20020251.pdfDATE RECEIVED
PERMITEXPIRES 4& 4
CITY OF EDMONDS
I 'E
U6 NE
PERMIT
15 NUMBER 0Z — 62
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CONSTRUCTION PERMIT APPLICATION
'AO'DRESS
IUITEIA PT
N R NAMEIN E OF BUS NESS
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PLAT NAMEISUBDIVISION NO. LID NO.
MAILING ADDRESS
LID FEE
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP A...'
an.— so.
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CITY
EXISTING
— PROPOSED ass]e iles..
11EIEPHONE
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REQUIRED
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DEDICATION— Fr un-go,,na
Vorn—u—
NAME
METER SIZE LINE SIZE NO. OF FIXTURES PAV REQUIR 0
1 YES C! No E3
I I
ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ADDRESS
CITY ZIP TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE CHE so Gy]
PROPE7T Ou T PARCEL NO*
o 0 0 00
ENGINEERING
FIRE REVIEWED BY
VARIANCE Oft CU
SEPA REVIEW
COMPLETE EXEMPT
BIG,
REVIEWEDIDATE
DATE
SHORELINE OR ADB# INSP CTI N 80 D
EaD POSTED
CIYES '3NO
SIGN AREA HEIGHT
ALLOWED PROPOSED ALLOWED PROPOSED
LOT COVERAGE
0 NEW fg-l-ESIDENTIAL jp-� I MECH ALLOWED PROPOSED
REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR FRONT L/H SIDE REAR
0 ADDITION
0 COMMERCIAL
OR
0
CNA'6' OCE USE
PARKING
LOT AREA PLANNING ROAMED BY DATE
0 REMODEL
0 APARTMENT
0 SIGN
REOD I PROVIDED
0 REPAIR
GRADING
YGE
(ENCE
0 X
REMARKS
0 DEMOLISH
0 TANK
0 OTHER
AGE
0 GARPO.T
o RETAINING WALL
0 RENEWAL
CA
ROOKERY
(TYPE OF USE, BUSINESS 0 "PLAIN:
CHECKED !��
GROUP
J!nOCCUPAW r'7
NUMBER
OF
Home 11
DWELL No
CRE'TA..AL y
SPECIAL INSPECTOR
OCCUPANT
STORIES
NITS
NUM E A
JAREA
REQUIRE 0 YES
LOAD
I
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REG`D
E 9
VAILUATION $
Description I
FEE Description I —FEE
Plan Check
Check
LOT 'Lop
Building
Building
PLAN CHECK NO: I.- DATE
P'.Inbrn.
Plumbing
APlan
.h..,.a,
Mechanical
ff.KT.
THIS PERMIT AUTHORM ONLY THE ORK NOTED. THIS PERMIT COVERS WORKTO
I. --V BRIEF
t:
..0. HE PU LID
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLI C
in.
Grading
d
M
DOMAIN JCUREIS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
'.'VBLL.E..'GE
2
SEPARATEPEAMISSiON.
Eng, REVIEW
Engr. Review
PERM"App"CATIO" 10 DAYS
PERMIT LIMIT, I YEAR - PROVIDED Won IS STARTED WITHIN IN DAYS
P'RM" YEA
'
Engr. Inspection
CK
SEE BACK OF PINK PERMIT FDA MORE. INFORMATION
BE
T"' -
-APPUCANR, ON BEHALF OF HIS OR HER SPOUSE� HEIRS. ASSIGNS AND SUCCESORS
Traffic Mitigation
'aff'o M"ge"on
"LF'
IN INTEREST, AGREES To INDEMNIFY DIIEND AND HOLD HARMU111 THE CITY 01
N T
ITS 0
EIRIONDS, WASHINGTON, FFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALI. CLAIMS FOR DAMAGES OF WHATEVE NATURE ARISING DIRECTLY OR INDIRECTLY
Fire Review
FROM THE 'SSUA NCE OF THIS PERMIT. SSUANCii OF THIS PERMIT SHALL NOT BE
E ISE I
DEEMED TO MOD FY. wail E OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
a "Y
IT
Fire Inspection
r
�y T,
NOR LIMIT IN ANY WAY THE CnVa ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
L.WNER.
andscapaInsp.
L La hTEp
I HEREG" ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
CK I
GIVEN IS CORRECT, AND THAT I AM THE OWNSIL OR THE DULY AUTHORIZED AGENT OF
THE 0 I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IOLATIO OF THE LABOR CODE OF THE STATE OF WASHINGTON R�I.ATING TO
IN V LA
IN V
FOR INSPECTI(
WORKMENG COMPENSATION 114�URANCE AND ROW 18.27.
Wo
W 0
N
(425)
771-0220
ATTENTION
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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
10/01
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Recording Fee
City Surcharge
State Surcharge
Plan Chk Deposit
Receipt III
Total Amount Due
R.C.iPt#
APP ICATION APPROVAL
This appi�',,..I. a..,reanarre.nrlie.red r, In.
8,11reno Midst or hisloor Depwy: and Fees are paid, and
...... 1.0ded.
ORIGINAL . FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ..............
Wall.......................
Pier/Porch .................
z
Retaining Wall
Slab Insulation ..........
A
PLUMBING:
Underground .............
rn
C:
Rough -in . ..................
0
Commercial Final
171
M z
HEATING:
Gas Test ...........
Gas Piping
Equipment .................
Commercial Final
ITIT
EXTERIOR SHEATHING
0 0
0"
NAILING ................
0
FRAMING ..............
FIRST FLOOR FRAMING
-4 r
INSULATION ...................
Floor Insulation ......... .
z
Wall Insulation ...........
Ceiling Insulation
ca
z
SHEETROCK NAILING
SPECIAL INSPECTION
ITI
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................