20020386.pdfIli IIilliCGATE RECEIVED
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PERMITEXPIRES
CITY OF EDMONDS
US' PERMIT
ZONE UMBER 'We"z—a—M,
CONSTRUCTION PERMIT APPLICATION
2DCAESS SUITEIAPT#
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OWNER NAMEINAME OF BUSH EBB
PLAr NAMEISUBDIVISION NO.
I LOT NO,
UD NO,
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MAIL NG ADDRESS
LID FEE S
14 C, t -t-
PUBLIC RIGHT OF WAY PER OFIMIAL STREET MAP
EXISTING — PROPOSED—
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CITY ZIP
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REQUIRED DEDICATION— FT
NAME
METER SIZE
LINE SIZE
NO- OF FIX1UR11
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ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLAIRAINAGE
CITY
NAME
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ENGINEERING REVIEWED/DATE
AaU
FIRS REVIEWED BY DATE
CITY ZIP
TELEPHONE
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STATE LICENSE NUMBER EXPIRATION
VARIANCE OR CU
SHORELINE OR ADS#
INSPFCTION
RE 'D
SOND
POSTED
C3YES 0 NO
0
PROPERTY TAX AC;�FdRCEL 110.
SEPA REVIEW
COMPLETE �XEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
EXP
0 NEW al.E.H)ENTIA1 ISDMECH
LOT COVERAGE
SEQUIRED SETBACKS (FL) PROPOSED
SETBACK$ P1)
0 ADDITION COMMERCIAL COMPLA CE OR
CHANGE OF USE
AL LOWED PROPOSED
FRONT SIDE READ
FRONT LIRSIDE BEAR
0
M
C
0
M 0
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BE PARKING
do PROVIDED
LOT AREA
I PLANNING REVIEWED BY DATE
REMODEL APARTMENT SIGN
0 C
REPAIR GRADING CyCe F NCE
( X F"r)
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REMARKS
0 DEMOLISH TANK OTHER
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GARAGE RETAINING WALL
R RENEWAL
CARPORT OCKERY
(1)
(TYPE OF USE, BUSINESS OR A3?rIM
-NUMBER
CHECKEDBY TYPE
OF CONSTRUCTION
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CCUPANT
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DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION REG'O
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VALUATION $ /7/1 /Y1110
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Description
FEE
Plan Check
OWING %
H&SOURCE Building
____ I I / 1)73
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E V51TED DATE Plumbing
0
Mechanical
THIS PERMITAUTHORCEES ONLYTHE WORKNOMED. THIS PERMIT COVERS WORK TO
DOE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE POUBLIC,
P
Grading Recording Fee
MAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL Re UIRE
SEPARATE PERMISSION.
Engr. Review City Surcharge
P"TIMMAPPLICATION: 1811DAYS
PERMIT LIMM. I Y. 0 WORK IS STARTED WITHIN ISODAYS Engr. Inspection State Surcharge
SEE BACK OP`PPJ"N0K`Pj2RMIT FOR MORE INIF RMAIDON
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HERS SSIGNS AND SUC ESORS Traffic Mitigation Plan Chk Deposit
IN INTS OLA
REST, AGREES TO INDEMNIFY, DEFEND AND H D HARMLE11 THE
EDMONDS WAIHIIGTON ITS OFFICIALS, EMPLOYEES, AND AGENTS Me ANY AND Fire Review Receipt #
ALL "�ii FOR IIAMAiifi�: OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM E.E.UANCE OF THIS PERMIT ISE ANCE OF T141S PERMIT SHALL NOT BE Fire Inspection Total Amount Due
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMINT OF ANY CITY ORDINANCE
... LIMIT 1. ANY WAY -IS CRT. ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Landscapelnsp. Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO CO PLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED -d
IN VIOLATION 0 LA OR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION 1P p—ded.
PEN
WORKMEWS S�TION INSURANCE AND Raw 18,27,
OF
NOWIGAS�12NATU? DATE
SIGNAT�'RE((OkNE fldR AGENT) DATESIGNED (425) (
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C- 71-022
_i:1) R411 OWE
ATTENTION EXT 1333
UNLAWFUL TO USE OR OCCUPY UNTIL 76 _/2 t3lo L
IT IS A BUILDING .11 STRUCTURE
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. U13C SECTION 109 FAX PINK -OWNER GOLD -ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ....................
wall
Pier/Porch
Retaining Wall ...........
Slab Insulation ..........
0
PLUMBING:
Underground ...........
Wks
M
Rough -in
M
0
Commercial Final
0
C:
HEATING:
In
ITI
GasTest ..' .................
C Z
GasPiping .................
>
Equipment
C
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Commercial Final
EXTERIOR SHEATHING
fn 1111
NAILING ............... : ..........
0
FRAMING
-7
Q 0
FIRST, FLOOR FRAMING
z
INSULATION ...................
;U
Floor Insulation
z
Wall Insulation ...........
Ceiling Insulation
Z'
SHEETROCK NAILING
SPECIAL INSPECTION
0
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................