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CITY OF EDMONDS
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PERMIT
NUMBER21/,2- -02-y,'�
CONSTRUCTION PERMIT APPI-ICATION
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SUITE/APT#
ADDRESS
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OWNER NAMENAME OF BUSINESS
41"y
PLAT NAME/SUSDIVISION NO.
LOT 110, LID 110,
MAILING ADDRESS
LID FEE a
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
CI Y
EXISTING — PROPOSED—
r.—n.n dern".-
REQUIRED DEDICATION—
FT
NAME
METER SIZE LINE SIZE
NO. OF FIXTURES _PRV REQUIRED
ADDRESS
LEMARK'I
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NAME
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ENGINEERING
REVEWFF7DATE
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FIRE REVIEWED BY
DATE
CITY
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STELICENSE NUMBER EXPIRATION
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BY
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
13 REQ-0
yes C3 NO
PROND
OSTED
;R PROPERTY TAX ACCOUNT PARCEL NO.
SEPA REVIEW
COMPLETE , EXEMPT
EX,
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
0 NEW 1#'�ESIDENTIAL JR/ I NEON
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOS 0 8 T ACKS (FT.)
FRONT E URESISDE REAR
ADDITION 13 COMMERCIAL o C MPLIANCE OR
CHANGE OF USE
PARKING I
NEaD I PROVIDED
LOT AREA
I PUNNING REVUEYWE0 By DATE
REMODEL APARTMENT 0 SIGN
[3 REPAIR [3 GRADING Yes 0 FENCE
( — X FT)
REMARKS
DEMOLISH TANK OTHED
Ei GARAGE RETAINING WALL
CARPORT 0 DOCKERY [I RENEWAL
(7�! OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
CHIC111, BY
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OCCUP
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HUMBER7� I NUMBER OF CRITICAL 106 �
0, 1 SWELL NG AS S
STORIES UNITS NUMBEB2r 2_-C�,- -4 51"
SPECIAL NSPECTOR �AREA
REQUIRED 0 YES
CCUPANT
)AD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER USC 1081FINAL INSPECTION REITO
VALUATION $
Description
FEE
Description
FEE
Plan Check
LOT SLOPE %
Building
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON TH PU LID
D E a
OULMH (CURDS. SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMITAPPLICATPON: INDAYS
Grading
Engr. Review
Recording Fee
City Surcharge
PERMIT LIMIT I YEAR -PROVID 0 WORK IS STARTED WITHIN ISDOWS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
State Surcharge
*APPLIC NT. ON BEHALF OF HIS OR HER SPOUSE . HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND 'I LD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS MOM ANY AND
Traffic Mitigation
Fire Review
Plan Chk Deposit
Receipt
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
0"
I M TTHE ISSUANCE OF 7 S PERMIT. ISSUANCE Of THIS PERMIT '"ALL NOT BE
DEEMED TO MODIFY. WAIVE R RED.- ANY ... UIRMENT .1 ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE HYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,'
----
Fire Inspection
Landscapeinsp.1
Total Amount Due
Receipt #
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I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNS . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION CODE OF THE STATE OF WASHINGTON RELATING TO
MP;E LABOR
ji�F-
WORKMENS SATION INSURANCE AND RCW 18,27.
IIGNAfURE�, �WNE R�qElfrl DATE SIGNED
OW"
APPLICATION APPROVAL
This pplicaln. I, net a amraft -11.19,nd by In.
CALL 0,11dingOlficialo,his or DernAy: and Fees am paid, and
FOR INSPECTION r allial Is ackolohlodgad In space prWIded.
OFFLCIALS SIGNATURE DATE
(425) / t '
771-0220 RELEASED BY *DAT
ATTENTION
M 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIF,. 771-0221
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX
1 ORIGINAL -FILE YELLOW, INSPECTOR
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FOUNDATION:
Footing..............
wall..........................
Pier/Porch ................
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Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
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Rough -in . ...................
0
0
J Commercial Final
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HEATING:
171 z
Gas Test
10-4
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Gas Piping .................
Equipment
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EXTERIOR SHEATHING
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NAILING ..........................
0
FRAMING ........................
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FIRST FLOOR FRAMING
-4
INSULATION ...................
;0
Floor Insulation
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Wall Insulation ...........
-4
Ceiling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY