20020841.pdfDATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAMEMAME OF BUSINESS
10 2 Im T 1 *1 . .....
CITY ZIP ITELEPHONE
ADDRESS
PERMIT EXPIRES
USE
ZONE PERMIT
NUMBER
ADDRESS 21
5-7(� 102 M, P I W 11ITITI
PLAT NAME/SUSDIVIStON NO. I LOT NO. L�D NO.
L D FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP CP
'=P.—
EXISTING — PROPOSED --
REQUIRED DEDICATION— FT
METER SIZE I LINE SIZE No OF FIXTURES PRV REQUIR D
I I YE.E3 NO E3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ADDRESS I
;2800-ffio&kb 6e
FIRE REVIEWED BY DATE
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CITY
STATE LICENSE NUMBER EXPIRATION
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VARIANCE OR CU
I IHOFEUNIORAD81
I INSPECTION
"En"
OVEs 13NO
STED
1. BOND
PROPERTY TAX ACCOUNT PARCEL NO,
QoLlic) 5S 00000 910n
11PA REVIEW
COMPLETE , EXEMPT
SIGN AREA
ALLOWED , PROPOSED ALLOWED
HEIGHT
, PROPOSED
NEW RESIDENTIAL ;2PLUMBING/MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.) PROPOSED
FRONT SIDE REAR FRONT
SETBACK$ (FT)
VRSIDE REAR C
COMMERCIAL COMPLIA CEOR
rl ADDITION 13 CHANGE OF USE
rl RE MODEL MULTIFAMILY M SIGN
PARKING
D
RE PROVIDED
LOT AREA
P NNING REVIEWED BY DATE
IF
0 REPAIR F1 GRADING PE CE
CYDS I — X — FT)
I I
REMARKS
rl DEMOLISH TANK OTHER
GAS E RETAININGWALL FIR SPRINKLER
CARPORT... LJ ROCKERY FIRE ALARM
UWE OF USE. BUSINESS OR AZ
CHECKS
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NUMBER
OF
DWELLING
"UNITS
CRITICAL
AREAS
NUMBER
SPECIAL 114FECTI.. ]AREA
RSOUI RE
YES
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER USC 1108/FINAL INSPECTION REO'D
N-CERW E-1 Qr-- PLARCF- I NII Rx
1W LAINIG
VALUATI0N_____j
$ —
— I I - I
Description
FEE
Description
FEE
Plan Check
1-
15
LOT SLOPE
Building Permit
City Surcharge
PLAN CHECK NO:
VEIIED DATE
Plumbing
THIS PERMITAUTHORIZISS ONLYTHE IN K.OTEM 1.'.1...nCOV.FIS.OFIK1.
BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION 014 THE PUBU
LKS, DRIVEWAYS MARQUEES, ETC.) WILL REQUIFICE
DOMAIN (CURBS'SIOMASEPAWEPERM;SStON.
PERMIT APPLICATION: ISODAYS
PERMIT LIMIT I YEAR - PROVID 0 WORK 16 STARTED WITHIN 1.0 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Mechanical
Grading
Engr. Review
Engr. Inspection
'AIPLICAW' (IN 11HALF 01 HIS OR HER S10111, HEIII, ASSIGNS AID IUCCESORI Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFN. DEFEND AND HOLD HARMLESS THE CITY OF — I
EDMONDS ITS OFFICIALS, EMPLOYEES, .0 AGENTS F OM A14Y AND Fire Inspection Receipt #
,..,WAIIINGTON
C
ALI. FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECHY
FROM THE ISSUANCE OF T141S PERMIT ISSUANCE OF THIS ERMIT SHALL NOT BE Landscapeinsp.
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Total Amt. Due
F
NOR LIMIT IN ANY WAY THE CIWS ABILITY TO ENFORCE ANY ORDINANCE PROYISION.'
Recording Fee Receipt #
I HERESY ACKNOWLED E THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER, I AGREE 70 COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC� "'-iI,MIIXiWwdbyffia
TION; AND IN DOING THE WO I AU I. PERSON WIL BE EMPLOYED CALL P ! F.
TH "ne-b"I .11111.111,1,y.Ild 11111paid.and
IN VIO THE LABOR CODE " B WAS SPECTION 6% Spp,JdDd,
ATE HINGTON RELATING TO FOR IN d..d
WORKMEN C�OMPENSA3 0 R W IJ.27. 7 E
SIG ATU INNER R AGE DATE SIGNED (425) If;, � jo, L
62' L; 771-0220 DATE
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-OR G HAL - FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ZK-OWNER - GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
F,
SETBACKS ..................
FOUNDATION:
Footing ...............
Wall ....................
Pier/Porch .............
Retaining Wall
Stab Insulation ..........
PLUMBING:
Underground .............
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Rough -In ...........
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0
0
Commercial Final
-4
3: M
HEATING:
I'D
Gas Test
8- 63
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...........
Gas Piping
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Equipment
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Commercial Final
M M
EXTERIOR SHEATHING
NAILING ................
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FRAMING .......... .............
ITI 0
FIRST FLOOR FRAMING
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INSULATION ...................
Floor Insulation
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Wall Insulation ...........
Ceiling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY