20020485.pdfeX 6 /E '17DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNERi SINESS
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MAILING ADD EBB
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PERMIT EXPIRES
USE
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PERMIT
NUMBERC&
JOB a Ii
A..PE
PLAT NAMEISUBDIVISION Nor
LOT NO,
LID NO.
". FEE
PUBLIC RIGHT OF WAY PER OFFICIAL
STREET MAP
TES P—od
a. — ..1. 1.
Sir- — 1 r.4rd
EXISTING — PROPOSED �
a,lerc—q-
-Onale 0
REQUIRED DEDICATION—
FT —
Qn—a
11
METER SIZE
LINE SIZE
NO- 01 11-Un"
PRV EQUIRED
I
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YES 0 NO C3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUORAWAGE
CITY
STATE LICENSE NUMBER
EXPIRATION DATE 1EG fjY
PROPERTY ACCOUNT MCEL NO.
2- 7-2— - 000
NEW
RESIDENTIAL
PLUMBING;MECH
ADDITION
Ej C MPLIANCEOR
C NGE OF USE
FIRE REVIEWED BY DATE
VARIANCE OR CU
SHORELINE OR ADS#
INSPECTION
REO'D
I PSO D
OSTED
13YES [3NO
$EPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
PROPOSED
EXP I
,
I
LOT COVERAGE
REQUIRED SETBACKS (FT.)
_ALLOWED
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE AEAR
FRONT LIRSIDE BEAR
DATE
O—REMODEL [I SIGN
0 REPAIR eyes [:J t NCE X Pit
0 DEMOLISH TANK OTHER
o GARAGE 0 RETAINING WALI.
CARPORT ROOKERY RENEWAL
REMARKS
iTYPE OF USE, BUSINESS OR ACTNTM EXPLAIN:
CHECKED BY
I TYPE DIV VION
L"$p
CCU`Ai
ROU
NUMBER
OF I
STORIES
BER 0
NUM F
WELL
NITS
AF
I or
Nt
SPECIAL INSPECTOR
AEOU RED 0 YES
JAREA
.. UPANT
LOAD
DESCRIBE WORK TO SE DONE
REMARKS
PROGRESS INSPECTIONS PER URIC 10811FINAL INSPECTION REO'D
1 .1 A/ I -T 15 Alat., J�uswr-
Description
FEE
FEE
'Osm /e-
Plan Check
_Description
HEAT SOURCE :E LOT SLOPE %
In
Building
VGrading
I VESTED DATE
PLAN CHECK Ni VESTED DATE
Plumbing
THIS PERMIT AUTHOPUZES ONLY THEWO KNOTED. THIS PERMIT COVERS WORK TO
Mechanical
t: BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBILIC
Recording Fee
M DONUUN (CURBS. GIDSWAIUKG, DRIVEWAYS MARQUEES. E'i WILL REQUIRE
SEPARATEPERM;SSQN.
Engr. Review
City Surcharge 5
OR ITAPPLICAIR.N: I..S
PERMITUMITJY
SEEB EAR-PROVID IS WORK IS STARTED WITHIN I " DAYS
ACK OF PINK PERMIT MR MORE INFORMATION
Engr. Inspection
State Surcharge
-1110AN" ON BEHALF OF 1111 OR 1111 SPOUSE, HIIII. ASSIGNS AND sUrlIESORS
Traffic Mitigation
Plan Chk Deposit
IN INIFTE R EST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
Receipt # P—
EOMON S WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
IALL Ci FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
Fire Review
FROM THE I SUANCE OF THIS PERMIT. ISSUANCE F THIS PERMIT SHALL NOT BE
I 'HALL " 'I
C'
Fire Inspection
I
Total Amount D Us
ANY CITY ORDINAN
9 DEEMED TO MODIFY. WA VE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
2 NOR LIMIT IN A NY WAY THE DRYS ABILITY TO ENFORCE ANY ORDINANCE PROVISJON.�
i
. . . —
I
I Landscapeinsp.1
Receipt # AV"
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICAROW T HAT THE INFORMATION
APPLICATION APPROVAL
GWEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
O.S .. C
THE OWNE . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATIN. CONSTRUC
CALL
The.ppUcial.0a... pa""'"n" signed aj the
0 "L PUGY�.
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLKTION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Official or haele, D ... ly: and FOOS are paid, and
.... Iple.6—I.Olged1cap ... p—ld.d.
WORKMEN'S COMPENSATION I tRANCE NO RCW 18.27.
OF C S SIGNATURE
SIGNED
(425)
RE d�lz--Jp-
771-0220 "R
DATE
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
!�)j
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI.
ORIGINA -FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER - GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall..........................
Pier/Porch .................
RetainingWall ...........
Slab Insulation
PLUMBING:
Underground
Rough -in ............
Commercial Final
HEATING:
GasTest . .................
Gas Piping ..............
Equipment .............
Commercial Final
MERIOR SHEATHING
NAILING ............ .............
FRAMING ........................
��,FIRSTFLO
RF AMING
INSULATION ....................
Floor Insulation
Wall Insulation
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ........
. . ... .........
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