20020917.pdfDATE RECEIVED
10
07_,-
PERMIT EXPIRES
CITY
PERMIT
ZONE
q'
OF EDMONDS
NUMBER
0 17.
CONSTRUCTION PERMIT APPLICATION
ITEIAPT#
ADDRESS
9-9:T iI t _�"_A
ER NAMEINAME OF BUSINESS
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NAME/SUBDiVISION NO.
LOT NO.
Ll NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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EXISTING — PROPOSED —
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E.UIRED DEDICATION— FT —
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METER SIZE
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PRV REQUIRED a
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONATIOUDRAWAGE
CITY ZIP JTEIEPIIONI
NAME I . I I
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FIRE REVIEWED By
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LOT COVERAGE REQUIRED SETBACKS (hj? OPOSED SETBACKS AFL)
SIDE AFAR FRONT URSIDE REAR
COMPLIANCE OR
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ALLOWED PROPOSED
FRONT 0
/0
PARKING
LOT AREA P NNING A 111WEll BY
REMODEL MULTIFAMILY
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[3 REPAIR El GRADING CYDS I _ X_FT)
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o RETAINING WALL
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NUMBER UMBER
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STORIES a U NITS
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DESCRIBE WORK TO BE DONE
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REMARKS
'MARKS
ROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REGO
IIISPECTIONPER
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VALUATION
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Description
FEE
Description
FEE
A- A� v-y\ l2x-�t o r,,s L'�jt k\ y-&Y\ a�
Plan Check
State Surcharge
SOURCE .—IN. % LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK ED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES NLY THE WORK NOTED. THISPEA ITCOVERSWORKTO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS MARQUEES. ETC.) WILL REQUIRE
t: SEPARATEPERMiSSION..
a
PERMIT APPLICATION; 1. DAYS
Engr. Review
PERMIT LIMIT I YEAR . PROVIDED W RK IS STARTED WITHIN 180DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLI A ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCFSORS
Fire Review
PlanChk.Deposit
IN INTC H`T. AGREES TO JNDEMNIF)� DEFEND AND HOLD HARMLESS lHE CITY OF
A S
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
OR
Fire Inspection
Receipt N
ALL CILAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY INDIRECTLY
Frio THE ISSUANCE OF THIS PERMIT. ISSUANCE 01 THIS PERMIT SHALL NOT BE
Landscape Insp.
!Tclal Amt. Due
E.MEG TO MODIFY IVE On REDUCE ANY REQUIREMENT IA CARINA CE
A NY CITY
OR LIMIT IN ANYWAYIHE CITVSABILITYTO ENFORCE ANY ORDINANCE PROVISION.-
""Cording Fee
Receipt #
I HERE ACINOWIIDCI THAI I HAVE READ THIS APPLICATION; THAT THE INFORMATION
ION,APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNE . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
I qappli sit" is not a Ad MR Until signed 4 Ind
I ROP'sy: Fees I.PInd,.nd
TION; AND IN DOING 714E WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN lIOLAT'O A DE OF THE STATE OF WAS14INGTON RELATING TO
AV "Is end
g
FOR INSPECTION f ldqdFtjsaHkI,"ns,, ... pn,yIdld.
W.Aii.ENS INSURANCE AND nCW 16,27.
�6r"TUR DATE
�IEII 'A A
(425)
771-0220
A By
EkTION
EXT 1333
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
6.
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORG AL � FILE JYELLOW - IN9PECTdA
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
K-OWNER - GOLD -ASSESSOR
04102 PRESS HARD -YOU ARE
MAKING 5 COPIES GREEN � ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing...................
wall
J
Pier/Porch .................
Retaining Wall ...........
a
�.�Slab Insulation
0
4
PLUMBING:
Underground ...........
-4
0
Rough -In
IR
C
..............
M 0
0
Commercial Final
0
C:
HEATING:
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M z
Gas Test ....................
10
C
Gas Piping ............
Equipment ..........
Commercial Final
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EXTERIOR SHEATHING
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NAILING .........................
C-4
FRAMING .....................
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FIRST FLOOR FRAMING
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INSULATION ..................
Floor Insulation
Wall Insulation ...........
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Ceiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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