20020978.pdfDATE RECEIVED PERMITEXPIRES
USE E PE MMT
CITY OF EDMONDS ZON NUR BERaL2- 6)?
CONSTRUCTION PERMIT APPLICATION JAOGRESS SZ)C) 'Pttf7 C�l AAJ 'u[TEIAPT#
OWNER NAMEINAME OF RUSIN
A/0 R I LOT NO,
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PLAT --U-D"dR'O N ... DFEE$
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TELEPHONE
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REQUIRED DEDICATION
NAME METER SIZE I LINE SIIE I NO. OF FIXTURES P REQUIRED
YES E3 me 13
79MARNS -
ADDRESS RM
nw—nin—W—ri RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP
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ZIP TELEPHONE I
DATE
11OPIVIT A77 17�
COMFTJ7E�jj - UEMPT
EXP
I ALLOWED I PROPOSED
ALLOWED , PI
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0 NEW
RESIDENTIAL
0 PLUMBING/MEC
D C
LOT OVERAGE REQUIRE SETBACKS (F-T.) PROPOS W
REAG
A LOWE C PROPOSE. FRDNFD SIDE CR R FRONTEG,
L 0 D
0 ADDITION
0 COMMERCIAL
C MPLLANCE OR
0 CHANGE OF USE
REMODEL
0 MULTIFAMILY
0 SIGN
REVIEW
PARKING LOT AREA P NI G ED BY DATE
PROVIDE
EO' D
R �4A I
0 REPAIR
0 GRADING
0 F NC5
x
NO MGG
R
FT) REMARKS
0 DEMOLISH
0 TANK
0 OTHER
RETAINNGWALL
0 FIR SPRINKLER
oGARAGE
CARPORT
0 ROOKERY
FIRE ALARM
(TYPE OF USE, BUSINESS OR ASWrlFr
CHECKED BY R.UFANT
C, Go O'C'W
IREMARKS
IMBER OF
YELL NG
I
CRITICAL
AREAS
Is OCCUPANT
PFCIAL IN CTI AN
OTS
NUMBER'or
F Yr's'
IAEDSPE LOAD
REQU 0
A) 61 r-
PROGRESS INSPECTIONS PER URIC IOB/FINALINSPECTIOI
5L
$ (s) 09)
Description
F
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE GIAIING i6 LOT SLOPE %
I
Building Permit
City Surcharge
PLAN CHECK NO: rED DATE
LP
mbing
chanical
THIS PERMIT AUTHORIMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON 7 HE PUBLIC
Grading
I, LL REQUIRE
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) Wl
SEPARATE PERMISSION.
PER ITAPPLICATION: INDAYS
Engr. Review
PERMITUMITly BAR - PROVIDED WORK IS STARTED WITHIN lad DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATIO 4
Fire Review
Plan Chk. Deposit
ON BEHALF OF HIS OR HER SPOUSE, HEIRS A SIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
III
eDMONDS,WASHINOTON� ITS OFFICIALS, EMPLOYEES. AN AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING D RECTLY OR INDIRECTLY
Fire Inspection
Receipt
FROM THE ISSUANCE OF THIS PERMU. ISSUANCE OF THIS PERMIT SHALL NOT BE
CITY ORDINANCE
Landscapainsp.
Total Amt. [)us
DEEMED TO MODIFY WAIVE OR REDUCE ANY REOUIREMENT OF ANY
.1 .08 LIMIT IN ANY WAY THE .11. AGILITY To ENFORCE ANY ORDINANCE PROVISION,'
Recording Fee
Receipt #
I HEREBY ACKNOWLE GE THAT I HAVE READ THIS APPLICATION� THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS "RECT. AND THAT I AM THE OWNER, On THE DULY AUTHORIZED AGENT OF
Cc
THE OWNER. I AGRE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONS'RUC'
CALL
"' "pi aillma I.ml. pitanfil,iatmd 4y th.
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLAT OANTHI LABOR Cool 01 THE TAT, 01 IASIIIIGTIIN 1ELAT'N. To
8.11dia, OMI�11 11 1,1010a DOPIT old F"s am paid. ald
FOR INSPECTION alelpt Ik,m1,d91d (a sp=o pm,lded.
W.Rpuas� NSATION INSURANCE go RCW I
0 DATE
DATE SIGNED
(425)
MIA Lp
1_21
771-0220
RE EASE Y DATE
L
ATTENTION
_
EXT 1333 7 Z122
4KIGINAW111ILE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
�'
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
17 INIII.
YE=LL
CATE OF OCCUPANCY HAS BEEN GRANTED� UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS
FOUNDATION:
Footing ......................
We ................
z
Pier/Porch ................ \,\n
Retaining Wall
Slab insulation ..........
PLUMBING:
M
C=
Underground .............
M 0
Rough -In
0 C
M
Commercial Final
IR z
ID
HEATING:
Gas Test ...........
co
Gas Piping ........ . ...
0
n
Equipment .................
M 1`111
Commercial Final
0
0Fn
EXTERIOR SHEATHING
C (j)
NAILING . ...........
FRAMING .............
FIRST FLOOR FRAMING
;lg
INSULATION ..............
z
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
0
M
SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR fy�s
OCCUPANCY ..................
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