20020247.pdfDATE RECEIVED
PERMITEXPIRES
sis,
CITY
U ZSE T
ONE
OF EDMONDS
'ERM
'M�
CONSTRUCTION PERMIT APPLICATION
- BIT,
ADDRES
Joe
OVIN 1�11 INESS
,!1 �GUI
PLAT NAMEISUDOWISION NO. LID NO.
MAILING ADDRESS
PL I/L)
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP IFNE, me—
ZIP TELEPHONE
EXISTING — P ....... .s.d
,6,111f -12�, 7
U—N—d
REQUIRED DEDICATION— FT sn...'used
NAME
METER SIZE LINE IRI REQUIR D
ES 0 NO 0
I
ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY
==:::I -
Type B 0;. 1, qcjit connectors - I
NAMV
0,,�jjej_bTjrnjng applianceS-In
C-lievy-SC-7-e—
ZEd
required
ENGINEEII&hetd S p,,,,. "I S152--.I.ATE
I-- —
TELEPHONE
"P Q-)
—7 -e5t
STATE LICENSE NUMBER ETN DA
_7 7 CKI;,V
C r
.Lr0
PROPERTY 1AX ACCOUNT PARCEL MO.
0(_p
FIRE REVIEWED BY DATE
"C
VARIANCE OR CU SHORELINE OR ADB# IN FOR I PBOND
'.ED OSTED
'D
DR.
SEPA REVIEW SIGN AREA C3 YES HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED PROPOILED
EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBAO 11 'IT .1
NEW
0 LUMBING I MECH
ALLOWED PROPOSED FRONT SIDE BEAR
FRONT UR SIDE BEAR
0 ADDITION
[3 C MPLIANCE 08
z
2
C ANSE OF USE
PARKING LOT ARIA PLANNING REVIEWED
BY OAT'
Mo DEL
0 SIGN
0 1 PROVIDED
SEATS
[3 GRADING C,.B 0 F NCE
I X FT)
REMARKS
0 DEMOLISH
TANK
[3 OTHER
A AGE
13 OCASPORT
STAINING WALL
13 SOCKERY
RENEWAL
OWE OF USrINES�R
R
A EIP
�'VnYl
CHECKED By J:X GO STRUCTION
.cup
.,IO.CUPA.T.,
C
OF
NUMBER 0,
"ELLIN.
T`AL
SPECIAL IIISPEITT.R
OCCUPANT
STORIES
ZK
"MIT.
'A.
FIER
REQUIRED YES JAfsEA
LOAD
DESCW1TE TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER USC, IOSIFINAL INSPECTION REOD
es
I
'9
0000
-
A I—, I —I',
4=1=A21 /
VALUATION $
V96 1_&4
Description
FEE
Description
FEE
Plan Check
SLOPE %
GLAZING % LOT SLOPE %
LOT j
Building
PLAN C14ZICK NO: VESTED DATE
Plumbing
THIS PERMIT AUT ORNUUi ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Mechafiical
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
Recording Fee
a
:3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
SEPARATEPERMiSSION.
Engr. Review
Surcharge
P, MITAPPLICATION: VIDDAYS
City
PERMIT UMM I YEAR - PRICING 0 WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
State Surcharge
SEE BACKOPPINK PERMIT MR NOR INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
AND AGENTS FROM ANY AND
Receipt #
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES.
ALL CLAIMS PON DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Review
-
FROM THE I SUANCE OF THIS PERMM ISSUANCE F THIS PERMIT SHALL NOT BE
'�Y RMNANCE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
YC 0
Fire Inspection
Total Amount Due
N OR LIMIT IN ANY WAY THE CiTYS ABILITY TO ENFOR CE ANY ORDINANCE PROVISION.-
"n"'CH
Landscapeinsp.1
Receipt #
I
no
I HEREBY ACKNOWLEDGE THAT I HAVE.READ THIS APPLICATION; THAT THE INFORMATION
APPILICATION APPROVAL
GIVEN is CORRECT. AND THAT AM T . OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
This anniestinn is not, pemit until signed by Me
TION; AND IN ING THE WORK AUTH1qnIZEO THEREBY, NO PERSON WILL BE EM PLOYED
VIOLATIO F THE LAO b HE STATE 1) WASHINGTON RELATING TO
FOR INSPECTION
B'11 ding Offi.I.I., In./h., Dsp.ty: end Fees idd Piskl�
necelptisackaml,cigd InSpace presided,
WORKMENS MPEN N FICINJO27.
Fy
BATIOX cg�..
U/
LIN
SIG qTUH IOWNE 0 ED
:ATEIGNID
(425)
771 -0220
�FIIEL.Mtb BY
ENtION
EXT 1333
----------
IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL 08 A CERTIFI-
ORICINAL-FILE - YELLOW, INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
P9,IK-OWNER - GOLD -ASSESSOR
10101
z
0
0
in
a in
a 0 'i
M 0
--10
0 C
-4
3: ro
in
o -n
'R
x
M M
0
C M,
_;; W
M 0
Z r-
-1
z
-4
GO
z
9
0
In
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ................
FOUNDATION:
Footing ......................
Wall ................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
—4 -n,
Underground
M
C (3
111
Rough -in ...................
0
-4
Commercial Final
0
--I
HEATING:
= IT
M
Gas Test .................
Gas Piping .................
E uIpment ..........
0
Commercial Final.
ITI
EXTERIOR SHEATHING
M
NAILING ..........................
0
0 Fn
FRAMING ............
0
FIRST FLOOR FRAMING_
z
INSULATION ....................
Floor Insulation
z
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
R11
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ...........