20020246.pdfOW DATE RECEIVED
A"
PERMIT EXPIRES
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
I
us's
"5 ��o PERM T
IN U M BE R, 4,&4
JOB SUIT
ADDRESS
7)W' 11
OWNER NAM11E 01PRIE11
PLAT NO, 1. N.,
OT
I'D In.
LID FEE S
MAILING ADDRESS
/90()/ �Dr
PUBLIC RIGHT or I.. OFFICIAL STREET MAP
EXISTING — PROPOSED—
REQUIRED DEDICATION— FT —
T— AF—se
mrsi—e-eds"
P-e
ro sume,nd
I=
ass.— s—
undont-,u:
yr,rg,.qW-
CITY ZIP TELEPHON
Llxa:�L
NAME
METER SIZE I
Lt.. SIZE
I NO. OF FIXTURES
P V REQUIRED
YES C3 NO 13
ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY ZIP
ITELIPHONE
---1
NAME /-) II
I
Type B or L Tent connectors
I
UNIC 815.7
JIM
-7' —f--)
0" OU
VARIANCE .11 Cu
SHORELINE OR ADB#
IN SPECTPON
REO-D
Elves j3NO
1 '10 D
OSTED
EX
STATE LICENSE NUMBER PIRATION DATE
CHEC ED BY
'H'C
11O1ERF 11, --------
FVARIANCE
SEPA REVIEW
.EPA REVIEW
COMPLETE E .. PT
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIG14T
ALLOWED PROPOSED
is
'0�;O
E -P
0 NEW ESIDENHAL n PLUMBING / MECH
LOT COVERAGE
LOT C VERAGE
ALLOWED PROPOSED
ALLOWED PRO .. ED
REQUIRED SETBACKS RT.)
FRONT SIDE BEAR
PROPOSED SEIRACKS (FT.)
FRONT URSIDE R�R
ADDITION OMMERCIAL [3 C MPLIANCE OR
0 ANGE OF USE
PARKING I
REDD I PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
XRS ... EL [3 APARTMENT SIGN
0
[j REPAIR GRADING CY.R 0 F NCE
I _ X Fn
REMARKS
[3 DEMOLISH [3 TANK 0 OTHER
GARAGE [3 RETANING WALL
C C ARPORT ROOKERY [3 RENEWAL
0
, (Type OF USE, LAIN:
a
MOMU4
Iq
CHECKED BY
JTYP:�=
I CC�,.71
OCCUPANT
G SOUP
NUMBER -UMBER OF CRITICAL
OF I
WELL No A EAS
I
I.SCIALE.I.ECT0.
OCCU NT
as STORIES U NITS NUMBER /A,-/fi
z
. OUR JAREA
YES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
-7 1
ROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RECIV
VALUATION
FEE
PLAN CHECK NO:
I 1111TED DATE
Plumbing
I
Mechanical
z
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
8 DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
I
Recording Fee
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATEPERIJUSSION.
PEAMITAPPLICATI N; ISO DAYS
E ngr. Review
City Surcharge
PERMIT LIMm I YBAS. PROVID WORK is STARTED WITHIN IN DAYS
lOspection
State Surcharge
SEE SACK OF PINK PERMIT FOR MORE INFORMATION JE:ngr.
-IU-NT ON BEHALF (11 HIS OR 11111 SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Traffic Millgallonn
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONO1, WASHINGTON, Jill OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Review
Receipt #
FROM THE ISSUA CE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT B
DEEMED To MODIFY. WA VE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
I
Total Amount Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION'.
Landscapoinsp.
Receipt #
I HEREBY ACKNOWLEOGS THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN 13 CORRECT, AND THAT I AM THE OWNER, OR TH DULY AUTHORIZED AGENT OF
—
APPLICATION APP OVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
This appilabol Is not, permit until signed by the
IRONIAND IN RESY, NO PERSON WILL BE EMPLOYED
IN VOLAT/ 0". THE --k Q F VDiE`STEAT. OF WASHINGTON RELATING T
THE IS.
FOR INSPECTION
Building Offlourd or hisber purely; and Foos are paid, and
recuptback ... [edged in areas, provided.
ychCJGF
WORKMEN COMPENSATION U CE ANPCW 18.27.
0 LALS SIG UBE DATE
— NATdif low
1 1 Ma�
(425)
771-0220
'RfLEASEDBY DA715
ATTENTION
EXT 1333
IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
1
771-0221
A FIN— INSPECTION — BEEN MAD. AND APPROVAL — in ... IR- ORIGINAL -FILE YELLOW -INSPECT R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK,OWNER GOLD -ASSESSOR
i0/01
z
0 M
C i I
M a
0
80
C
In
ITI Z
0 7111
It
ITI in
0
0
001
C
99)
ITI 0
Z 171
71
X
z
z
0
I'D
RECORD OF INSPECTiONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATIOW
Fooling .....................
wall..........................
Pier/Porch
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
pri
C
Ma
0
Rough -In . ..................
0
Commercial Final
IMI
m
HEATING:
C
Gas Test
Gas Piping .................
Equipment .................
0 -n
M
Commercial Final
rR pR
EXTERIOR SHEATHING
NAILING ..........................
C
FRAMING .....................
co
M 0
FIRST FLOOR FRAMING...
z
74
INSULATION ...................
Floor Insulation
>
z
Wall Insulation ...........
Ceiling Insulation
z
SHEETROCK NAILING
SPECIAL INSPECTION
R1
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
ztz