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DATE RECEI
_Z21-46
C17Y OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
2-4?-o Auc. W
CITY _14EI-11HO I
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PERMIT EXPIRES
BE PERMIT
ONE
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on SUITEIAPT#
FLAT NAMEISUBDIVISION NO.
LOT NO,
LID N
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
n1.11,A,
W P.
EXISTING — PROPOSED
R ese
REQUIRED DEDICATION— FT
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METER SIZE
LINE S11
PRV REQUIRED
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YES C3 NO C3
;EMARKS
3WNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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CITY ZIP
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21�9
EXPIRATION
III
Inv
PROPERTY TAX ACCOUNT PATICEL Is
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4
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
DATE
SHORELINE OR ADS# INiPECTK`N N
REQ D So
E3 YES No I
SIGN AREA HEIGHT
ALLOWED PROPOSED ALLOWS I P11 POSED
—AEXP
[3 NEW RESIDENTIAL PLUMBING / MECH
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SUOACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
ADDITION COMPLIANCE On
CHANGE OF USE
I
WREMODEL SIGN
D FIXING ED]LOT
REC' RA PROVID
;TNNING REVIEW ED By DATE
0 REPAIR [3 GRADING CYOS 0 (FENCE X FT)
REMARKS
0 DEMOLISH TANK 0 OTHER
GARAGE
C [3 RETAINING WALL [3 RENEWAL
ARPORT - -ROOKERY
ITYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
sc. 40. L—
CHECKED BY ITY11 OCCUPANT—.
SOUP,&/
NUMBER NUMBER OF CFUTK`AZ&
0 . Uu
F IN N. AREAS
'DIAL UI.P�.Ton
EON
'5CCUPANT
0 T.IRES UNIT2 NUMBER, 4
�
REQUIRED [3 YES
LOAD
DESCRIBE WORK TO BE DONE
RIMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
Description
IS c
FEE__
Description
FEE_
P I a n
Plan Check
C
_
—GLAZING %
LOT SLOPE % Building
u d I n
PLAN CHECK 0.
M— z 1;��
[VESTED DATE Plumbing
P u To b
Mechanical
M a c IT
THIS PERMIT AVIRPORLIES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK To
O-K To
'I. -
t: BEDONEONPRIVATEP OPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
I
D OMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE ad n,
SEPAMTEPERMISSION.
Engr. Review
PE MITAPPLICATI.N: UVIDAY. t
PERMIT Leirn i YEAR- PROVIDED OPIK IS STARTED WITHIN INDAYS Engr. Inspection
E..' h
R Scooting Fee
City Surcharge
—W32
State Surcharge
a. BACK OF PINK PERMIT FOR MORE INFORMATION
PlanChkDoposit,
-APPLICANT' ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS Traffic Mitigation
CES.-S Traffic
CITY OF
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
NY A F
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Review
' No re
LY
ALLCLAIMIPOIDAMAGESOFYINATEVER NATURE, ARISING DIRECTLY OR INDIRECILY
Receipt Sit
TatalAmLLPID..
jji1j.6
FROM THE 111—Cl 01 THIS PERMIT. 111-NCI OF 'Ills PERMIT SHALL NOT BE
T SE B. fo
Y NCE Fire Inspection
DEEMER To Mooll .1VE OR REDUCE ANY SIOLISE.X OF AN CITY ORDINA CE
rw
NOR LIMIT IN ANY WAY THE CITYB ABILITY TO ENFORCE ANY ORDINANCE PRON SION,'
- Landscapainsp.1
R ... ipt #
INERE ACKNOWILEDGETHAT 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
T IS OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS FIEGULAIING CONSTRUO,
CALL
I then Is "' a ponne unig Signed bY the
his applies
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMP toy 0
US VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
UUV dingOtfict.le, Isih., Sp.Iy:.dFS,ePS1d,.nd
. 0
,Ipt is a,ktodged Jr.p plavidle.
WORKMENIS COMPENSATION INSURANCE AND ACW 18,27.
(425)
OFFICIALS SIGNATURE T
�-
SIGNATURE
DATE SIGNED
LlIzz)
771-0220
DATE
ATTENTION
EX`r 1333
141W ",A)
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
,0kQ
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGJNAL�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 ......................
wait ...........
Pier/Porch .................
Retaining Wall ...........
z
Slab Insulation ..........
m
PLUMBING:
Underground ...........
Rough -In ..............
am
C:
ma
0
Commercial Final
0
C
HEATING:
-4
m
Gas Test ....................
z
C
Gas Piping .................
>
Equipment .................
Commercial Final
3:
EXTERIOR SHEATHING
ITI m
NAILING ..........................
0
FRAMING � ..................
0
C
FIRST FLOOR FRAMING...'
M 0
Z
INSULATION ............
Floor Insulation
Wall Insulation ...........
z
--i
Calling Insulation
x
SHEETROCK NAILING
z
SPECIAL INSPECTION
m
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ...............