20020371.pdf0 E RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
zip I TELEPHONE
m
I.......................
.. .........
PERMIT EXPIRES
PE 'IT
ZONE
62( NuRm'sER �(Z, Z - 0�� 7
SUITEIA-
2
10T HANSISLEDIVISIO1 N.,
LOT NO,
LID NO,
LID FEE S
PUBLIC FIGHT OF WAY PER OFFICIAL STREET VAR
EXISTING — ppopOS,,D—
' �WX 0
13
REQUIRED DEDICATION— IT
METER SIZE
LINE SI
P V REQUIRED
I
YES 0 NO 0 A
REMARKS
NER/CONTRACTOR RESPONSIBLE FOR EROSION CONTFOLiDRA!N4GE
ADDRESS
3'� 3 S h k+k,\ Aug, 6ftiri.,�,-
CITY ZIP
PHONE
ITEL
C
STATE LICENSE NUMBER EXPRIATION7TE
Fo ue (`f 1: 1.0 C r7
PROPERT:�. �AQT 1;7b�A.
NEW 4 RESIDENTIAL PLUMBING I MECH
0 AODIT 0 COMMERCIAL o CONIPLANCE A
ION
CHANGE OF U E
0 REMODEL APARTMENT 0 SIGN
REPAIR 0 GAIDUNG CY.G C3 'IN-'
"Rf DEMOLISH 0 TANK 0 OTHER
RETAINING WALL
GAR G.1,
'ARPO ROCK ly 0 RENEWAL
0
(TYPE OF USE. BUS CTtVITY9PLAIN:
S-F slu
NUMBER
05
OR ITICAL
OF
CUMBER
ETS
AREAS
o STORIES
LWEI-LING
NUMBER
DESCRIBE WOR, 10 BE 0-1,
FIRE REVIEWED By DATE
VARIANCE OR CU SHORELINE OR ADS# INSPECTION I 'BOND
RE." OSTED
0 YES ONO
SEPA REVIEW SIGN AREA HEIGHT
_COMPLETE I EXEMPT ALLOWED I PROPOSED ALLOWED , PROPOSED
_XP
LOT COVERAGE REGUIRED SETBACKS JFTJ PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
PARKING I LOT AREA I PLANNING REVEJWED BY DATE
CHECKEDBY ITYP
S ECIALINSPECTOF
REOUIR.D E] YES
OCOU NT
GROUP ,
VALUATION
FEE
PLAN CHECK FEE
ejAj SgCE GLAZING %
LOT SLOPE
BUILDING
PLANCHECKNO�,
IVESTED DATE
PLUMBING
.,�
j6,2,
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WOSK TO
GRADINGIFILL
I: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON T E PUBLIC
a DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MAROUEES. ETC,) WILLE REOUiAE
SEPARATE PERMISSION
—
'ET<TE SURCHARGE
PERMIT APPLICATION: 180 DAYS
ENG, PFV11111 FEES
PERMIT LIM T� I YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
ENG� INSPECTION FEE
W IN NrEREST AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY 01
2 E MONDS,MSHINGTON,ITSOFFICI LS. EMPLOYEES, AND AGENIS FROM ANYAND
ALL CLAIMS F R DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIFECI LY
FROM THE ISSUANCE .1 THIS PERMIT ISSUANCE .1 TRIK PERMIT SHALL NOT BE
DEEMEDTOMOOFY,VVAIVE OR REDUCEANY REQUIRE.ENTOF ANYCITY ORDINANCE
LANDSCAPING
INSPECTION FE�
PLAN CHECK DEPOSIT
REcEIP7
I
0 NOR LIMIT IN ANY WAY THE CH Y'S ABILITY TO EN FORCE ANY ORDINANC E PROW SION,-
TOIL AMOUNT DUE
1
R E C F t PT LC ;hy
IHEAE Y ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION. THAT I HE INIO MATION
ED AGENT .1
GIVEN IS CORRECT, AND THAT AM THE OWNER. OR THE GUi-YAUTNGFIZ R
THEO NER I AGREE TO COMPLY WITH CITY AND STATE LAWS 9EGULAI NO CONSTRUC
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EM'Lo'ED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
—
CALL
OR
APPLICATION APPROVAL
d,,SOffi,,a D,F,,Iy F111, all P.- z—
... pt pl—d-
WORKMEWS59�IS�INSATIO.l SUqANCEANDFCW,8.27
FINSPECTION
(425)
1.0
1 1 --N20
EXT1333
OFF 0 T RE. DATE
�iki 51:) �
IIGN:=GINT)
DATE SIGNED
FELEA16 BY DIRE
ATTENTION
Te.PA
IT IS L RI III DING OR STRUCTURE UNTI
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI
771-0221
ORIGINAL� FILE - YILLO -INSIECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
FAX
PINK OWNER - GOLD ASSESSOR
5198
0
c m
rn 0
-40
00
c
Rl m
Z
0
0 -n
n
r" M
0
0 In
a ch
c 0)
rill 0
Z r-
71
Z
0
m
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
PierlPorch .................
Retaining Wall ...........
Slab Insulation
PLUMBING:
Underground.............
Rough -in ...................
Commercial Final
HEATING:
Gas ..........
To
Gas Piping ..............
fcIulpment ..............
Commercial Final
EXTERIOR SHEATHING
NAILING ....................
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Calling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FIN AL APPROVAL FOR
OCCUPANCY ..................
am
C
ma
0
80 � I
C
IT IT
'04
a
.n
m M
0
0 Fn
co)
MO
M
z
z