20020273.pdf*A DATE RECEIVED
-2
,121-
-
A -A I
PERMIT EXPIRES
CITY OF EDMONDS
ERMIT
NUMBER
k�, I-D- P OD- (273
CONSTRUCTION PERMIT APPLICATION
El
JOB UITEIAPTO
ADDRESS P, A
OWNER NAMERIAME OF SUS11 EBB
/\/
. .
PLAT NAMEISUBDIVISION NO.
LOT NO.
LI NO.
,�Irj me�� H onvoe,
.. FEE I
MAILING ADDRESS /I f_3 I Z At iio�C
PUBLIC FIGHT OF WAY PER OFFICIAL STREET MAI
I—
— P:AsP
EXISTING — PROPOSED
REQUIRED DEDICATION— Fr —
esperes. . ..a
a":." n."'.
U=.V, 'Zoad 13
CITY ZIP
&d-ot ITIL
PHONE
NAME
P/A
METER SIZE I
LINE Bill
1 110. 0111-111
P V REQUIRED
I YES 13 No C3
AIDEIR�.a
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP
ITILIIHONE
NAME
i��ave Klevevl 'beQKC1ra4'4cr6
ENGINEERING REVIEWEDIDATE
X A DRESS
5/3
se
M,
z
FIRE REVIEWED BY DATE
CITY
Lyr) I-) Wbl)j C191)'PS-4
TELEPHONE
as
9
SO rn
ma
0
0
8 C
STAT LICENSE NUMBER EXPIRATION DATE
bOC KC ** 01 06-D 102—
VARIANCE OR CU
SHORELINE OR Amhr
I
INERPEE&ION
MIr
r3yea 0
IPBOND
PROPERTY TAX ACOOU- PARCEL NO-
00 6 04 -1— 000 01 cxi)
SERA REVIEW
COMPLETE I E17
EXP
S ION AREA
ALLOWED , PROPOSED
HEIGHT
ALLOWED I PROPOSED
NEW �RREERRE 0 PLUMBING I MECH
OMPLIANCE OR
0 ADDITION Eric 0 CHANGE OF USE
0 C
REMODEL [3 APARTMENT 0 SIGN
0 F NCE
0 REPAIR [3 GRADING CYDS ('_ X FQ
r] DEMOUGH 0 TANK 0 OTHER
LOT COVERAGE
ALLOWED 11010,
357. Ai6
REQUIRED SETBACKS (FT.) PROPOSED
D FRONT SIDE a. I
Z5 io 09
SETBACKS (FT.)
,�SIDE 11.11
;T P
I �(
PARKING
REQO I PROVIDED
IVC
I LOT AREA
PLANNING REVIEWED BY DATE
REMARKS
0 GAIIAG 0 RETAINING WALL
CARFOFIT ROCKERY E3 RENEWAL
As
0
I
ITI in
0
0 r
0 9i
C: CA
go
111
z
—1
/rIN:
ITYPE OF USE, BUSINESS 7�P
as
§
CHECKED BY TYPE
17Z
I OCCUPANT
GROUP W. ?
BE.
'M':
Is I:
0 ].T.:
RE':
I ]�U
NUMBER 0
0 WELLINOF
UNITS
CRITICAL
AREAS
NUMBER
SPECIAL INSPECTOR
REQUIRED E3 YES
rREA
OCCUPANT
LOAD
DESC!��
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQO
JAEMARKS
aLu
4mv
z
VALUATION $
DescrIptlon
FEE'
Descriallo
FEE
0)
z
P an Check
9
HEAT SO 0
,�� I 11!�� I LO Building IT
PLM CHECK NO: Plumbing
_ /,D n I VESTED DATE Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: HE DONE ON PRIVATE PROPERTY ONLY. ANY COBSTRUCIRON ON THE PUBLIC
13 R Grading Recording Fee
OMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, FTC.) WILL EQUIRE
SEPARIATEPERMISSION.
Engr. Review City Surcharge
PERMIT Luee I PERMIT APPLICATI N: IN DAYS tq 6L
ACK OF PINK PERMIT FOR MORE INFORMATION State Surcharge
BUD YEAR-PROVI ED WORK IS STARTED WITHIN '80 DAYS Engr. Inspection
NT' Traffic Mitigation n Chk Deposit
'APPLICA ON BEHALF F HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS Pla
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS , WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Review Receipt #
fils
ALL CLAIMS FOR DA MIT. RI NATURE. ARIS No DIRECTLY OR INDIRECTLY
FROM THE iSSUANQ`1A`OF`T0HFiWPHEARTVE NUANCE OF THIS PERMIT SHALL NOT HE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Fire Inspection Total Amount Due
Ox NOR LIMIT IN ANY WAY THE DRYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
— Landscapainsp. Receipt #
Mid
..—
I HEREBY ACKNOWLED E THAT I HAVE READ THIS APPLICATION; THAT THE rKFie!AAATtON
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHOR ZED AGENT OF APPLICATION J1
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRI.C. CALL B,jjThIa appil-I.. Is net. pneft uatU signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED One Offeial a, his/her Depety: and Fees are paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION . ae.ipII,.ek..w1.d9sd1n.p ... p—Ided.
WORKMEWS COMPENSATI;=NCE AND POW 1827. OF*JAL� SIGNATURE DATE
CAT SIGNED 42t5
M25 - I _0
I —_ /7 f7 2�2 0 ST
LON _E DATE t
ATTENTION M 133
IT IS UNLAWFUL TO USE OR OCCUPY A BUILIONGOR STRUCTURE UNTIL �L V/( 0/6 �z—
_j.. �. .,_ - 21
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- UORIGINAL-FILE ALLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109 FAX PINK . OWNER GOLD - ASSESSOR
10/01
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ................
FOUNDATION:
Footing .. ....................
wall
P10dPo1ch
Retaining Wall ..........
Stab Insulation ..........
PLUMBING:
Underground ...........
Rough -In .................
Commercial Final
HEATING:
Gas Test ....................
Gas Piping .................
Equipment
Commercial Final,
EXTERIOR SHEATHING
NAILING ........................
FRAMING ...........
FIRST FLOOR FRAMING...
INSULATION ...........
Floor Insulation
Wall Insulation
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
A
01711
C
MID
0
0
C
M
C
Oil
n
ITIM
0
0
H,
C u),
ITIO:
;U
z
Z
9
0
M