlaad
EXISTING — PROPOSED—
a" ——.-.Z-1n,d`od
a.-. � ff.d—d
Unda,a—rd
Wftanad
REQUIRED DEDICATION—
METER SIZE
LIII1 SI
P V REQUIRED
I
YES C3 No C3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTA.—RAI—E
Id DRE
AD as
I IL—'y N
ENGINEERING REVIEWED/DATE
All
&OLS'
ZIP
FIRE REVIEWED BY DATE
F4:ZNE
UCEN.E
PT
-77 1
4A
—A-
NUMBER EXIMATIEW GATE
17
VARIANCE OR CU SHORELINE OR ADS# INSPECTION BOND
Ij-01.0;7
_
(Z
REGO
E3 YES 13 NO
POSTED
TV
PROPERTY TAM Auco arn PAR EL NO.
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
42 -1 *7-0 —00q
— QO
I
,
I
EXP
NEW
r[:A
RESIDENTIAL
[3 PLUMBING / MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACK$ (Fr.) PROPOSED
FRONT SIDE BEAR
SETBACKS (FT.)
FRONT URSIDE REAR
D
. ITH
ADDITION
0-1-MMERCIAL
OMPLIANCE OR
E3 CHANGE
MD.
2'.HE ... EL
0 APARTMENT
C 0. USE
0 RON
Reci PARKING
D PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
[3 REPAIR
GRADING
rl PENCE
I
eyes
( — X Fr)
REMARKS
DEMOLISH [3 TANK
13 OTHER
[3 GARAGE — RETAINING WALL
CARPORT LJ ROOKERY
[3 RENEWAL
(TIVE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
+—
OCCUPANT
NUMBER
OF
FCHECf!=TR..Tl..
1.00.
'72
GROUP
STORIES
SPECIAL INSPECTOR JAREA
REOUIRED[3 YES
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
I....E. INSPECTIONS PER DEC 1081FINAL INSPECTION REO'D
FEE
LOT SLOPE %
I"", "'"" I I
Building
PLAN CHECK NO: BITTED DATE
I
Plumbing
THIS PERMIT AUTHORIZES ONLYTHE WORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN
Grading
Recording Fee
LKS, Onar
(CURBS, SIDEWA MAYS MRQUEES,ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
City Surcharge
P
P RIMMAPPLICATION. INDAYS
PERMIT UMM I YEAR - PROVIDE WORK IS STAIRTE. W.I. Igo DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
;a
Engr. Inspection
State Surcharge
-PIJC , ON BEHALF OF HIS 01 HER SPOUSE, HEIRS, ASSIGNS AND SUCCES.Re
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
WAS
a EDMONDS. HINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTEI FROM ANY AND
Fire vow
AD I
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT S11 NOT BE
I
DEEMED TO MODIFY, WA VE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Total Amount D US
NOR LIMIT IN ANY WAY THE CITYS ABIL17Y TO ENFORCE ANY ORDINANCE PROVISION.-
Landscapelrep.
Receipt #
P
I HEREBY ACKNOWLE BE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGRE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSIUKIC.
CALL
TION, AND IN DOING THE WORK AUTHORIZED THEREBY. No PERSON WILL BE EMPLOYED
,,,ThlsapPlic.tia.lsnMapemitultilslgnodbyffi.
ding Official or halfier Dap,dy; and Fear; are Fold, and
I S
N VIOLATION OF THE LABOR CODE OF THE TATE OF WASHINGTON RELATING TO
YORKMEN'S CIDyy INSURANCE AND RCW 18.27.
FOR INSPECTION
dcalrd [a cnrdwJ.dgdd In apan. proWd.d.
'_E�SATIO
sic URE WNE A E IGNED
(425)
OF7Ftl SIGNATURE DATE
771-0220
RELEASED BY DATE'
T'ON
�T.ITIWFU
EXT 1333
I - F OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
----
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI.
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGNAL-FILE YELLOW- INSPECTOR
10/01
FAX
PINK -OWNER GOLD -ASSESSOR
z
ITI
M 0
0
80
a
M M
0 -in
M 1711
0-
0 Cn
0 ITI
2 co
C Co
M 0
z
V)
z
0
RR
I
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ......................
FOUNDATION:
Footing ............
Wall..........................
z
Pier/Porch ... ..............
0
Retaining Wall ...........
Stab Insulation
C65)
PLUMBING:
0 11111
Underground .............
0 2
0
C:
Rough -In ...................
Final
M
M
Commercial
ID
HEATING:
GasTest ....................
C
> z
Gas Piping .................
Equipment .................
Commercial Final
0
EXTERIOR SHEATHING
NAILING ..........................
Ind C)
FRAMING ........................
FIRST FLOOR FRAMING—
;D
INSULATION ................... .
-4
z
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
z
SHEETROCK NAILING
IT
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...............