20020662.pdf=DA_TE RECEIVED
PERMIT EXPIRES
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use PERMIT
CITY OF EDMONDS ZONE C'
NUMBER
CONSTRUCTION PERMIT APPLICATION JAODRESS C., 70 , SURE1APT#
01"rNAMEINAME OF BUSINESS . I �7 to
EC) iC (r, CL(of PLAT NAMEISUDDIVISION NO. LOT NO, L
L�D NO.
MAILING ADDRESS 0 FEE S
P—se
Dd1V0VJV PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP R1.1 =
pill
.1w zip IRRiONE EXISTING — PROPOSED — $ua Rie-ead
6 LOD "-2)n REQUIRED DEDICATI N_ FT
NAME METER SIZE J LINE 11 P�T.E.UIAED
yes E3 No 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTR IUDRAINAGE
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CITY
I
FIRE REVIEWED BY DATE
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RESIDENTIAL
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ADDITION
COMMERCIAL
COMPLIANCE OR
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MULTIFAMILY
SIGN
REPAIR
GRADING
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(TYPE OF USE, BUSINESS 01, 5;rlorll:
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NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
STORIES
UNITS If
AREAS
NUMBER
DESCRIBE WORKJq BE D - E
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COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED I PROPOSED
P
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE BEAR FRONT UR SIDE REAR
PARKING Am" PLANNING REVIEWED By DATE
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Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING I
IOT ILCIPE
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORUDESONLYTHE OAK NOTED. THIS PERMIT COVERS WORK TO
t DONE Oil PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
BE
30MAIN JCURBS, SIDEWALKS, DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
Grading
SEPARATE PERMiSSION.
-1
PER IT APPLICATION: IN DAYS
Engr. Review
F
PERMIT LIMIM I Y -An-PROVID 0 WORK 18 STARTED WITHIN IGDITAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEMS. ASSIGNS AND SUCCESORS
Fire Review
PlanChk.Deposit
IN INTEREST, AGREES To INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
.
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
ecejpt #
FROM THE ISSUA CE OF THIS PERMIT. ISSUANCE OF THIS PERMA SHALL NOT E
A
DEEMED OR REDUCE
Landscapelnsp.
Total Amt, Due
TO MODIFY WAIVE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY$ ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
I Receipt # 43T?
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT 141E INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNE . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
This application Is lot a parent Until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF T14E LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMENS COMPINSAT91A AND RCW 18,27.
Building Official or his/her Deputy: and Foes are paid, and
FOR INSPECTION leulplisllklollodgedi,,pa,,prmidod.
.4IiISUQRANCE
SIGNATURE (OWNER OFfAtENT) A A
(425)
.11ICIAZ AIZ�AE D';
77 11-0,Z20
RELEASED BY DATE/
AT7ftTIOff_
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-
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
OR GINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN -ACCOUNTING
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ITT
PERMIT NO: 9 6 4 3
City of Edmonds PERMIT EXPIRESA(A2§2--
SIDE SEWER PERMIT
Address of Construction: '�6-'�70 2.(% 14 2i.d LID#
Property Tax Account Parcel No. 2)0%A,3oo.Oz0I?00
Attach copies of all access and utility easements—Z-1ed and Approved by
Owner and/or Contractor- (-'Folt-CE Cli'vii- 6 g.,L- W"A>--,
#. NIA
Contractor License#: CIEWCOfIO312k Building Pern
i�o 1�1165 6W 0�&
Yes M No
,j!J'Single Family Invasion into City Right -of Way:9 �11
n Multi -Family (No. of Units *RW Construction Permit
n Commercial (No. of Units Cross other "Private Property: ZYes F1 No
Public "Attach legal description and copy of recorded casement.
Ownwl<z fkolaz-
Owner or contractor signature and acknowledgement statement: Date
By signing for this permit I certify that I have read the City's public handout entitled
Side Sewer Specifications, and shall comply with all City requirements outlined therein.
2 CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION 9
W FOR INSPECTION CALL 425-771-0220 extension ILIRM
24 TIOUR NOTICE REQUIRED FOR ALL INSPECTI &Bffl-U—ESTS
Permit Fee $— �n � . ..... . 0,;p3w-�W_ issued BY:
Trunk Charge Date Issued
q5Assessment Fee Receipt NO:
City Permit Surcharge Fee $5.00 Total Fees Paid
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED.
Job Site Ready YES_--NO_Date:_InitiaI:
partial Inspection: Date: nitlal:.
Partial Inspection: Date:______jniflaI:
FINAL INSPECTION APPROVED- Date: ...... _As -built to Street File:
f� PERMIT MUST BE POSTED ON JOB SITIE
WhileCopy: File &ftnGopy: Inspedm BACOPY, Appfmnz
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Commercial Final
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3: IT
HEATING:
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Gas Test ...........
Gas Piping .................
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Equipment - ..............
Commercial Final
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EXTERIOR SHEATHING
0
NAILING
0
FRAMING .......................
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FIRST FLOOR FRAMING
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INSULATION ...................
Floor Insulation
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Wall Insulation ...........
Ceiling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................