20020307.pdf$I
DATE a- - __F -
ECEIV� Z 77
EXPIRES
PERMIT r
PERMIT
ZONE
CITY OF EDMONDS ... NUMBER
CONSTRUCTION PERMIT APPLICATION JACOGRESS IS 0 / LS 5,-,4 NXIAU��
OMIR NAMEINAME OF BUSINESS
'_/ 4_/ PLAT NAMEISUSDIVISION NO, LOT NO, LID NO,
MAILING DRESS LID FEE It
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PUBLIC WGHT OF WAY PER OFFICIAL STREET MAP 4W..
P_. r.
CITY TELEPHON EXISTING - PROPOSED- '�%P=0"'q 'd
D REQUIRED DEDICATION- FT
13
NAME METER SIZE LINE 1111 MV REQUIRED
YEsC3 NO C3
I
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROU DRAINAGE
CITY
NAME Vh_Q,
E GINEERING REVIEWEDIDATE
ADDRESS
WED BY DATE
cm ZIP TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADS# INSIP.&U)N N..
CSTE
'E D 1'.
MYES ONO
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
CrOd
0 Wn
77Yq'T L EXP ,
LOT C VERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKrI I'
'KIRESIDENTIAL )<:�MECH ALLOWED 0 PROPOSED FRONT SIDE READ FRONT UR SIDE REAR
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'6A.11ITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
2
=ED BY DATE
REMODEL APARTMENT SIGN
0 REPAIR o rRADING Y., Ej F NOE
( 7_ X FT) REMARKS
DEMOLISH TANK OT7ER
CCARAGE o RETAINING WALL
3 GARPORT , OCKERY 0 RENEWAL
(TYPE OF USE, BUSINESS OR AV
CHECKED BY ITYPMID 1777cCUPA76
R. UP
RITICAL
FDRIES REAS SPECIAL INSPECTOR CCURANT
JAREA
ID
ST UMBER REQUIRED [] YES LOAD
DESCRIBE WORK TO BE DONE
Voe REMARKS
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P -.11ONS PER USC 108/FINAL INSPECTION REaD
F 9
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VALUATION $
Description I FEE Description FEE
PI.TC'1G.1_7T_
Mechanical
THIS PERMIT AUTHORUES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
ONLY ANY CONSTRUCTION O"THE PUOU
t; BE DONE ON PRIVATE PROPERTY JC
Grading
Recording Fee
2
:1 130MAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE
SEPARATE PERMISSION. _
Engr. Review
City Surcharge
PC MITAPPLICATION: 16DIDAYS
PERMIT LIMIT I YEAR-PROVI SO WORK IS STARTED WITHIN He DAYS
Engr, Inspection
State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
1<1 'APPLICANT, ON SEHAL F HI OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
' -
Traffic Mitigation
Plan Chk Deposit
XA IN PREFIEST. AGREES To INDSEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
Receipt #
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS MOM ANY AND
LY
ALL CLAIMS FOR DAMAGES OFWHATCVM MATURE ARISING DIRECTLY OR INDIRECT Ii
Fire Review
—
Z45
FROM THE ISSUANCE OF THIS PERMIT ISSUANCi OF THIS PERMIT SHALL NOT HE
DEEMED TO MODIFY WAWE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDiNANC
Fire Inspection
Total Amount Due 1
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION . .
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Receipt #
— I RN�'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
..............
OPLICAMN AP PROVAL
GIVEN IS CO RECT: AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. IAGRE' TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
Tt/1
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
INA.O.LAT' a GDE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
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W E. INSURANCE AND RCW 16 27.
OFF I AIU E
SIG R (OWNE A
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77-0220
rELE&ED
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BY DATE'
EXT 1333
UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A 11— 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 - COLD - ASSESSOR
10/01
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Footing ......................
Wall .........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
lin 0
Underground ...........
-40
0 C
Rough -in ...................
Commercial Final
M
M Z
10-4
HEATING:
3:
GasTest ....................
0,
Gas Piping .................
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Equipment .................
M M
Commercial Final
0
EXTERIOR SHEATHING
NAILING ..........................
(j)
M 0
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FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
ITI
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ............. _% ....... ....
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