20020225.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
A ir2-
MAILING ADDRESS
Y) Tl-t f1t SO
CITY ZIP jT111PH0 I
7AME
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PERMITEXPIRES
USE -
ZONE PERMIT
NUMBER &V;_
JOB SUITEIA11
ADDRESS
ID 0.
PLAT NAMEISUBDIVISION NO. T77777 L 17D
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP LID FEE $ ____ff
EXISTING __ PROPOSED-- 13
El
REQUIRED DEDICATION- FT
METER SIZE I LINE 51ZE I NO. OF FIXTURES SIRV 1EGUI1 11
y s13 No E3
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAJNAGE
ZIP
ITELEPHONE
1�pe B or L vent connectors
NAME
requir ed on fuel -burning appliances in
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GINEEfunneatel spar. IED/DATE
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es. UMU 8W
ADDRESS
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TELEPH NE
REVIEWED BY DATE
C_ V i.- f�z e T-r- e ;ko
STATE LICENSE NUMBER 7-
EXPIRATION DATE CHE By
0H
VARIANCE OR CU SHORELINE OR ADS# INSPECTION
OSTED
�5_,t
Ile, <-- At
REaD IPBOND
j3YES 13NO
PROPERTY TAX ACCOUNT PARCEL NO,
7
$EPA REVIEW SIGN AREA HEG
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
0C,?
EXP , , ,
0 NEW RESIDENTIAL
PLUMBING I MECH
LOT COVERAGE REQUIRED SETBACKS JET) PROPOSED SETBACKS (Fr)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
ADDITION RCVL
o COMPLY, CE On
CHANGE OF USE
PARK DATE
REMODEL
SIGN
REIID_t
FENCE
[3 REPAIR 0 QRAIINI CYDS 0 1 _ X Fit
REMARKS
DEMOLISH TANK
0
r
(MR :Zr
GARAGE ETAINING WALL
CARPORT OROCKERY
RENEWAL
(TYPE OF USE, BUSINESS OR ACTFVITY) EXPLAIN:
CHECKED BY JTYP��ION JWJ OCCUPAN
a" up
NUMBER N�.UMBI," OF
CRITICAL
d'
OF BL, No
AREAS
SPECIAL INSPECTOR CCU NT
E.S. I
NUMBER
JAREA
REQUIRED[] YES LOAD
10
DESCRIBE WORK TO BE DONE
BE MARKS
PROGRESS INSPECTIONS PER UEC 10811FINAL INSPE-10.
ve 40 ow on(
FEE
Z SOURCE I G�ING % LOT SLOPE
Building
5
PLAN CHECK NO: TED DATE
I
Plumbing
Mechanical
LReview
THIS PERMIT AUTHORiZES ONLYTHE ORKNOTED. THIS PERMIT COVERS WORK TO
11 DONE ON P111 PROPERTY CNI ANY INSTRUCTION ON THE PUBLIC
I
Grading
Recording Fee
ONIAUN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUESS. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. view
City Surcharge
PER ITAPPILICATION: ISSDAYS
PERMIT LIMIT. I YEAR PROVIDED WORK IS STARTED WITHIN 160 DAYS
Engr. Inspection
State Surcharge
SEE BACK OF PINK PERMIT rOn MORE INFORMATION
C
-APPLICANT. ON BEHALF OF HIS 08 HER SPOUSE, HEIRS A IONS AND SUC ESORS
Traffic Mitigation
Plan Chk Deposit I ...... j
IN INTEREST AGREES TO INDEMNIF)� DEPEND AND HOLDSHARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS O11ICIA11, EMPLOYEES, AND AGENTS 1101' ANY AND
Fire Review
Receipt #
ALL CLAIMS FO DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
5
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED To MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Total Amount [)us
NOR LIMIT IN ANY WAY THE CITYS ABILITY 70 ENFORCE ANY ORDINANCE PROVISION.-
Landscapoinsp.
Receipt #
1 HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN is CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I ACRE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUD-
Thl�.ppk.1111. P-s ntil.ig"dby
TION; AND IN DING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
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IN VIOLATION OF THE LABOR ODE OF THE STATE OF WASHINGTON RELATING TO
CALL
FOR INSPECTION
2 .�d
B,RdIng Official 0, h1,Ihor Deputy: � F P.1d.
_Ipil-0 ... lodged In spac, pro,Ad,d.
WORKMENTS,PWj;)FNSATJON INSURANC AND RCW 18.27.
OF TUBE
SIGNATURE VNE R ACEII
125)
92
EIEASEW DATE
ATTENTION
�11"0220
1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221 1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
FAX
PINK � OWNER - GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .............
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .............
Retaining Wall ...........
0
Stab Insulation
PLUMBING:
a M
Underground .............
C
M
Rough -in ..........
Commercial Final
-4
3:
IT
HEATING:
_q
C5
Gas Test ..............
Gas Piping
4-1
..............
Equipment .................
0
-n
3m:
Commercial Final
M-
0
EXTERIOR SHEATHING
0
0 Fn
NAILING ..........................
0)
C0
FRAMING ........................
0
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
z
Wall Insulation ...........
(0
Ceiling Insulation
z
9
SHEETROCK NAILING
0
IT
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
4- t-7
OCCUPANCY ..................