20020623.pdfr
d"'V'N DATE RECEIVED. _
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PERMIT EXPIRES ?
CITY ®F EDM®Ivi®S ZONE PERM T
NUMBER;
C�ONSTRUCTIONPERMIT APPLICATION 'IOD SUITE/APT,
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ADDflESS /tom,( J/'l /'}(` TIC
E(LNaME/NAME
OF BUSINESS jf
1�)��1711,_,) IJ !n��� �tAT Ha"'SUBDDIIVI`SIIOON NNO.`J LOT 140.V L NO.
✓`-' l_
I(N7O ADDRESS LID FEE 5
CJ PUBLIC RIGHT OF WAY PER OFFICIAL STREETnt pq Ac pMualrea
MAP a". u.. Paanu n.o
Zip TELEPHONE EXISTING PROPOSED Impscean RsnWroa
en..nka•wk.a
isREQUIRED DEDICATION FT 1Yiaano�MWaea
�+ METER SIZE
LINE SIZE
(NrO. OF FIXTUURES
Al1-A , l' l
PRY REOUIfl
YES ❑ NO
CITY
21P
TELEPHONE
FIRE REVIEWED BY
DATE m
/J
lehJV
STATE LICENSE NUMBER
E IRATION DATE
C
VARIANCE OR CU SHORELINE OR ADB#
INSPECTION BOND
IPI
7 `/ /
RE
❑YESDONO
POSTED
'ROPERTY TAX ACCOUNT PARCEL NO.
v 4'
SERA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
!�C S 6-5
t70 0 C>
I
I
EXP
❑ NEW
[SrRESIDENTIAL
❑ PLUMBING MECH
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
I
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/R SIDE REAR O
❑ ADDITION
❑ COMMERCIAL
❑
CHANGE OF USE
PARKING
LOT AREA
TTZ�
5
REMODEL
X❑REPAIR
❑ APARTMENT
❑ SIGN
REQ.D PROVIDED
PLANNING REVIEWED
BY DATE
❑ GRADING
❑ ;ENCE
CYDS
X —
FT)
REMARKS
❑ DEMOLISH
❑ TANK
❑ OTHER
GARAGE
❑ CARPORT
❑ ROOKIERY NING WALL ❑ RENEWAL
(TYPE OF USE, BUSINESS OR CTNLLYJ EXPWN:
ONE BY5TIP.1F
CONSTRUCTION
OCCUPANTGROUPNUMBER
G k/
`
OF ✓J
NUMBER OF
DWELLING
CRITICAL
AREAS
SPECIAL INSPAREA.
OCCUPANT
STORIES G/
UNITS
NUMBED
REQUIRED
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
IsINSPECTIONS PER UBC 10B/FINAL INSPECTION BEO'O a
Cr -r- is
VALUATION $
+ 6 ao
Description
Plan Check
H(IATTSSOLIRCE GLAZING % GOT ELOffE
/' "
i1nl.. /�"T/ -' /,NBuilding
/
PLAN CHECK NO: VESTED DATE
Plumbing
THISPERMIT AUTHORIZES ONLY THE WORK NOTEO.THISCTION
Mechanical
C BE DONE ON PRIVATE,SIDEWALKS, PROPERTY CONSTRUCTION ON
NTHEPUSUC
DOMAIN
Grading
DRIVEWAYS,
(CURSE, BIOEWALKS,ORIVEWAYS, MAROUE£$ETC.I WILL REQUIRE
WILLREQUIRE
t fiEFARATE PERMISSION.
2
�i PERMITAPPLICATION: INDAYS
Engr. Review
PERMIT LIMM t YEAR• PROVIDED WORKISSTARTEDWITHIN 180DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
i EDMON13S, WASHINGTON, RS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT $HALL NOT DE
9 DEEMED TO
Fire Inspection
MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.•
se
landscape lnsp.
I HERESY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT 1 AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. i AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC_
TION; AND IN
CALL
DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
WORKMEN'S COMPENSATION I MNCE AND ROW la27.
SIGNATURE ER O GENT) DATE SI NZ(425)
S o z
771-0220
ATTENTION
M 1333
IT IS UNLAWFUL TO USE OR OCCUPY A OR STRUCTURE
A FINAL INSPECTION HAS BEEN MADEBUILDING AND APPROVAL OR A CERFI TII-
771-0221
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
10/01
FAX
FEE
Recording Fee
City Surcharge J
State Surcharge
Plan Chk Deposit
Receipt #
TotatAmount Due
Receipt #
_ICATION APPROVAL
adon is not a permit until signed by the
a or hlslher Deputy: and Foos are paid. and
Is ackc-tedgad in space provided. Vr
ORIGINAL - FILE YELLOW • INSPECT
PINK - OWNER GOLD ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ..
I....
FOUNDATION:
.. ...Footing .. ......... -
,, Wall ....... .........
a Pier/Porch .............:...
O ,
a.
� Retaining Wall :.....:..
�.
Slab insulation ..........
m
PLUMBING:
Underground
Y`r 1
p m
m v
. Rough -in .... .....
p
Commercial Final .....
i
C
HEATING: _
mm
z.
_ a
Gas Test ..................
�
r
' Gas Piping .................
Equipment
.Lj T.
`y
. Commercial Final .......
IH m
EXTERIOR SHEATHING -
p y. ,
- NAILING ....
`' L.1J1 r 7 --u
n m..
C-�.
.
FRAMING-.................m
N
`FIRST FLOOR FRAMING :...Z-I
on-3
r'
INSULATION ....................
Floor Insulation ...........-.
_.
Z
,
_ Wail Insulation ...........
_
Ceiling Insulation ..:....
Z
.
SHEETROCK NAILING ... ,._:-'� _)Z)
SPECIAL INSPECTION ...
O
m
. ' MISCELLANEOUS ..........
-FINAL APPROVAL FOR �N1� ^a
OCCUPANCY ..................
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