20020762.pdfDATE RECEIVED
PERMIT EXPIRES
NE 1,2 PERMIT
CITY OF EDMONDS __ NUMEIER,,�/M �- lo4"'52-
CONSTRUCTION PERMIT APPLICATION jos `�
OWNER NAMEANA E OF BUSINESS ADDRESS /0 57Z-6, / A
lq4)f4'7tl JZ PLAT NAME/SUBDIVISION NO, LOT 110, L
'�D 0,
MAILING ADDRESS D F E $
PUBLIC RIGHT OF WAY PER OFFICI STREET MAP
le)'GAI b�V' A LT. W
CITY H EXISTING PROPOSED — In.peee � ann
ft'-d
REQUIRED DEDICATION— FT UWH`.=;-__ 13
�7 PnV —.E..IRE.
NAME METER SIZE I LINE -1 YES E3 NO 0
ADDRESS REMARKS Z
CITY ZIP I TELEPHONE OWNFRICONTRACTOR RESPON DRANA.j:j i
AIAJ FC� I //ye 1 -1 ENGINERAING REVIEWED BY DATE
FIRE REVIEWED BY DATE
CITY ZIP TELEPHO E
r
ITELEPHO
156A77z 1r, 5'1
CKE �Ry
VARIANCE OR CU SHORELINE OR ADS� INSPECTIO BOND
STATE LICENSE NUMBER EXPIRATION DATE REO'D
0,.. ON. S
';:;EV"4 o4"
SEPA REVIEW SIGN AREA HEI
PROPOSE. AL I L PROPOSED
PM TAX 11C, COMPLETE EXEMPT ALLOWED CIA
qAR,6W EXP , ,
LOT COVERAGE REQUIRED SETBA KS PROPOSED SETBAr.KS (FT.)
171 NEW RESIDENTIAL E] PLUMBING I MECH ALLOWED PROPOSED FRONT SIDE BAR FRONT URSIDE REAR
C MPLIANCEOR
[3 ADDITION 0 COMMERCIAL 11 CHANGE OF USE ---EAT.
IT PARKING LOT A )PLANNING R FEWED
REMODEL MULTIFAMILY SIGN ECID I PROVIDED
FENCE
REPAIR GRADING CYDs X FT) REMARKS
rl DEMOLISH TANK 91`111 �C_
AGE o FRESPANKLER
FIETAININGWALL
oGA
CARPORT OCKERY FIRE ALARM
(TYPE OF USE. BUSI BED OR ACTIVITY) Ex LAIN:
CHECKED PIE OF ON
'S6.75MI44- I50_f607_ G'
IC
NUMBER N
0 F DIA SPECIAL SPE 0 N OCCUPANT
STORIES UUN REQUIREINC]"T' JAREA
LOAD
YES
Arde-
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER USC 108/FINAL fNSP;F:ON REaD
Xttbepug 6 F tueiv'D P%Apil Alt, -1-0
re.
s 461
FEE
Description
FEE
Plan Check
State Surcharge
'J'su
REA GLAZING %
rDescrfptfo�n
U, ,_,I
'Im. '
City Surcharge
lf�__
Plumbing
.-
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
I: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE FUND
Grading
OMAIN (CURBS, SIDEWALKS, nswSways, MARQUEES, ETC.) WILL EQUIRE
2 0 It
SEPARATEPERMISSION.
PE MITAPPUCATION: INDAYS
Engr. Review
PERMIT UNIT. I YEAR - PROVI ED WORK IS STARTED WIT14IN '80 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS,
Fire Review
Plan Chk. Deposit
IN INTEREST AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
IOMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENT" FRO" ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Receipt # Y 0
FROM THE I SUANCE OF THIS PERMIT ISSUANCE F THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapoinsp.
Total Amt, Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,
0"'NANCE PnOVS N'
Recording Fee
Re'
Receipt #
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIOW THAT THE INFORMATION
APPLICATION APPROVAL
GIVE IS CORRECT AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
- UG
THE OWNER. I AGRE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTAU.-
CALL
Jee I- la -I. pennelt.etil Idgn.d by ft
e.PPI 11
G 0. L BE EMPLOYE.
TION; AND IN DING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
ding date, Idelhe, D,p,ty: and Fees are, pad, and
E,,,Tni .,I
RE_T'NG To
IN VIOLATION 0 ODE OF THE STATE OF WASHINGTON RELATING TO
I
FOR INSPECTION
FO
WORKMEND C I N -11,
N� All 11 11
OM�f ai�
�LS S12NATURE,,.DATC
.'G.A�URE to N SIGNED
T
(425)
VAI
'TE
I,
7
DATE
A E NT,
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW - 14SPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK.OWNER GOLD�ASSESSOFt
04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
z
3:
C RI
MO
0
80
C
--I K
3: M
M z
CA
01
"ni
M M
0
2
Cf)
9 (A
M 0
X
z
_q
CD
z
M
ESTIMATE#
o
CUSTOMER DNrF
2212 QuEEN ANNE AVE. N.
PMB 261 AWRESS
SEA17LE, WASHINGTON 98109
(206) 282-1314 PHONE`L�' I ALTPHONE
�F
—I -EFI — 4-4—
17_
_1
J
-P,—L
J
L
Ea
-
I +
L
-4
ld
4-
Eir "c�--t]
Til
M
r
4f,
4-
3
. . . . . . . . . . .
T 4- __T
LU_,_
.
...........
....... ---
_T.
..... .....
_j=
'o
rz
GTri.
SUBTOTAL 7,196t t)
TAX vy
TOTAL
PAYMENTS TO BE MADE AS FOLLOWS:
1/2DOWN 1/20NCOMPLETION
El
SIGNED
f
z
m
ma
MM
MZ
0)
0 -n
m m
ni �
0
0 M
C/)
M 0
z
co
z
9
0
m
.... . ...... .
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
t
SETBACKS ....................
FOUNDATION:
Footing .............
wall............ .............
Pier/Porch .................
Retaining Wall ...........
SI ab Insulation ..........
PLUMBING:
R1
Underground .............
M
0
0
Rough -In
C
M
Commorcialfinal
M
I
HEATING:
Gas Test
>
r
.....................
Gas Piping ..........
_n it)
Equipment
M M
C.Mm.rcla"'Inal
or -
EXTERIOR SHEATHING
0
NAILING ..........................
co;
M 0
FRAMING . . .....................
z
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ..........
z
0
Ceiling Insulation
d
SHEETROCK NAILING
0
M
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
4"-