20020475.pdfDATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS AYER--,
7AILING —ADORESS
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CITY 7,Fll� TILII..� _
0 1 -77 — FY33
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1"" IPERMITUPIRES
USE
ZONE PERMIT
NUMBER 2CD2 02 175
JOB SUMAPT#
ADDRESS
_711��
PLAT NAMEISUBDIVISION NO.
LOTNO.
L NO.
I
L�D
D FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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a.. U.. P.Min Wd
EXISTING — PROPOSED—
I-r—a Inc—
..—. n.1— 8
REQUIRED DEDICATION— FT
METER SIZE
LINE SIZE
MO. OF IIXTURS.
PRV BEGINS 0
I
YES 0 NO C3
RE ARKS
OWNERJCONTRACTOR RESPONSIBLE FOR EROSION CONTROUTIMINAGE
ICITY ZIP
ZIP
TELEPHONE
ITELEPHONE
NAME
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ENGINEERING FIEVIEWEDRDATE
ADDRESS
4115 1%*114 ST sw)
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FIRE REVIEWED BY DATE
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T SLOP ONE
11 �t'13`4
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71= ;U..ES EXPIRATION
P E IN 19-TS -1 -7 R 0 1 2-/We 3
CH
VARIANCE OR CU
SHORELINE OR ADS#
IN SPEanON
RE 0
C3 YESO[3NO
BOND
POSTED
AX ��
;I PROPERTY TAX ACCO No./
SEPA REVIEW
11 PLOTS EXEMPT
IGN AREA
ALLOWED 1110PO1111
HEIGHT
AIL.WEII PROP011.
/xr) -
EXP ,
,
,
[0] NEW PLUMBING I MOOT
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACK$ (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT LIRSIDE BEAR
0
ADDITION C MPLIANCE OR
0 ITO.
CHANGE OF USE
[3 REMODEL 0 SIGN
SKING
REaDFA I PROVIDED
LOT AREA
DATE
0 REPAIR GRADING GYDS 0 FENCE
( _ X FT)
REMARKS
0 DEMOLISH 0 TANK 0 OTHER
[i GARAGE o RETAINING WALL [3 SEN.
CARPORT ROOKERY
(TYPE OF USE, BUSINESS OR A�
CHECKED BY
TYPE
.UIA.T
=N
I
GROUP
OF
STORIES
NUMBER OF
. WELLING
ONITS
C ITICAL
A EAS /t//91—
NUMBER
SPECIAL INSPECTOR IJAREA
REQUIRED [] YES
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
(ms LWE PLItitAbiI46 L,7_6WJP4-s�
REMARKS
GRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RECI'D
_30e_bj�4 -aam
Plan Check ,
--h-O'cal
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORKTO
-rading
Grading
rReview
t: BEGONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
7
00 MAIN (CURBS, SIDEWALKS, DRIVEWAYS, MftRQUEES, ETC�) WILL REQUIRE
Engr.
t: SWARATE PERMISSION.
PER ITAPPLICATION: IODDAYS
PERMIT Uri I
SEE YEAR-PROVID 0 WORK IS STARTED WITHIN I So DAYS
BACK OF PINK PERMIT FOR MORE INFORMATION
r. ,
En n.,.cilon
1
'APFUGAN7. ON OEM F His OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
IN INNTEFIEST, AGREES T INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CL4JMS FOR DAMAGE$ OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINA CE
NORLIMITINANYWAYTHE ITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN 19 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 THEAODY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LA DE OF THE $TAT OF WASHINGTON RELATING TO
FOR INSPECTI(
WORKMEN'S COMPENS SPOCE AND RCW 18.27'
ATI;;2p
SIGNATURE (0)MOR DATE SIGNED
(425)
21 -CI'2-
771-0220
ATTENTIOr
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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
10101
rdifi
Recording Fee
City Surcharge
State Surcharge
Plan Chk Deposit
Receipt #
Total Amount Due
R .. 1pl #
APPLICATION APP
Thl� applicall-Wootapencl—ni
ding Official or hinther O.puly: and
ORIGINAL -FILE YELLOW - INSPECTOR
PINK,GWNER GOLD -ASSESSOR
z
0
0 m
C 0 i ,
m 0
80
7: m
m z
C-1)
0
"n
m m
0
0
001
C
C u)
M 0
3:
z
m
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .............
Wall..........................
z
Pler/Porch .................
Retaining Wall ...........
Stab Insulation ..........
PLUMBING:
M
Underground .............
C: 0
m 0
Rough -in ...................
—4
0 0
C
Commercial Final
M
HEATING:
GasTest...............
73 e.
Gas Piping .................
0 -n
Equipment ............
-n ;0
Commercial Final
rn M
EXTERIOR SHEATHING
0 Fn
NAILING ..............
0)
ca,
FRAMING ........................
IT! 0
Z
FRAMING...
71
FIRST FLOOR
INSULATION ...................
Floor Insulation
z
Wall Insulation ...........
Ceiling Insulation
z