20020511A.pdfIPERMIT
EXPIRES
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CITY OF EDMONDS
USE
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CONSTRUCTION PERMIT APPLICATION
J03
SUITEIAPT#
ADDRESS
24103 77 P1 W
OWNER NAMEINAME OF BUSINESS
Ron Summers
PLAT NAME/SUBDIVISION NO. I LOT NO. I. NO.
MAILING ABUSE 8
L�D
D FEE S
24103 77 P1 W
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Trso.=.
CITY
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Edmonds 74-4797
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NAME
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ZIP ITELEPHIONE
12601 132 Ave NE
2 ITELEPH NE
G-Kirk 9 8 z01P3 4 425-814-3124
STATE UCENA� &ER EXPIRATION CATE I CHECKEDBY
OWNEFUCONTAACTOR
F RE REVIEWED BY
DATE
PROPERTYTAX ACCOUNT DEL NO.
COMPLETJ��� f1P.?1rf �rl.I.OWED Pf1P11E1
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EXP
NEW
RESIDENTIAL
@ PLUMBING I MESH
LOT COVERAG REQUIRED SETBACKS (Fr.) PROPOSED SEt�KS (FT)
ALLOWED PROPOSED RF NT SIDE REAR FRONT URSIDE REAR
ADDITION
11 COMMERCIAL
o C MPLIANCE OR
PURS - jq-p W Ernl; -
REMODEL
APARTMENT
CHANGE OF USE
171 SIGN
19 q VMU DATE
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D I PRO21 BE I
0 REPAIR
0 GRADING CYOS
[3 F NCE
X
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—BAR
Fn REMARKS �iHUTOFF
[3 DEMOLISH
TANK
OTHER
o GARAGE
CARPORT
'R'ET11NING WALL
OCKERY
RENEWAL
(TYPE OF USE. BUSINESS OR A,7r
HECKED BY TYPE OCCUPANT
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32 ... Up
;UMBER
OF
NUMBER OF
WELLING
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AREAS
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SPECIAL INSPECTOR AREA ... U N,
STORIES
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NUMBER 19—.
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EQUIRED [j YES LOAD
FR
OFSC::=TO BE DONE
FURSUK917 To UPC 565.1
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ff ater
heater
REMARKS__
ill 1141SEUMMERMWECTION REQ'D
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I in utility
room 40,000 btu's
jL BE INSTALLED ON TFM
VAILLIATION $
LU'
449.00
Description
FEE Description FEE
Plan Check
HEAT SOURCE GLAZING Is LOT SLOPE %
A.ATrPlumbing
Building
PLAN CHECK NO:
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
b: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
X
Grading
Recording Fee
DOMIJUN (CURBS, SIDEWALKS, DRIVEWAYS MARQUIEIS, ETC.) WILL REQUIRE
SEVARATEPERM;SSION.
__
Engr. Review
City Surcharge
R PERMTrAPPLICATION: INDAYS
T PERMIT UNIT It YEAR -PROVIDED WORK IS STARTED WITHIN 180DAYS
Engr. Inspection
State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATIO!
"APPLICAN"' ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST. AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE 01 THIS PERMIT, ISSUANCE OF THIS PERMIT $HALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
unt Due
NOR LIM I IN ANY WAY THE Cn*YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
X0
-
Landscapainsp.1
Receipt #
1 HERE ACKNOWLEDGE THAT I HAVE READ THIS APPUCATION� THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVA
THE OWNER. I AGREE TO COMP WITH CITY AND STATE LAWS REGULATING CONSTRUC.
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
CALL
are This application Is not a permit until signed by the
ding Offinelt., his/her Deputy: And Fees— paid. a
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION 'ecelptisecknoM,dg0bapa,,prmided.
S, WORKMEN-$ COMPENSATICkVINSURANCE AND CWI&27.
OFFICIALS SIGNATURE DATE
SIGNATURE OATS SIGNED
(4,25)
_7 IWO:
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s is,
I I I -V&A11W
RELEASED BY T TE
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTI L
771-0221
L_
I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIF -
ORIGINAL - 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
SETBACK$ ..............
FOUNDATION:
Footing ..............
wall ..... .....................
Pier/Porch . ................
Retaining Wall ..........
Slab Insulation
LUMBIOG;
Underground
Rough -in . ...................
Commercial Final
HEATING:
GasTest ....................
Gas Piping,
Equipment
Commercial Final
EXTERIOR SHEATHING
NAILING ...........
FRAMING .............
FIRST FLOOR FRAMING
INSULATION ...............
Floor Insulation
Wall Insulation ...........
Calling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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