20020968.pdf0
*�""4 DATE RECEIVEM
[PERMIT EXPIRES
us,
MS r 'MT
CITY OF EDMONDS W 'I�UMI�Ep
CONSTRUCTION PERMIT APPLICATION JOB SUITDAPTN
ADDRESS 7- SO 7-1? W
OWN� 1W,11,E1171 01 IZI�Ell
I_ b PLAT NAMEISUBDIVISION NO, LOT NO,
MAILING ADDRESS _ L 0 FEE $
X"'Al 1—
P BLIC RIGHT OF WAY PER OFFICIAL STREET MAP
T,s 0 zg loo Ave -
CITY ZIP TELEPHONE EXISTING — PROPOSED —
I TH PU LIC
REQUIRED DEDICATION— PT
_�'ETER
NAME
SIZE
LINE SIZE
NO.OFFIXTURES
PRY REQUIRED
I
I
YES 0 NO 0
.3
ADDRESS
R MARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP
TELE HONE
NAME
613,6",
At-e.'l C, C.)
ENGINEERING FIEVIEWEDIDATE
&?<
it
FIRE REVIEWED By DATE
CITY ZIP
TELEPHONE
q2.T- 776- 9 196--
z
0
. *AI. ER SK—HON DATE
'J��
IlAll 11
11111ELIll 01 A111
Apg_ol_ 1-11 AeRSECIO
MSIECTI.N
,
YS 0 NO
P�.blD
DST
�
.
A-e- r r vAl c o "77 c
f2>
SP_
A A'Vii
COMPLETE E
SIGN AREA
WE!.t PftED
HEIGHT
Ajy 0 IP ;P10SED
141
47
PROPERTY WX —ACCOUNT PARCEL NO.
EX, I
1
m
m
_L
RESIDEN
W 0 RESIDENTIAL PLUMBINC/.ECH
LOT COVERAGE
ALLOWED
REQUIRED SETBACKS f�.)
REAR
PROPOSED SETBACKS (FT.)
FRONT URSIDE REAR
ADDITION COMMERCIAL COMPLANCEOR
0 M
CHANGE OF USE
�APAATMENT
PROPOSED
FRONT SIDE
1 0 't-'5
0 V13
C=
M 0
0
PARKING
I LOT ARIA
REVIEWED BY T
0
c
C] REMODEL 0
R EQI=ED
�/;NNING
F NCE
C] REPAIR C] GRADING CY�S M (E_ X FT)
m
IT!
REMARKS
:TU@L, 6tiktj AV 4M�W Fox -
C] DEMOLISH 0 TANK 0 OTHER
GARAGE
RITA NING WALL C]
C APORT 0 ' My RENEWAL
A K
(TYPE OF USE, BUSINESS .� ACTIVITY1 EXPLAIN:
77777E
01
'ri j7
1704— .1c, PANh
HOUR
710
0
In T I
-4 ,
NUMBER
OF
I NUMBER OF
DWELL, N.
ITICA
SAS
CNAMBE
SPECIAL,�NSPECTOR 'X PANT
STO IES
U.TS
U R
JAIIIA IOCCU
E) LOAD
REQUIRE [D YEE
r1l IT!
0 'm
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC, 108/FINAL INSPECTION REO'D
CA
M 0
z
7- � 1�4 11 C4 4i-4s I
>
z
VA�UATIO�
FEE
z
HEAT SOURCE
LOT SLOPE %
BUILDING
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORT( TO
BE DONE ON PRIV—ATE P OPERTY ONLY. ANY CONSTRUC NON 6 8
STO U GRADINGIFILL
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEE , ETC.) WILL RED ME
SEPARATE PERMISSION,
p R iT APPUCATION: 180 DAYS
F E
T PERMIT LIMIT-. I YEA , PROVID D WORK IS STARTED WITHIN 180 DAYS ENO REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS END INSPECTION FEE
IN INTEREST AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING
* EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND INSPECTION FEE
ALLCLAIMS FOR DAMAGESOF WHATEVER NATURE, ARTSING DIREC LYORj'-C`ECTc' __ — RE]�
FROM THE ISSUANCE OF THIS PERMIl ISSUANCE OF THIS PSRM`TT,SliALL NOT a PLAN CHECK DEPOSIT
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY C TY ORDINANC
* NOR LIMIT JN ANY WAY THE CITWS ABILITY TO EN FORCE ANY ORDINANCE PROVI SIO� TOTAL AMOUNT DUE REC
I HEREBY ACKNOWLEDGE THAT I HAVE READ THI S APPLICATION: THAT TH E INFORMATION
GIVEN IS CORRECT, AMD T AT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF Td�!!�15ATI�N APPROVAL
H I , :�I
THE OWNER. I AGREE TO C PLY WITH CITY AND STATE LAWS REGULATING CONSTRUC, 0" n.I nd I .-1 10 .,g— by
0 F CALL S."n, Id Flls — Illd. Ind
TIOW AND IN DOING THE WORK AUTHORIZED THEREBY, NO P . RSON WILL BE EMPLOYED �p
IN VIOLATION OF THE LAID TH TATE OF WASHINGTON RELATING TO FOR INSPECTION a.wlId9dd.n — bl-ld.d,
WORKMEN'S CC.PENSAT K5UR 7.
J�k5UR CE=18 --Is 0 � A.S S' UBE /Z� ATE/o
SIGNATURE (OWN A AGE (425)
771-0220 REL ED By
20
20
X p e
ENTION E X CT//P3 33 3
1 21
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING 08 STRUCTURE UNTIL _0 1,
1-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILE YELLOW INSPECYOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER - COLD - ASSESSOR
W98 /) 42l:ZWl
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
P0
Footing ......................
wall .. .......... ............
L,
Ple�/Porch
Retaining Wall
0
Slab Insulation ..........
PLUMBING:
Underground
B,
C
M
0
Rough -In ...................
0
C
Commercial Final
t"
3:
ITIZ
HEATING:
to
Gas Test ..........
Gas Piping .................
Equipment .................
0 -n 1r;
-n
Commercial Final
M M
EXTERIOR SHEATHING
00)
NAILING ........... — ............
0
a ca
FRAMING ........................
Q 0
FIRST FLOOR FRAMING
z
INSULATION ...................
Floor Insulation
z
Wall Insulation ...........
-4
Ceiling Insulation
z
SHEETROCK NAILING
0
SPECIAL INSPECTION
M