20020638A.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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ADDRESS
UW
�PERMIT�EXPIRES
20 E
ERMIT
NUMBER Z'�
JOB SUITEIAPT#
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PLAT NAMEISUBDIVISI.14 10.
LOT 1.
LIE) No
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TF. —
RW , R.4.i d
EXISTING —
PROPOSED
REQUIRED DEDICATION—
FT
13
METER SIZE
LINE SITE
PRV REQUIR50
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YES C3 NO E3
REMARKS
WNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL
NAME
JCBL
I
ENGINEERING FEVI.E. .1 DATE
X
0
ADDRESS
FIRE REVIEWED BY DATE
CITY
ZIP TELEPHONE
x
STATE LICENSE NUMBER
EXPIRATION 0=
VARIANCEOPOU
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INSPECTION
RE .0
POSTED
1� BOND
MYES EINO
SERA REVIEW
SIGN AREA
HEIGHT
PROPERTY TAX ACCOUNT
PARCEL NO,
COMPLETE EXEMPT ALLOWED PROPOSED
ALLOWED RO'O"D
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LOT C VERAGE REQUIRED SMACKS (Fr.)
PROPOSED SETBACKS IFL)
NEW
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RESIDENT A
PLUMBING/MECH
ALLOWED PROPOSED now SIDE HEAR
FRONT URSIDE BEAR
ADDITION
COMMERCIAL
0 COMMERCIA
C MPLIANCE OR
CHANGE OF USE
REVIEWED
By DATE
REMODEL
MULTIF AMILYL
0 SIGN
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RECmA IKIPMAGOV
LOT A
rl REPAIR
0 GRADING GY)a
rl FENCE
x Fri
REMARKS
DEMOLISH
F1 TANK
El 017H-E—R
o RETAININGWALL
F1 F SPRINKLES
oGARBAGE
CA PORT
ROOKERY
FIRE ALARM
(TYPE OF USE. BUSINESS
OR 15rCN:
CHECKED BY
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NUMBER
OF
NUMBER Of
DWELLING
CRITICAL
AREAS
SPECIAL INSPECTION
Fa
,
OCCUPANT
STORIES
N
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NUMBER
REQUIRED [] YES
JAVIEA
LOAD
DESCRIBE WORK TO BE DONE
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REMARKS
PROGRESS INSPECTI NS PER USC 108/FINAL INSPECTION REQ'D]
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VAILUATION
$
Description
FEE_ Description FEE
Plan Check
State Surcharge
H)j60f)0g7 OWING % LOT SLOPE %
Building Permit
CjtY Surcharge
PLAN CHECK!!_______ VESTED DATE
Plumbing
—
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVER WORK To
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMIN (CURDS. SIDEWALXS, DRIVEWAYS QUEES. 0c) WILL REQUIRE
SEPAMTEPERMIMAR
SSION.
2
PE MITAPPLICATJON: 180DAYS,
Engr. Review
PERMIT LIMIT, I YEAR - PROVID D WORK IS STARTED WITHIN IS. DAYS
En9r. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF 01 "'1 OR HER SPOUSE, HEI11. ASSIGNS AND SUCCESORE
IN INTEREST, AGREES To INDEMNIFY, DEFEND AND HOIO HARMLESS THE CITY III
Fire Review
Plan Chk. Depos
G OFFICIALS, EMPLOYEES, A 0 AGENTS FROM ANY AND
EDMONDS ON, ITS
Fire Inspection
Receipt #
C"�WASHINGT
ALL FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTY
FROM THE ISSUANCE BE THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY WA VE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CIWS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
R cording Fee
a
Receipt #
1 HEREBY ACKNOWLE GE THAT I HAVE READ THIS APPUCATION� THAT THE INFORMATION
APPLICATION APPROVAL
GIVE IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHOR ZED AGENT OF
THE OWNE . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERS N WILL BE EMPLOYED
CALL
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ding Offi. 'h!,jh., p.Iy:.dF — pidd, nd
IN VIOLATI ODE OF HE STATE OF WASHINGTON REILATiNG TO
FOR INSPECTION
.colpti,,c�nowledg,di,,par.op�id���
WOFIKMEI,r��XTIGNORINSURANCE AND RGW 18,27,
OFFICIALS SIGNATURE
%TU11 DATE SIGNED
T
(425)
771-0220
12L
DATIf
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
"ORIGKd-FILE YELLON-INSIIIECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING
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Sough -in .............
Commercial Final
HEATING:
GasTest ..................
Gas Piping .................
Equipment ..........
Commercial Final
EXTERIOR SHEATHING
NAILING ................
FRAMING .......... .............
FIRST FLOOR FRAMING
INSULATION . ..................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..............
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