20020376.pdfDATE RECEIVED
I '
LPERMIT EXPIRES
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
USE
ZONE PERM T
N BIER
UM
Joe
ADDRESS va ou
r
M �111,NAME�AME of BUSINESS
PLAT NAMMUSDIVISION NO.
LOT NO.
L
'�D N .
D FEE S
IL�Nq ADDRt
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED --
REQUIRED DEDICATION— FT
T.1.1.11 —
S-1 =
P.- A...
R., 11
I, A�
ITELEPHONE
ME
METER SIZE I
LINE 1111
1 NO. OF IMUMS
PIV RECURRED
IDA C3 No C3
DRESS \j ---------------
15W'NE-ZICONTRACTOR RESPONSIBLE FOR EROSION CONTROIJORAINAGE
NAME
ENGINEERING REVIEWEDIDATE
0 ADURE)EIS
0 -A "I
I ,
FIRE REVIM1. BY DATE
CITY
I T�E PH�NE
STATE MANSE NUMBEA EXPIRATION DATE
CHECKED BY
AV
VARIANCE OR CU
SHORELINE OR ADB#
SP'C7
IN "N
RED .
DYES ONO
'IONO
OR TED
PROPERTY T
:�3906)— 1
SEPA REVIEW
COMPLETE , E�EMP
XT
EXP
SIGN AREA
ALLOWED
'k
I N/
HEIGHT
ALLOWED , PRO D
0 NEW PQ-,ESIDENTIAL 0 PLUMBING I MACH
0 COMMERCIAL 0 C MPLIANCE OR
CHANGE OF USE
Dcc)r-
0 REMODEL 0 APARTMENT 0 SIGN
0 REPAIR 0 GRADING CYDS 0 F NCE
( _X_Fr)
0 DEMOLISH 0 TANK 0 OTHER
oGARAGE o RETAINING WALL
CARPORT ROOKERY. 0 RENEWAL
LOT COVERAGE
ALLOWED PIROPOSED
I REQUIRED SETBACKS (Fr.) PROPOSED
I FRO IT SID AFAR
2-0' G'.
SETBACKS (FF.)
FRONT UR SIDE REAR
PARAING LOT AREA
a 7; p
1 0 IIE W ATE
REMARKS U
ITYPE OF USE, A CTIVITYI EXPLAIN:
5r7c
CHECKEDBY ITYPEOFCO I CLO
jq�
SPECIALErNSPECTOR
REQUIR 0 YES JARIA
hir-40 wrz%moccu
I DO UPANT
GROUP
NUMBER NUMBER OF
OF DWELLING
a STOR UNITS
CRITICAL
AREAS
NUMBER
PANT
LOAD
DESC WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION REaD
noicli r;r LA
0 VALUATION
PLAN CHECK NO: ()�
A
VESTED DATE
T
P 'u An b
Plumbing
In g
M a c It cal
Mechanical
h a
THIS PERMIT AUTHORIZES ONLV THE ORK NOTED. THIS PERMIT COVERS WORKTO
V 0 A K To
G
Grading
BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
H A U C
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYr. MARQUEES, ETC.) WILL REQUIRE
LL A B A
U
'a It In g
t: SEPARATrE PERMISSION.
Engr. Review
PERMWTAPPUCATIONL INDAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT MR MORE INFORM ION
Engr. Inspection
;APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRSASSIGNS AND SUCCESORS
AS
N INTEREST, AGRE To INDEMNIFY. DEFEND AND HO D HARMLESS THE CITY OF
Traffic Mitigation
Fire Review
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING D RECTLY OR INDIRECTLY
FROM THE ISSLAN E OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODI WAIVE
FX
Fire Inspection
to I.
nap.c� n
OR REDUCE ANY REQUIREMENT OF ANY C17Y ORDINANCE
TY III
NOR LIMIT IN AM WAY THE CITYS ABIUTY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscapainso,
A a
I HEREBY ACKNOWLEDGE THAT I HAVE AM THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
TION'. AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
WORKMEWS COMPENSATI=NCE AND RCW 10.27�
1= OniLV DATE SIGNED
(425)
771-0220
ATTENTION
M 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.
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
10/01
FAX
Recording Fee
City Surcharge
State Surcharge
Plan Chk Depo—
Receipt #
Total Amount Due J(
Receipt #
ICATION APPROVAL
A."N"s by "a
alhis/her laptay: and Feal—PaId..nd
ORIGINAL - FILE - YELLOW - INSPECT A
PINK - OWNER - GOLD - ASSESSOR
z
9 .. r
0
a M
C 0
ITI 0
80
C
IT III
z
'O-q
K 0)
0 In
1111171
0-
0 C'0
001
C
9 to
ITI C)
Z
z
(A
z
9
ITI
I)PIVF- k*n NM12, 57t:A5 1(911
Avr fi,
20,6" -ol,
H
52,
16,
few
lei 19"
Ay
TIT
APP VE BY IqC,
R E C E:��
MAY 0 oo 2002
EOMCIA45 S77 FC)mwO5 �QA 61002-0
-DC
1"� 20,
_or
Fi-*
T-
/_or Cr->VFe'A&_,=
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
AETBACKS .....................
FOUNDATION:
Footing......................
wall .............
Pier/Parch ................
_T A-0
Retaining Wall ...........
P t—rls'
Slab Insulation
PLUMBING:
Underground .............
Rough -in ............
Commercial Final
HEATING:
GasTest ....................
Gas Piping .................
Equipment .............
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
MS
05 0Z
FRAMING ......................
FIRST FLOOR FRAMINO...
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
65 76
z
0M
C
Ma
0
-4 0
0
3: ITI
C: —
0,n
M M
0
0
0
C=
M 0
z
z
ITI