20020396.pdfDATE RECEIVI;, i
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us PERMIT
CITY OF EDMONDS ZO'N
NUMBER zu
C N P; a SUITE/APTJr
ONSTRUCTION PERMIT APPLICATION 'ADDRESS
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7.-
T-WN;EFI N;AME NAME OF R�INESS
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MAILING ADDRESS FEE $
-7 7 FL k! PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP P%15.1141—
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CITY EXISTING — PROPOSED
REQUIRED DEDICATION— FT —
7-7� 59-79 Yan"s
NAME METER SIZE I LINE SIZ�—] .0. .1 FIXTURES PRV REQUIRED
ES E3 NO
ADDRESS REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY RMD .a FtA;A L—,
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NAME
OW-N PR REVIEWED/DATE
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ADDRESS
6 nL 9-1q,02
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— -T FIRE REVIEWED BY DATE
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STATE LICENSE NUMBER EXPI VA%�E OR CU SHORELINE OR ADS# INSPECTION
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SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALL117�L:10110 ALLOWED PROPOSED
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5`59 2)() 000 1
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1:3 NEW RESIDENTIAL LOT COVINAGE REQUIRED SETIA'�11 IFTI PROPOSED SETBACKS (FT.)
PROPOSED N SIDE , EAR ` HEAR
,ijALLOWED [11E
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ADDITION COMMERCIAL [3 COMPLIA E OR -6-7- Icj
0 CHANGE F USE
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PARKING LOTAREA PLANNI G R IEWED By EY
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REMODEL 0 APARTMENT 0 SIGN P�
Ei F NCE
REPAIR OZML CYDS ( X Fn REMARKS
DEMOLISH TANK OTHER
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o GARAGE 0 RETAINING WALL
CARPORT ROOKERY 0 RENEWAL
(TYPE OF USE. BUSINESS OR EXPLAIN:
"7HECKED
BY TYPE.0 C CTION -'CUU
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NUMBER CRITICAL J.
DWELL NO .. A, SPECIAL INSPECTOR AREA '14 OCCUPANT
I I NUM ER OF
OF UNITS U... 0 1 REQUIRED LOAD
STORIES
DESCRIBE WORK TO BE DONE
PROGRESS INSPECTIONS PER IUSC 1001FINAL INSPECTION REOD
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negeripticin FEE Description FEE
LoTs)'.P'
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14. to. �7( t N
PLAN CHECK NO:
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THIS PERMIT AUTHOFIIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
..............
t BE DONE ON PRIVATE PROPERTY ONV4 AM CON67RUCTION ON THE PUBLIC
Grading
Recording Fee
I
3 DOMAIN (CURBS, SIDEWALK% DRIVEWAYS. MARQUEES, ETC,) WILL REQUIRE
k: SEPARATEPEn U)SION,
PERMIT APPLICAR-Ne: IN DAYS
Engr. Review
City Surcharge
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN IN DAYS
Engr. Inspection
State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLI. NT, Oil E.1 F 01 HIS OR HER INGUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTE'EST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY A
ALL CLAIMS FOR DAMAGES OFWHATVVER, NATURE ARISING DIRECTLY OR INDIRECTLY
Fire Review
—
Receipt # .4
FROM THE ISSUANCE OF MIS PERMIT, SSUANCi OF THIS PERMIT SHALL NOT BE
Fire Inspection
Total Amount Due
DEEMED TO MODIFY' WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT I
at N ANY WAY THE CHYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
Landscapainsp.
Receipt #
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
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 CONSTAUC�
CALL
This a
applies ban is not a permit until signed by ur
TION. AND IN DOING THE WORK AUT14ORIZED THEREBY, NO PERE N WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING 10
FOR INSPECTION
.."caus Official or his/her Deputy: and Fees we pal,
water I—Ins—lary,rd [.up ... p—ld.d.
WORKMEN-SCjRMPENSATI1,N1URVsC1 AND IICW 11,11,
-;F-
—. IA1. IGPIATURE DATE
SIGNAT R OWNE ORA l�WICNED
1
(4,25)
RELEASED BY
A E TON
M PIT 4
EXT 1333
2,
IT T F OR OCCUPY A BUILDING OR STRUCTURE UNTIL
q BEEN MADE AND APPROVAL OR A CERTIFI-
771-0221
ORIGHM�L-FILE )ELUM-INSPECTC
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER —'GOLD - ASSESSOR
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APPROVED BY PLANNING
FZECEIVED
APR
177 1�e
BUILDING
DEPT.
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .... . ..............
wall ..................
Pier/Porch ...............
Retaining Wall ...........
Stab Insulation ..........
PLUMBING:
Underground .............
Rough -in .............
Commercial Final
HEATING:
Gas Test ....................
Gas Piping .................
Equipment ...............
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation
Wall Insulation
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...............
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