20020693.pdfF_
I PERMIT EXPIRES
-BE PERMIT
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CITY OF EDMONDS INUNIEI"'��_�
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
OWNER NAMEINAME OF ADDRESS 6 j -_> f-,, � ),C �- -
PLsT NAMEISUBOIVISION NO� I LOT No, LID NO,
LID FEE It
MAILING ADDRESS PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Tss P
-7
CITY ZIP ITILEIH NE EXISTING — PROPOSED� s 11,ni_
REQUIRED DEDICATION— IT — .—r—
REQUIRED
NAME M.— SIZE I LINE SIZE I NO, OF FIXTURES P I
YESO No E3
TELEPHONE
7�
FIRE REVIEWED By
7ATE
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ZIP ELEPHONE
-2
EXPIRATION E CH ED By
_DA:�j
VARIANCE OR CU SHORELINE OR ADS#
INSPECTION BOND
POS TED
RED,
ES (3 NO
E3Y HEIGHT
IROIEFITYTAX ACCOUNT RCELNO.
SIGN AREA
COMPLETE EXEMPT ALLOWED PROPOSED
ALLOWED I PROPOSED
00 4,f 17�176 s'o 0
SKI,
0 M
a 0
Tn 0
LOT CO ERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (IFT)
NEW RESIDENT0, 103 UUMBING I MECH ALLOWED 'PROPOSED FRONT SIDE HEAR FRONT URSIDE BEAR
0 ADDITION E] COMMERCIAL
[3 C MPLIAN Eon
CHANGE OF USE
--10
0 C:
PARKING LOT AREA PLANIIII FIEVIEWED
BY 01
3: M
REMODEL 0 APARTMENT
SIGN
REDD I PROVIDED
I
TR
REPAIR 0 GRADING CYCS
[3 F NCE
( X FT)
REMARKS
0
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DEMOLISH [3 TANK
OTHER
0
>
Ei CGARAOE a RETAINING WALL
ARPORT ROOKERY
RENEWAL
0 -11
_T1
,,Y,S USE, IIIIIIN 81 OR ACTrWM EXPLAIN:
Tvp�
CZ,�7
OCCUPANT&
OROUP
NUMBER
OF
"a /0,
ZONSTRU2CTION
SPECIAL IDNSPECTOR JAREA
fal.C,A1. BI6.T.0R
It UIR D
EOL IS
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-OCCUPANT
LOAD
1711 M
06
q.
STORIES
Y S
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0
0
DESCRIBE WORK TO BE DONE
C:
REMARKS
PROGRESS INSPECTIONS PER UBC 10S/FINAL INSPECTION REO'D
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14-111,09 9.11
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VALUATION $
VALUATION $
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Sc'p
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Plan Check
GLAZING % LOT SLOPE %
'or SLOPE
Fescription
Building
ST.. DATE
PLAN CHECK NO: STED DATE
".I'd
umbm.
Plumbing
Mechanical
Mechanical
K'.
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
BE . PmwDS Pad'emr, O.,y. AN, Co..... PUBLIC
Grading
t:
DOMAIN JCURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATEPEAMISSION.
a
Engr. Review
15
PERMITAPPLICATI W 190DAYS
PERMITUMMIYEM-PROVID D WORK is STARTED WITHIN 1.11DAYS
Engr, inspection
IT
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
rReview
-APPLICANT, ON BEHALF F HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCSSORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Traffic Mitigation
I
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire I'.
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMT1. ISSUANCE OF THIS PERMIT $HALL NOT BE
'He 'rin_.Km
DEEMED TO MODIFY, WAIVE OR REDU E ANY REQUIREMENT OF ANY CITY ORDINA CE
N OR LIMIT IN A14Y WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,'
22==—L
Landscapeinsp.
1.
I HERESY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION; THAT THE INFORMATION
,
I
GIVEN IS CORRECT�. AND THAT AM THE OWNER. OR T14E DULY AUTHORIZED AGENT OF
THE OWNEIL I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC,
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR Cool 01 THE STATE OF WASHINGTON RELATING TO
FOR INSPECTU
WORKMEfNjjQiiW,ENSATION INSURANCE AND RCW 18.27.
Sra��NER A A
(425)
771-0220
ATTENTION
EXT 1333
IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
10101
Recording Fee
City Surcharge
State Surcharge
Plan Chk Deposit
Receipt #
Potal Amount Due
Receipt # A2 A�,
APPLICATION APPROVAL
Thi-ppil-kinIs n*1 I PWMII nnt sipad by the
sui,dngotb�jsjii, hisfibl, DOP'sy: dFItssP.Id,srd
,ecalpt Is iiknowtiniged In sp,ce p—ldrid.
IOALS S19N ITURE D . AT
ORIGINAL - FILE YELLOW - INSPECTOR
PINK. OWNER GOLD � ASSESSOR
,71
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall .....................
Pier/Porch .................
z
Retaining Wall ...........
Slab insulation ..........
PLUMBING:
Underground
Rough -in ...................
M
C:
M
Commercial Final
0
0
HEATING:
ITI
M
Gas Test
....................
C
Gas Piping .................
Equipment
Commercial Final
EXTERIOR SHEATHING
ITI R1
NAILING .....................
a
0
0 rn
FRAMING ........................
ca
V)
FIRST FLOOR FRAMING
M 0,
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling insulation
0)
SHEETROCK NAILING
z
SPECIAL INSPECTION
0
171
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
411,
VV.