20020790.pdfDATE 11011110 Z'
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USE
CITY OF EDMONDS ZONE P=
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CONSTRUCTION PERMIT APPLICATION JAODGRESS 5UIT1'APT'
OWNER MAMEINAM9 OF BUSINESS 6� L_
i1-QVAhU(,v" PLAT NAMEISUDDIVtStON NO I LOT NO, LID NO,
MAKIN ADDRESS LID FEE $
L L L V PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
CITY ZIP ITELIEPHONE EXISTING - PROPOSED-
ed �-i on o � cf$�C)20 15 7 1_1 J_,3�5-
E.UIBF. DEDICATION- FT
NAME LINE 1111 1 NO. OF 11011EI YEIRV "out' 11
SO NO E3
ADDRESS REMARKS
TRACTOR RESPONSIBLE FOR EROSION CONTROLJDRAINAGE
CITY
NAME
6-em craflert>
ENGINEERING REVIEWEI
A DR111
I C) -3 C) I cc q suk)
FIRE REVIEWED BY
CITY ClIk ATILEIHONE
1,00 Ld
7-71-3-3-:)
STATE UCE BE NUMBER EXPIRATION DATE
lo'2-
on
VARIANCE OR CU
SHORELINE OR ADS#
IN!
SEPA REVIEW
COMPLETE , IX��
EXP
'let' ARIA
ALLOWED 1111POSED
ALL
PSOPERTYTM ACCOUNT DEL NO.
(._�o L4 1�1.415 0001 01171" 0
TmNew RESIDENTIAL 0 PLUMBING I MECH
ADDITION 0 COMMERCIAL [i C MPLIANCE OR
HANG
GO E OF USE
0 APARTMENT
0 REMODEL SIGN
GRADING FENCE
0 REPAIR 0 Dyes 0 ( X FT)
[:I DEMOLISH 0 TANK ER OTHER
V 4__�
E:i GARAGE RETAINING WALL
CARPORT 0 ROOKERY [I RENEWAL
LOT COVERAGE
ALLOWED OSED
FRO � 0.'
REQUIRED SETBACKS LFT)
FRO SIDE BEAR
FRO
_2�
PROI
FRC
AMONG
F..V,.E.
T A
PLANNING REVIEV, ED 0
R A..
(TYPE OF USE, BUSINE= EXPI.Aft
'%
CHECKED BY
FREMA.AK'R
ITYPE=N
1Cq7
NUMBER
OF
STORIES
NUMBER OF
DWELL No
UNITS
AREAS
TIOAL'J;�
CNIUMBER
RPECIAL��DNSIICT.a
, Eau a 13 YES JANEA
I
DESCRIBE WORK TO BE DONE
PROGRESS INSPECTIONS PER USC 11081FINAL It
VALUATION $ 6.4-1 z -_
Deacricytion FEE
HEAT
ILAZINE
LOT SLOPE
Building
'!q.ijB19F-
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY ME ORK NOTED. THIS PERMIT COVERS WORK TO
-THE PUBLIC
1: 0 COME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON .UC
Grading
M
3 DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MAROUEFS, ETC.) WILL REQdU1RE
b SEPARATE PERMISSION.
Engr. Review
PE MITAPPLICATION: INDAYS
W
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS SSIONS AND SUC ESORS
S NOLA
IN INTEREST, AGREE TO INDEMNIFY; DEFEND AND I) HARMLESS THE
Traffic Mitigation
EDMONDS, WAIHINOTON, ITS OFFICALS, EMPLOYEES, AND AGENTS MOM ANY AND
ALLCLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Review
FROM THE ISSUANCE OF MIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Fire Inspection
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF MY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CDYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscapainsp.
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECr. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER, I AGREE TO COMPLY Wrm CITY AND STATE LAWS REGULATING CONSTRUC�
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, No PERSON WILL BE EMP"WED
IN VIOLATION OF THE; THE TE OF WASHINGTON RELATING TO
FOR INSPECTION
PLAr4DE'OF
WORXMEN's COMPEY k CE AND RCW 18.27.
(425)
771-0220
A;;NTION
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
DATE
OR UP
Recording Fee
City Surcharge
State Surcharge
Plan Chk Deposit
Receipt #
Total Amount Due
Receipt #
APPLICATION APP
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VAL
by M.
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'Id.d.
IGINAL-FILE YELLOW-INSPECTi
PINK -OWNER GOLD -ASSESSOR
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RECORD OF INSPECTIONS
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing................
lo fLo -z-
wall ..........
z
Pier/Porch
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
0
.............
M
CUnderground
M
0
Rough -in ...................
0
Final
C
Commercial
m
z
HEATING:
Gas Test
....................
Gas Piping ..............
0 It
Equipment .................
n
Commercial Final
rn
EXTERIOR SHEATHING
0 Fn
NAILING ..........................
FRAMING ........................
Q 0
z
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Calling Insulation
z
SHEETROCK NAILING
M
SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..................
COW- Io/