20020487.pdfA/00,01,t/iy AS 44 DATE RECEIVED,,/,
—Z—�-06 /I� .,EAr . I
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMENAME OF BUSINESS
MAILING A DRESS
Zl
CITY ZIP IT11,11 ONE
NAME
ALIDRESS
--:N, -TI, �,-j 4 U,-
CITY ZIP ITELEPHONE
��fvv- I � qo4, b?,S, St3
NAME
--1 , -- 1�qL
LL�]
P
ITL
PERML
L
US' PERM T�
ZONE NUMSE
Joe UITE/APT#
PLAT NAME/SUBDIVISION NO.
LOT I'D
LLID PEOE,
It
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
--adl
EXISTING — PROPOSED —
i—ree, R..
res—ell '-d
REQUIRED DEDICATION— FT —
n.—.
weieq.".
METER SIZE
LINE SIZE
NO. OF FIXTURES
PAV REQUIRED
I
I
YE.0 No E3
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
At, & 41�& —
C
I ----
Tr
FIRE REVIEWED BY
DATE
do
T
STATE LICENSE UMBER
IXPIRAT 11 1"I�C D BY
VARIANCE OR CU
SHORELINE OR ADS#
INSPECTION ORND
IPSO
REO'D TED
4.4 E4
*1
#
13YES ONO
PROPERTY TAX ACCO NT PARIEL No.
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
"'a
'RT
ALLOWED PROPOSED
73 0?- -4 o
6o 0 .4
EXP
I
,
NEW
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
0 PLUMBING MECH
ALLOWED PROPOSED
FRONT SIDE HEAR
FRONT LIRSIDE HEAR
ADDITION
o C MPLIANCE OR
CHANGE OF USE
I I
EMODEL
;ii,r
0 SIGN
PARKING I
REGG I PROVIDED
LOT AREA I ILANNIIII REVIEWED
BY DATE
REPAIR 0 GRADING 0 F NOR
CYSS
I X FT)
REMARKS
[3 DEMOLISH [71 TANK
OTHER
Ei GARAGE [3 RETAINING WALL
0 RENEWAL
CARPORT ROOKERY
(Me (7tiBUSINE a OR ACTIVITY) EXPLAIN:
veq f
CH� TYPE O��ION C
J��
ccuuPP27/
NUMBER
I I NUMBER
OF DWELLIN
on Inc
A ".
SPECIAL INSPECTOR
OCCUPANT
STORIES UNITS
NE.:ERL�&�E
HIQUIRED 0 YES
JAREA
LOAD
I
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
ON I I Net�, &l &r.4cr'-C
se
FEE
Description
FEE
P, Ian Check
HEAT SOURCE GLAZING LOT SLOPE %
LDescription
Building
VE�STED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERM A COV ERSWORKTO
AM�T q . le � 1,
Ic, BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUB . LIC
2 00&WN (CURBS. SIDEWALKS, DRIVEWAYS. MARQUEES, ILL LRR,
ETC.)W AEG
Grading
Recording Fee
c SEPARATE PERUISSION.
Engr. Review
City Surcharge /I—
PERMITAPPLICATION: INOAYS
PERMIT UM . I YEAR - PROVIDED WOFIK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
State Surcharge
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCIESORS
Traffic Mitigation
Plan Chk Deposit
IN NTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYE S,ANDAGENTSFAOM ANYAND
Fire Review
Receipt #
ALL CLAIMS FOR DAMAGES OFWHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
THE ISSUA
FROM CE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT E
Fire
Total Amount Due
8E
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINAND
Inspection
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISIOrL.
i.—
Landscapainsp.1
Receipt #
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APP�OVAL
GIVE" IS CORRECT. AND THAT I AM THE OWNER, OR THE BILLY AUTHORIZED AGENT OF
THE OWNER . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
This application Is not a patraft,ofit signed by Me
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON ABLATING TO
FOR INSPECTION
Building Ofireal., 101111,11 Deadly: and Fees are paid, and
,color Is acknowledged [,,p,,o panided
WORKMEN'S COMPENSATION INSURANCE AND RCW 182T
OFFICIALS SIGNATURE DATE
SIGN:20V�NEA 0 DATE SIGNED
(425)
,51, L, ,
771-0220
�12 111-02-
IRELEASEV
11
DATE
ATTENTION
EXT 1333
A414,
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
�
- I 4)=1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW � INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD � ASSESSOR
10/01
z
65 -4
0 x
C: in
Ma
0
M
VIA z
j0--I
0 -n
111 RA
0 r1-4
0 M
C Co
C CO
M 0
z T—
z
z
9
0
IT
.. ... .....
RECORD OF INSPECTiONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ... . .................
j,
wall ...........
Pier/Porch .................
Retaining Wall ...........
Z
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
M
Art
0
Commercial Final
0
HEATING:
M
M
Gas Test ....................
10
C —
z
Gas Piping
Equipment
0 n
Commercial Final
-n
EXTERIOR SHEATHING
rn M
NAILING ..........................
FRAMING ................
0 M
C co
FIRST FLOOR FRAMING
M Cft
M 0
INSULATION ...........
Floorinsulation
Wall Insulation ...........
z
Ceiling Insulation
SHEETROCK NAILING
Z
0
4
SPECIAL INSPECTION
0
MISCELLANEOUS ..........
FINAL APPROVAL FOR (vNs,
OCCUPANCY ..................