20020461.pdfCITY
I DATE RECEIVED
PERMIT EXPIRES
CITY OF EDMONDS
US' PERMIT
ION NUMBER)a)2-- ()q(ol
CONSTRUCTION PERMIT APPLICATION
JOB UITEJAPT#
ADDRESS
E? NAMEINAME OF allSINESS
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PLAT NAMEISUBDIVISION NO. LOT NO� LID NO,
ING ADDRE&S
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LID FEE I
PUBLIC H1.11 .1 . PER OFFICIAL STREET MAP Py'
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YES 13 N
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTRCL[DRMNA
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ADDRESS
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FIRE REVIEWED By
DATE
III TELEPHONE
STATE LICENSE NUMBER
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C Y
VARIANCE OR CU
SHORELINE 5 ADS#
INSPECTION
REQ6,6
I BOND
POSTED
YES
-
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PROPERTY TAX ACCOUNT FARCI
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
& 7,9
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g2j�Z
EXP V___
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0
,
7_5' 7-4'
,
0 NEW
51 RESIDENTIAL
0 PLUMBING I MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SFTSACKS IFT.)
FRONT SIDE RW
PROPOSED SETBACKS (FT.)
FRONT LAR SIDE REAR
ADDITION
[3 COMMERCIAL
0 COMPLIANCE OR
CHANGE OF USE
35 _2 ZI %12-5- -7.9 19
12-t, 'n., 12
PARK NG
LOT AREA IrNING REVIEWED 11 DATE
REMODEL
0 APARTMENT
1:1 SIGN
REDD
I PROVIDED
5T3P
REPAIR
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'INCI
n F
X FR
REMARKS
3
DEMOLISH
0 TANK
n OTHER
GARAGE
RETAINING WALL
[3
CARPORT
o ROOKERY
RENEWAL
:=BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY
TYPE O�r
A7N
172
OQCUPAN�e
GROUP
NUMBEB
OF
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CITTI I/
AREA
C T'00,46 7?
S ECIAL INSPECTOR
OCCUPANT
STORIES
UNIT.
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LOAD
DESCRIBE WORK TO BE
'ONEAga
REMARKS
INSPECTInNq PER URC 108/FINALiNSPECTION REO'D a
hL. � Z' h r- /--'I%
Plan Check
.—ING LOT SLOPE %
S32-
69(�
al�.R.E
Building
L5L
PLANCHECK rED DATE
lumbing
Mechanical
IN.. PEII AUTHORIZE. Be- IN. WORK .-a- Ilea PERMIT COVERS WORK TO
I. 1111"111111 PROPERTY *"I ANY CONSTRUCTION am THE 111"I
Grading
Recording Fee
OMAIN (CURDS, SIDEWALKS, DRIVEWAYS MAR UEES, ETC.) WILL REQUIRE
t SEPARATE PERMissioN.
Engr. Review
i5D City Surcharge -6,
PER ITAPPLICATIONt INDAYS
ED WORK IS STARTED WITHIN
PERMIT LUBIr. I YEAJR-PROV4 180DAYS
SEC BACK OF PINK PERMIT FOR MORE INFORMATION
N
Engr, Inspection
IS& State Surcharge
'AIPUCXIT. ON BEHALF OF HIS OR HER SPOUSE, ITEMS. ASSIGNS AND IUCC�SORS
Traffic Mitigation
Plan Chk DellL"_
IN INTE ST. AQ11ES To IIIIIIINII� DEIE40 AND HOLD HARMLESS THE .111 01
WASHINCQON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Receipt #
EDMIIN'DS,
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, AS SING DIRECTLY OR INDIRECTLY
OF NOT BE
Fire Review
V
�M '
FROM THE ISSUAN E OF THIS PERMIT. ISSUANCE THIS , PERMIT $HALL
OR RE ICE ANY REQUIREMENT OF ANY CITY ORDINANCE
FY N C, 0. 1 ct�
DEEMED TO M000"Y'
'Rsp I,
Fire Inspection
TotalAmountDue �6+
VjAWAIVE
0 CE .. V'S'CrI.
T OR., N
X1 NOR LIMIT IN ANY HE CIWS ABILITY TO ENFORCE ANY NA
.c. I sp
Landscapeinsp.
I HEREBY ACKNOWLEDGE TH KAV READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR ME DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
appktft i� �W. p-1, K �Ign.d by ft
TION; AND IN DOING TH WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
8,11TH,
dmIr Offid.1.1 hiS/h., D�Puly: nd F.—I. P.1d, ..d
Ipl Ikn..I.dg.d 1. �p.. p.Ad.d.
WOR�M�NS 00��K IISATION INSUHANC�IAND RCW 18 27.
IC' OAT
a RE WN R G
(425)
'@ z
ID
771-0220
EASE. .1 ATE
ATTEOTION--
EXT 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-
ORIGZ"LE - YEILOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
10101
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-40
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10
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0
m M
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0
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS
FOUNDATION:
Footing
......................
Wall..........................
Pier/Porch ...........
tMA
-7 - 0'Z
Retaining Wall
Stab Insulation ..........
0
PLUMBING:
Underground .............
x
0 M
C=
Rough -In ..........
M
0
Commercial Final
0
C
HEATING:
M
M z
Gas Test ............
-42
oz
Gas Piping ...............
co
Equipment .................
on
Commercial Final
x
E TERIOR SHEATHING
NAILING ..........................
0
FRAMING
0
C:
C ca
FIRST FLOOR FRAMING
ITI 0
z
--I
INSULATION ...................
7-10
Floor Insulation
Wall Insulation ........... .
z
Ceiling Insulation
SHEETROCK NAILING
0)
z
SPECIAL INSPECTION
—01
M