20020743.pdfDAT RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
a'&O)
MAILING ADDRESS
CITY ZIP ITELEP"ONE
F'D'A10f_H0S
NAME
Il,j a
PERMIT EXPIRES
ZONE PERMIT
NUMBER
JOD UITEJAPT#
ADDRESS4,V & _j,, 14
FLAT NAMEISUDDIVISION NO.
LOT 110-
110,
I
D FEE $
'�D
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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EXISTING — PROPOSED-
U.. 1—
REOUIRED DEDICATION— FT
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LINE SIZE
PRY REQUIRED
E3 No 13
_YES
REMARKS
WNERICONTRACTOR RESPONSIBLE FOR EROSION CONTRO
CITY ZIP
ITILEPHONI
NAME
JCBL�aft,
ICA �r�'i r-K�
ENGINEERING REVIEWED By DATE
ADDRESS
(,2,Ce -. 3
FIRE REVIEWED By DATE
CITY
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STATE L DENSE NUMBER EXPIRATION 0 Are
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ED
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SHORELINE.RAD�l
INSPECTION
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RON
POSTED
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TAX ACCOUNT PARCEL
SERA REVIEW
I ... _ EXEMPT
SIGN AREA
AL Pa.
LOWED POSED
EIGHT
I ALLOWe PROPOSED
J.Y
7
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EXP I
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NEW [3 RESIDENTIAL MEC-
LOT E
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PROPOSED
REQUIRE SETO KS TT
FRONT D SIDEAC REAR I
PROPOSE S KS (FT)
FRONT R SIDE REAR
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ADDITION 0 COMMERCIAL CHANGE OF USE
RKING
REoPA I PROVIDED
LOT AREA
I PLANNING REVIEWED BY DATE
rl REMODEL [:8 MULTIFAMILY rl SIGN
REPAIR 0 GRADING GYDS FENCE
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REMARKS
[3 DEMOLISH 0 TANK OTHin
— GARAGE — RETAININGWALL FIRE SPRINKLER
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S CH'CK'O'Y JTYPEjr"2j'a'UCT' OCCUPANT
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A GROUP
NUMBER "UMBER OF CRITICAL
OF DWFLLING AREAS .1ECI-INSPECTION JAREA .. UPA.T
U 7- NUMBER REQUIRED [] LOAD
STORIES NITS YES
DESCRIBE WORK TO BE DONE REMARKS dy
PROGRESS INSPECTIONS PER UBC 1101111FINALINSPECTION REDID
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eacription
FEE
Description
FEE
'455V
Plan Check
State Surcharge
HEAT SOURCE OWING I LOT SLOPE
Building Permit
CitySurcharge
ff
PLAN CHECK NO: 1111TED DATE
Plumbing
Mechanical
THIS PERMr AUTHORIZES ONLY THE ORK NOTED, THIS PERMIT COVERS WORK To
t: 11 DONE 11 1111E PROPERTY NIUL .1 CCIAISNRUCTIO. ON THE PU..
Grading
OMAJN ICURBS. SIDEWALKS. DRIVEWAYS MARQUEES, ETC.I WILL REQUI E
FIC
SEPARATEPERMiSSION.
Engr. Review
P6 MITAPPLICATION: 180DAYS
PERMIT UMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUC ESORS
C
Fire Fle�vl
Plan Chk. Deposit.
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CI OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
S
FROM THE I SUANCE OF THIS PERMIT. ISSUANCE F THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REGUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt.
Noll LIMIT IN ANY WAY THE CITY1 ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
I Receipt It 17'AA'z_
I HEREBY ACKNOWLED E THAT I HAVE READ THIS APPLICATIOM
DUL� THAT THE INFORMATION
GIVE" IS CORRECT; AND THAT I AM THE OWNER, OR THE AUTHORIZED AGENT OF
AP A APPROVAL
N'_`7
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
-�P I' I '.nod by doe
opl.�P�'
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
no Foos I.p.1d,.od
'.. In
FOR INSPECTION nwl.d..dln _Id.d,
WORKMEN'S COMPENSATI=SURANCE AND RCW 10.27.
SIGNATURE (OWNER ORAGENIJ GATI SIGNED
(425)
0 ALS SIG E Cj PATE
'1. 11_Q102
C? -7-
771-0220
-
�JLFASED BY
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-
OFIGINAL-FILE YELLM-INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
PiNK.MNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING
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0
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0
M
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ....................
FOUNDATION:
Footing ...................
Wall..........................
z
Pier/Porch .................
0
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
A
C
Underground .............
ma
0
0
Rough -In ...................
C
Commercial Final
M
z
10
HEATING:
E: —4
Gas Test
'n
Gas Piping ..........
0 r
n
Equipment
M ITI
Commercial Final
0
EXTERIOR SHEATHING
0
NAILING ....................
Q 0
FRAMING ...................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation
z
Ceiling Insulation
SHEETROCK NAILING
IT!
SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..................
40 711,9voo'