20020843.pdfDATE RECEIVI) It /3
CITY OF EDMONDS �u
CONSTRUCTION PERMIT APPLICATION j
A
IER NAMEMAME OF SUSIr4ESS
CITY ZIP
NAMP
.I ADDRESS
MOM
NEW
ja RESIDENTIAL
I MECH
ri ADDITION
/M COMMERCIAL
ZNJ6--IN-
COMPLIANCE 0
.NGE OF use
MULTIFAMILY
rl SIGN
g'EMODIL
N EPAIR
n GRADING OYDE
n FENCE
I X FT)
[3 DEMOLISH
TANK
o OTHER
GARAGE
A ING WALL
ci P SPRINKLER
FIR
FIREALA!LM
C R RETAIN
A PORT OCKERY
(rYP41MSINESS OR ACTIVITYI EXPLAIN:
L.J
NUMBER
NUMBER OF
N'T'CAL
OF
DWELL NO
STORIES
DESCRIBE WORK TO BE DONE
UNITS
NUMBER
Z,
7M-
70" [PERMIT EXPIRES
Y7
SE PERMIT
ONE NUMBER OW-0
0 0. U /A
Don �E
Ess
NESS
A
PILAT NAME/SUBDIVISION NO,
LOT NO,
I
LID No.
LID EE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
7E_rC_PMV1od
Rw P I fl�
pe "We
EXISTING — PROPOSED
=%�` , , , `d'
REQUIRED DEDICATION— IT —
—'r-
13
MET CA SIZE
UIE SIZT]
NCL OF FWURES
PRV REQUIRED
I
I YES E3 NO 13
REMARKS
E
Type B or L VLr1t COY1132dol*S
required On Tuei-Uuri)"�. appilances M
FIRE REVIEWED BY DATE
VARIANCEORCU I 111ORIU11ORAD81 I INSPECTION IS BOND
RE 'D .S_.
OYES ONO
SEPA REVIEW SIGN AREA HEIGHT
C -D
:MILE11 , EXEMPT ALLOWED , PROPOSED ALLOWS I PROPOSED
LOT COVERAGE REQUIRED SETBACKS IFT.) PROPOSED SITTGACK$ (FrI
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE HEAR
PARKING I LOTAREA IPLANNINGREMEWEDBY DATE
'NECKED BY
TYPE ]=CT
Up
So
SPECIAL INSPECTION JAIEA 2"�. .P^A.T
REQUIRED 0 _a LOAD
JEMARKS
IFICIGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REOD
AU
VALUATION
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING k LOT SLOPE %
Building Permit
City Surcharge
'AT'
PLAN CHECK NO: VESTED DATE
Plumbing
Plumbing
Me han,�al
Mechanical
OV .. Wom".
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
-L
HE PU I
h: 0 DOME ON PRIVATE PROPERTY ONIX. ANY CONSTRUCTION ON THE PUBLIC
Grading
Too"
V.
L REQUIRE
DOMAIN JCURBS, SIDEWALKS, DRIVEWAYS MARQUEES, CTC.) WILL REQUIRE
SEPARATE PERM; SSION
Engr. Review
PERMIT IRADI YEAPRE- PMA�OV-IDPL'D—WO'ORKN:IS'S-TAW—ED WITHIN 180 DAYS
6
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*AIPLICANT, ON IEHAIF OF HIS ON IRS SPOUSE, HIMS, ASSIGNS AMR �UOCIS.Ra
Fire Review
III INTERE T, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE C17Y OF
D S f
EDMON S. WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS TO DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
OF THIS PERMIT NALL NOT 8
OF THIS PERMIT SH
FROM THE ISSUANCE ISSUANCE
TO MODIFY, WAIVE OR REDUCE OF ANY CITY ORDINANCE
Landscapoinsp.
Total Amt. Due
DEEMED ANY REQUIREMENT
NOR LIMIT IN ANY WAY THE DAYS ABILITY TO ENFORCE ANY DINAN F 'R VISE
Recording Fee
Receipt #
I HESESY ACKNOWLE GE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
LIC ION AP PROVAL
19 Co I,
GIVEN RICT, AND THAT I AM THE OWNER. On THE OULY AUTHORIZED AGENT OF
N,GULA
a I , THU.
THE OWNER. AGREE TO COMPLY NTH CITY AND STATE JAWS REGULATING CONSTRUC
I st md by the
CALL
N
TION; AND E 0 AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
ING WORK
R ELATING TO
�'THE STAT OF WASI RNGTON RET.. To
IN VIOLATI IVMPTENTS �IN
a."
FOR INSPECTION
F.e. Id. ere
Weed,
0 U AND RCW 18.27.
WORKMEWI
G,
DATE SIGNED
L)
771
-0,220
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 CEFITIFI-
ORIGINAL - FILE YELLOW, INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 1 09
PINK
OWNER GOLD - ASSESSOR
04102 PRESS HARD -YOU ARE MAKING 5 COPIES
GREEN - ACCOUNTING
z
0 in
C
M
0
80
C:
X in
In Z
z
-4
CA
0 -n
in IT!
0 8
OC
90) 1
M 0
X
z
z
9 1
0
in
I
INSPECTOR DATE APPROVED
SETBACKS ..........
FOUNDATION:
Footing ................ -
wall ...............
Pier/Porch .................
Retaining Wall
Stab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
commercial Final
HEATING:
Gas Test ....................
Gas Piping .................
Equipment
Commercial Final
EXTERIOR SHEATHING
NAILING ...........
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...............
Floor Insulation
Wall Insulation ...........
Ceiling insulation
SHEETROCK NAILING
SPECIAL INSPECTION
Mlqr.ri t ANEDILIS
z
M
M
0
80
M
5
0
N
M IT!
a ra
0
o Fn
C C4
K 0j.
Q 0,
z
z
z
0
F)
M