20020816.pdfDATE RECEIVED
PERMIT EXPIRES
CITY OF EDMONDS
ZS
ONE
PE RMT
IN MEER
CONSTRUCTION PERMIT APPLICATION
JOB
SUITEtAPT4
ADDRESS (1qI(
OWNER NAMEINAME OF BUSINESS
�e/
FLAT NAMEISUBDIVOION NO,
LID NO.
MAILING ADDRESS
PUBLIC
LID FEE S
TESCFAIP-d 0
0 jjq 9 SI) PL V�
RiGHT OF WAY PER OFFICIAL
STREET MAP W �
UT: 2,::-z'
CITY
[03
0
0
ITILIPH011
REQUIRE
NAME
[Elji$TIN�
METER �
Zrre IM1,111
`60,1141p
RV RE9111RID
migi 19.
fnd SIT q
0
t ADDRESS REMARK,
CITY
N.,C WS�EQBJW�
�ROUDRAINAGE
NAME
BL&v- FLAYI102- el� EN.I.�ERIN.
REVIEWEDIDATE
ADDRESS -- 7 .....
r;7, =-
0 _ Ne -
I 8_Vi C) AVe -19 Zfectrical
RAEREV WED -Permit
P IT LEPHONE
0
0 State Labor & fil dust
"02.0
z
1 6z)I 41975- 3;7 7 7 - --
-7
0
7"OFF —6HORELINFPFtA2L4, INSPCC N 1, BOND
STATE LICENSE NUMBER VARIANCE 0.
EXPIRATION
, POSTED
I'lot
d
YES 0 N'�'
L FL -* ctll 12, 1
0
71
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE E�E.PT ALLOWED 1�.101�0 ALLOWED PROPOSED
P OR E 7, ;921709-m-3 EXP
49i
LOT ' R#T15 CKS (Fl�)
�UIREQSETBACKP(FT� PHqPO$%S
NEW PLUMBING MECH A
RESIDENTIAL LLOWED t8IDE! AEA� 'I- �FIONT.l REAR
6141.kl-, t 'A
X,
0
0 171
E] ADDITION COMMERCIAL cl CHANGE OF USE is open 4r o
M
PAR, 11 LoTA�,!� -1 -140fFWOBY��' DATE,
0
'o
0 c
C] REMODEL APARTMENT SIGN R LED
City C de. B,
0 F NCE
REPAIR x EMARKS
C] GRADING CYGS FT) 8
M
IR Z
DEMOLISH 0 TANK 0 OTHER
c
APACE
OAR
C3 POIRT E3 a E NO WALL 0 RENEWAL
r (TYPE OF USE, BUSINESS OR AD IVI PLAIN:
JC CHICKEDOY jl`�JP�TION CCU F
U GRO
�y 10 PAX3 I
0 -n
'n
NUMBER OF ITIC AL
'U1111 OF
.Z I
OF OWELLIN AR SPECIAL INSI�Gl
G EAS
/�& OR AREA
REQUIRED
V
M M
_STORES LIN NUMBER
ITS 0 Y �S
DESCRIBE WORK TO BE DONE
REMARKS
055
0 f-
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
'r
0 M
C Into
76 6015t 6/4-oo474- e—
C ca i
Mo
Z
VA/Md- S-M�AS-
r- LX--L& 14- '70 67K tvt7k2L I'Q
Jv�& htow
VALUATION
FEE
PLAN CHECK FEE
z
LOTSLOPI!�Z BUILDING
PLAN CHECK NO: VESTED DATE PLUMBING +
0
M
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THISPERMITCOVER WORKTO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINWFIL4
ADI `F` '
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
FCF"
PERMIT APPLICATION: 180 DAYS
P. PERMIT LIMIT I YEAR -PROVIDED W RK IS STARTED WITHIN 180DAYS ENG, REVIEW FEES
N EN �W - ES
SEE BACK OF PINK PERM170FOR MORE INFORMArION
[EN
F
-S �CH.N FEF
-A PLICANT. ON BEHALF 0 HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS ENG, INSPECTION FEF
IN NTEREST, AGREES TO I DEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING
LCS�A FIND
E WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND INSPECTION FEE
A L CLAIMS FOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
RECEIPT
FR M THE ISSUANCE OF THIS PERMIT. I SSU NCE OF THIS PERMIT $HALL NOT BE
9 DEEMEDT MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITI ORDINAN , PLAN CHECK DEPOSIT
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
TOTAL AMOUNT DUE
IHEACS ACKNOWLEDGE THAI I HAVE READ THIS APPLICATION: THAT THE NIOR.ATION
APPLICATION APPROVAL
GIVEN IS CORRECI AND THAT I AM THE OWNER� 08 THE DULY AUHHORIZED AGENT OF
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC CALL T, -,I ..q �, ll�.
D,,l
TION AND IN DOING THE WORK ALIHORIZED THEREBY. NO PERSON WILL BE EMPLOYED P.-
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION P,d
WORKMENS COMPENS;jelf CW 18.27
f 'URANCE AND I S ORE DATE
OFFK`I
0 E SIGNED (Z125)
771-022C, RELEAS�D Sl DAIE'
ATTENTION EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 771-0221 1 ORIGINAL -FILE Y51-LOW—SPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED� UBC SECTION 109 FAX PINK - OWNER COLD � ASSESSOR
5198
PLUMBING:
M
Underground .............
rn a
0
0
Rough -in ...................
C,
-4 C
Commercial Final
= M
M z
ID -I
HEATING:
AA
z
Gas Test'!
-n
Gas Piping ...............
0
"n
Equipment .................
:t C f.-
IT
Commercial Final
M
Cr)
EXTERIOR SHEATHING
0
0;;
C 0)
NAILING ............ .............
K 0)
FRAMING ........................
IT! 0
z -
r
FIRST FLOOR FRAMING...
;a
INSULATION ...............
z
Floor Insulation
4
Wall Insulation ...........
z
Ceiling Insulation
SHEETROCK NAILING
0
IT!
SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..................