20020707 (2).pdf01,1�4 DATE RECEIVED
PERMIT EXPIRES
CITY OF EDMONDS
PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB SUITEIAPT#
ADDRESS -A nVe wr.
)Di io or,
OWNER NAMEINAME OF SUSINFRA
MAILING
PLAT NAMEISUBDIVISION NO.
LOT NO,
L�D 110,
D FEE S
ADDRESS
PUBLIC FIGHT OF WAY PER OFFICIAL STREET MAP
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CITY ZIP ITELEPHONE
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'NAME
METER SIZE LINE SIZE NO. OF FIXTURES
REQUIRED
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ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTAOUDRAINAGE
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CITY ZIP ITELEPHONE 16-11113171AW
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ADDRESS
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STATE LICENSE NU DER EXPIRATION DATE ft5qu%V on all'Rd "TWw"IfIks REO'D
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ADDITION COMMERCIAL o COMPLIANCE OR
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CHANGE OF USE
LOAPARTMENT
P LOT BAT
[3 REMODEL SIGN RECrD or
0 REPAIR 0 GRADING C,GS F NICE
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GAIAGI RETAINING WALL
CARPORT 0 ROCKERY [I RENEWAL
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GROUP
NUMBER BIT L
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OF DWELL No AREAS Sp NSPECro` OCCUPANT
JAIIA
STORIES UNTS NUMBER REECCIIARLED YES LOAD
DESCRIBE WORK TO BE DONE REMARKS
INSPECTIONS PER USC ICS/FINAL INSPECTION HE 0
1 &02�/
Description
FEE
Description
FEE
Plan Check
C—ND LOT SLOPE % -1
IMechanical
PLAN CHECK NO: VESTED DATE
Plumbing
THIS PERMIT AUTHORIZZES NV( THE WORK NOTED. THIS PERMIT COVERS WORKTO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTIONONTHF PUBLIC
Grading
Recording Fee
3 DOMAIN (CURIDS, SIDEWALKS, DRIVEWAYS, MARQUEES, M.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
City Surcharge
PER ITAPPLICATI.N; I..
PERMIT UMM I YEAR - PflCIVIDEDW RK IS STARTED WITHIN 180DAYS
Engr. Inspection
State Surcharge
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
He OR
P HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
'C_ ='T.
;APPL 0
S.sil. A INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
:1 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
Receipt #
ALL CLAIMS TO DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
THE PERMIT
FROM ISSUANCE OF THIS PERNUT. ISSUANCE OF THIS ALL NOT BE
SHORDINAN
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY BE
Fire Inspection
0 NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISIOW
Landscapainsp.
Receipt #
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNS � I AGREE TO COMPLY WITH CITY AND STAT LAWS REGULATING CONSTRUC'
CALL
A 1,.ateptata—Visignadlaym
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYE D
IN VIOLATIO F H OF THE ST E OF WASH114GTON ABLATING To
FOR INSPECTION
U.'eThi-ppl.ase
ditto Offic�al,, histher Deputy: mad Fees ate paid, and
.... Ipt I-ake-fisdig.al 1,, speed p,.Idsd._
WORKMEN'S OMPENSATI I RANCE AND HOW - 18,27.
OF DATE
I E NID
(425)
2
771-0220
ENTION
E)ff 1333
RELEASED BY
_ /
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
I / t ,
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL-Fili � YEULOW-11,16PEC4
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC, SECTION 109
FAX
FINK-OW111EW- GOLD -ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ....................
wall ............... w
Z'
Pier/Porch ...............
0
Retaining Wall
Slab Insulation
M
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PLUMBING:
M
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Underground .............
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C:
Rough -in .............
M
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Commercial Final
to
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HEATING:
4-
3:
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Gas Test ..................
0 -n
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Gas Piping 'w
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Equipment ................
0
Commercial Final
0 M
EXTERIOR SHEATHING
M or
NAILING ......................
FRAMING
FIRST FLOOR FRAMING
INSULATION ...................
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Floor Insulation-l'..
Wall Insulation
z
0
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Ceiling Insulation
0
IT!
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................