20020271.pdfDATE RECEIVED
PERMIT EXPIRES
CITY OF EDMONDS
2C
JA00DRESS ' 71:�.. � _ SUITEIAPT#
CONSTRUCTION PERMIT APPLICATION
OWNER BUSIT
PUT NAME/SUBDIVISION NO.
'GNO
LID FEE $
a c c,
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TL7 ADI)RESS
PUBLIC RIGHT OF WAY PER .111.1. STFEET MAP
EXISTING — PROPOSED—
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CITY ZIP
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LL12-70J-165
1220—
REQUIRED DEDICATION— FT
NAME
METER SIZE
LINE SIZE
PRV REQUIRED
I
YES E3 No 13
ADDRESS
EROSION CONTR
WNERICONTRACTOR RESPONSIBLE FOR 1.
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21
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NAMS�__
IF T_ PL V i/11 k) te-1 Tvll� cc,
required on fuel-niarnling
111 4p, 91 7
-5
ENGINEETUIRIfigneaten spa- I
ADDRESS
g0i:2 '�— 103 It' r—
FIRE REVIEWED BY DATE
1ALLOWE.
STATE LICEASE NUMBER EXPIRATION DATE
CV77
VARIANCE OR CU
SHORELINE OR ADS#
INSPECTION
YREO'D
ES E3 NO
1 so D
OSTEC
SEPA REVIEW
C XEMPT
Exp
SIGN AREA
ALLOWED , PROPOSED
HEIGHT
ALLOWED PROPOSED
PROPERINT FM
NEW RESIDENTIAL
�� I EC-
LOT COVERAGE
PROPOSED
REQUIRED SETBACKS (FT.)
Fee. SIDE BEAR
PROPOSED SETBACKS (FT.
FRONT ...I.E FEAR'
0 ADDITION COMMERCIAL o C MPLANCE OR
CHANGE OF USE
REMODEL APARTMENT 0 SIGN
PARKING _[
REaD I PROVIDED
LOT AREA
LANNING REVIEWED By DATE
REPAIR GRADING CYDS F NCE
( x FT)
REMARKS
11 DEMOLISH 0 TANK OTHER
E:i GARAGE HITrAINING WALL
CARPORT _13, ROCKERY 0 RENEWAL
(TYPE OF USE, BUSINESS OR A;��N:
CHECKED By
1TYP=N
OCCUPAN;<.S
cup
IMBER OF
tELLING
Ina
CRITICAL
AREAS
NUMBER L&
1PEC,[AL INSPECTOR
FEW IRED [3 YES JAREA
.0
OCCUPANT
LOAD
DESCRIBE W
tEMARKS
IROGRESS INSPECTIONS PER UDC 1081FINAL INSPECTION REO'D
8 c k
Plan Check
P I a IT C IT
T S L 0 P
HEAT SOURCE LOT SLOPE %
_'
E T E D D A T
PLAN CHECK 1410� ESTED DATE
P u in I
Plumbing
in b g
IT c a I
Mechanical
M a c IT a I
E R M IT C 0 V E W RK To
THIS PERMIT AUTHORIZES ONLY THE WORK NOT D. THIS PERMIT COVERS WORK TO
S 0
E P U
HE DONE ON PRIVATE PROPaRTIf ONLY, AM CONSTRUCTION ON THE PUBLIC
Grading
'a d g
Recording Fee
W L E I. E
-WAYS MARQUEES. ETC.) WILL REQUIRE
DOMMUN (CURDS, SIDEWALKS, DRIVE
sepAPA-rE PERM;SSION.
V,
a v I W
Engr. Review
City Surcharge
PE IMITAPPUCATION: INDAYS
W H B's A Y
PERMIT LINKS 1 YEAR - PROVID 0 WORK IS STARTED WITHIN I B's DAYS
I M 0
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
i
E Inspecton
p
'n
State Surcharge
a AN E"."S
'APPLICANT. ON SEIQLF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
a SUCC
t
it' a ".
Traffic Mitigation
Tia if M g
Plan Chk Deposit
M E. B HE C
T I OF
TY
IN INT 11EIT, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS Till CITY 01
-A.
NTS 0 A NY AND
'DMO Nos. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
mRE Y
CTL ND'FEQT`Y
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE ARISING DIRECTLY OR INDIRECTLY
BE
B a.
a E T HAL
PERMIT SHALL
'"D
V w
Fire Review
I L NOT
FROM THE ISSUANCE OF THIS PERMrr. ISSUANCi OF THIS NOT
C
EMED To M0131F A WE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE�
DEE
Fire Inspection
.Bp..t,..
Total Amount Due
�W
0 YT IT E
R LIMIT IN ANY W
zi NO HE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
Landscapoinsp.,
Receipt #
I HEREBY ACKNOWILE E THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
THE DULY A THORIZED AGENT OF
GIVE14 19 CORRECT. AND THAT I AM THE OWNER, On LY .. OR'Z�. ENT
ST REGULATING C.Nsr.u.
THEOWNER. AGREE TO COMPLY WITH CITY AND ATE LAWS REGULATING CONSTFHJC�
Sj
CALL
CALL
This aPPlication is a Fermi! unljl�spion*d bpyv"'
I SON WILL BE EMPLOYED
TION. AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERS N WILL BE EMPLOYED
ELRNGTON FELAT'N. To
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
FOR INSPEC
Gii�jdjiig ,,,nl Dspii,.isiid ssd�s Id. d
his,
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WORKMENS SPIMfErta�TION NSURANCE AND ACW 18.27.
OFFICIALS NAT
FE�TION
DATE 111111
NEIL I T. EKINED
(425)
( )
LRE,,
r
el 2
771-0220
RE'EASEC
AfTENTION
EX7r 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
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 ...........
z
Pier/Porch .................
Retaining Wall
M
Slab Insulation
4
PLUMBING:
Underground
C:
IT! a
0
Rough -In ...................
0
C
Commercial Final
M
M
HEATING:
S
C —
Gas Test
CA
Gas P,,In,
EcipipmqnI, . ..............
0 n
-n
Commercial Final
M M
CA
EXTERIOR SHEATHING
0
0
NAILING ............... ..........
a co
co
FRAMING ...................
0
r
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation
z
Wall Insulation
Ceiling Insulation
z
SHEETROCK NAILING
ITI
SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
6'
OCCUPANCY ..................