20020211.pdfRECEIVED
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PERMIT EXPIRES
CITY OF EDMONDS
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PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION
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- OWNER NAMEMAME OF BUSINESS
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PLAT NAME(SUdDIVISION NO.
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MAILING ADDRESS l
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111 LID FEE S
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PUBLIC RIGHT OF WAY PER OFFICIAL
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STREET MAP
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CITY
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EXISTING PROPOSED eon Peaukatl
21P TELEPHONE
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REQUIRED DEDICATION
eklawaik Peauintl
FT Vaa.�arowa
wianOreu�ew
NAME
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•F�r
METER S12E LINE SIZE
1 110. OF FIXTURES PRV REQUIRED
YES CI NO ❑
FADDRESS ,
MARS
O NERKCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
FIRE REVIEWED BY
DATE
TELEPHONE/
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EXPIRATION GATE
CHECKED BY
VARIANCE OR CU
SHORELINE OR AOB#
INSPECTION BOND
RED' POSTED
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..mow.•„--•�Y°
YES NO
ARCEL NO.
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SEPA REVIEW
COMPLETE
SIGN AREA
HEIGHT
f
❑ DEMOLISH
❑ TANK
❑ OTHER
PW4140!,.
r^•� GARAGE
RETAINING WALL
-
❑
CARPORT
❑ ROCKERY
RENEWAL
- (TYPE - OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
IREw.-
CHECKED 6Y TYPE OF CONaTFlu
NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
SPECIAL INSPF,CTOP AREA Ll"J,L
to
STORIES
l✓' UNITS
NUMBER
REQUIRED I�X yE5li'{I,,I
�l
DESCRIBE WORK TO BE DONE
t'
REMAflKe
PROGRESS INSPECTIONS P
Plan Check
rr? 79' -•'
HEAT SOURCE GLAZING % } LOT SLOPE %
Building
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O -i'-
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
Recording Fee
� DOMAIN 1CUROS.SIDEWALKS,DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
t SEPARATEPERMISSION.
Engr. Review
City Surcharge
a
R PERMiTAPPUCATION: INDAYS
S PERMIT UMIE t YEAR- PROVIDED WORK IB STARTED WITHIN 180 DAYS
Engc inspection
State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
C( 'APPLICANT ON BEHALF OF 1113 OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chit Deposit
0,f IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
i EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
ISSUANCE OF THIS PERMIT SHALL NOT BE
FROM THE ISSUANCE OF THIS PERMIT.
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Fire
Total Amount Due65
Oz NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.•
Landscapeinsp.
Receipt# ('
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT 1 AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. t AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application Is not a permit until signed cy the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
Buiidiag Offidel or his/her Dapuly: and Fees are paid, an
FOR INSPECTION receipt is acknewlodBed In apace provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18,27.
OFF] /6.18 SIGNATURE 1/) DATE
81GNATUR OWN Oft GEN(�_.. DATE SIGNED /
(425)
Y' it fC
!71�y q `02/day20
p
RED BED 0Y� .. DATE
ATTtkTION
EXT 1333
•
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-022'1
F rf ' ,i'JL •--•, r• %;
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
YELLOW'- NS
ORIPINK-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
SOR
PINK -OWNER COLD -ASSESSOR
PINK -OWNER
IG101 /I
1--e.lnll#trGULl,9'I.A$
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RECORD OF INSPECTIONS
..
INSPECTOR DATE
I
rA�P�PROVED
SETBACKS .........VIAF
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FOUNDATION:
,
.-.. Wall :.........................
ZI
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Pier/Porch ................. -
-
;
.
Retaining Wall...........
Q
m .:
Slab Insulation ..........
- -
PLUMBING:
am ;
" - (
Underground .....
m a
. ;
0 C
Rough -In
-i
" - s
Commercial Final
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1
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HEATING:"
Gas Test....................
..Equipment ...,....:..
_
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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 ..........
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Floor insulation ..........
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Wall Insulation ,i......... -
.
Ceiling Insulation .......
O
"
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m.
SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
MISCELLANEOUS ..........
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FINAL APPROVAL FOR Iy i�
OCCUPANCY ................,, ice ..... =
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AmontlW0 . , ReWIP011.262'
Date I %,
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AmountPaId� �RecePt
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DatePbrebmd
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Amount Paid $ ,,.--Reeelgttl_
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