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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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ADDITION
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COMPUANC OR
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GRADING CYGG
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GARAGE
CARPORT
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DESCRIBE WQRK.TO BE DOINE
07- IVI PERMIT EXPIRES I I I IG I
usE
PERMIT
ZO.E
NUMBER
NM
JOB
ADDRESS /133
5+1
vku�77'
PI.AT NAMUSUBDIVISION NO.
LOT No,
LID NO,
I
LID FEE S
7,7, `RG� OF WAY PER OFFICIAL
STREET
7AP
'E .. "W"
P
E ISTING — PROPOSED�
REQUIRED DEDICATION—
FT
7ETER SIZE
LINE SIIE
NO. (IF FIXTURES
P ED
RV RIQUI
I
YESO NO 13
REMARKS
nINFRICONTRACTOR RESPONSIBLE F04 EROSION CONTROIJORAINAGE
FIRE� REVIEWED BY
P
VARIANCE OR Cu
SHORELINE R INSPECIFICH
REG D
BOND
POSTED
Es EINO
$
SERA REVI
A
EIGHT
coMip
AL L OWED P liopo sED
ALLOWED PROPOSE
IL�IEXEMPT
I .
I
LOT COVERME—
REQUIRED SETBACKS' '"T
PROPOSED GET ClAs IF
A LLOWED PROPOSED FRONT SIDE REAR
�PI`IONT UP SIDE REAP
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PARING
EA
LOT A EA
PLANNING REWEVVIED
By DATE
DIED
I
CHECKED By
SPECIAL INSI
REQUIRED
IIAEMARKS
LOAD
PER UBC JoB/F[NAL INSPECTII.N III
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VALIJAIJUN
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Description
FEE
DeScription
FEE
CA
]an Check
State Surcharge
f- HEXT,� LOT SLOPE
DUN
4/1
Building Permit
Citiy Surcharge
PLAWdHECKOO: -STED DATE
"Urntoing
mechanical
THIS PERMIT AUTHOR21ES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONO,. ANY CONSTRUCTION ON THE PUBLIC
Grading
3 DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS MARO E28,0C.) WILL REQUIRE
SUARATE PERUiSSIONU
-
Engr. Revle,r
PEFIMrTAPPUCATI N: INDAYS
PERMIT LIMIT I YEAR -PROVIDED WORK IS STA 0 WITHIN ISO DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
File Ravi"
Plan Chlk. Deposit
PLICANT. ON BEHALF OF HIS 08 HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
INIINT1111T, AGREES TO IND14411, DEFEND AND HOLD HARMLESS ,, ,,, —
EDMONDS, WASHINGTON, IT$ OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection
Receipt Al
ALL LAWS FOR DAMAGES 0FWHATEVEA,NATURE ARISING DIRECTLY OR INDIRECTLY
FROC THE ISSUANCE OF THIS PERMIT. SSUANCi OF THIS PERMIT SHALL NOT I.E
Landscapelnsp.
Total Amt. Due
DEEMED To MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINAN
I LIM I IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION
0 No t
N,
Receipt N
I HEREBY ACKNOWLEDGE THAT � HAVE READ THIS APPLICATION, THAT THE INFOR ATION
APPLICATION APPROVAL
GIVEN 13 CORRECT. AND THAT AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
.,pk. on 11 P. . pourl, ..J slgnod 0, To
T11, I
THE OWNER I AGREE TO COMPLY WIT. Cl A1,11) G.E LAWS REGUI-ATING CONSTRUC
ON WILL BE EMPLOYED
CALL
d,, ..,n,:.dF .. ... polcl, .1
.. �`
Tick ORIZWED THEREBY. NO PER
A..,. DOING THE WORK AUTH
IN VIO,_ATION E OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
&Ck ... lodged I, space piWdedd
OF THE
WORKMENG COMIPENSII�1514 �INU NCE AND RCW 15 27'
OF C DATE
6, IN � "!� / D
(425)
/A (77M h, � Id
771-022 0
I(IELE� /D�TG
ATTENTION
EXr 1333
07
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL I INSPECTION HAS BEEN MADE AND APPROVAL 08 A CERTIFI-
��ARIGINAI. -FILE - YEL-LON-INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER - GOUD-ASSESSOR
04/02 ppFq.Q WARn _vnI I ARF RAAI(IM(' Z 9 rnDIFN2 GREEN -ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ...................
FOUNDATION:
Footing ......................
wall..........................
Plot/Porch .................
5
M
Retaining Wall ...........
Slab Ins lotion ..........
u
7
M
PLU MBI NG:
M
tv.
Underground .............
0 r
....................
MHoUgh-in M
Commercial Final
10
C
HEATING:
id,
Gis Test . .........
Gas Piping .......... 114-fl
n
r
Equipment ..........
M ITI,
Commercial Final
C'
EXTERIOR SHEATHING
NAILING..........................
FRAMING ............ ...........
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
ij
a
Wall Insulation ...........
Z
Ceiling Insulation
0
M
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR 03
OCCUPANCY ..................
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CITY OF EDMONDS ZONE Vc, NMER _W7 P
CONSTRUCTION PERMIT APPLICATION 'AO.ORESS -I-"
// � � 151- �
OMER PLAT NAmEISUBDIOSION NO I LOT NO. L
t�D NO.
imu nn D FEE S
MkILING ADDRESS IN`-
q0q "ka vis L PUBLIC RIGHT OF WAY PER OFFICIAL aTREET MAP . _=. 8
� C3
EXISTING — PROPOSED-
111E
(7,Wo uI
4n (f 14� REQUIRED DEDICATION— FT — _ C3
METER SIZ:E�_LINE SIZE I INO, 01 FIXTURES REQUIRED
P"
YES 13 NO 13
1EI ADDRESS REMARKS
T ...F."..NTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
I '1--IJ IffI0111 a % (/W_6V _1 'A U L/
NAME
4
EN.1 ED .1 DATE
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'�FIRE:
RIEVIEWED By _�__UATIE
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es
,,JIILIPIINE
VARIANCE OR CU SHOSELI
OR INSPECT
STATE LICENSE NUMBER
_�NE
RE I
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SEPA REVIEW
COMPLETE EXEMPT
SIGN Aft-
ALLOWED PROPOSED ALLOWED
HEIGHTT
PROPOSED
CD
I
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0M
2
;�Z 2
IMECH
E P
LOT COVERACT
REQUIRED SETBACKS (FT.) PROPOSED
F80W SIDE REAR 'FRONT
SETBACKS (FT.)
QRSIDE HEAR
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0
M 0
0
NEW
go
RESIDENTIAL
A LOWED PROPOSED
I I 1
0 C
ADOMON
OMMERCIAI_
C OMPLMC OR
CHANGE OF USE
--T-,7-
'DATE
0 REMODEL
MULTIFAMILY
SIGN
— PARKING LOT
!�VIDM
AREA
PLANNING REVIEWED By
10
GRADING PENCE
REMA CYDS X
A MARKS
C
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01;77ER—
DEMOLISH TANK
FIFIE
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RETAININGWALL [:]
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CAR287
(TYPEOI`jt��) ij_Nn�V)EXPUUU
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REQUIRED
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UNITS
NU MBEA
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YES
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DESCRIBE VJQRKTO BE DORF
REMARKS
C (n
PROGRESS INSPEC IONS PER UBC IGH/FINAL INSPECTION R
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VAL ATION
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FEE
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C,�,Knw*- '11t r
Pian Check
State Surcharge
—I
0
NO %
LOT SLOPE I
Building Permit
CitVsurcharge
ITI
—ACHECK00: 1
—1, DATE
Plumbing
echan cal
THIS P ERMIT — 0"IZEa ONL, THE WORK NOTED. THIS P�RMR CO%SR5 WORK TO
BE DONE ON PRN— PROP ON- — DQNSTRU-.. ON THE PUBLIC
nading
OOuAtN (CURBS, SIDIEWALKS, DRIVEWAYS �QUEES. VC.) WIIJ. REQUIRE
SEPARIXTEPERMiSSION.
rzj
n9r. Revi—
PER ITAPPUCKDOW 180DAYS
MIT
PERMIT LIMID I PROVIDED WORK is BTARMI) WTMIM HIDDAYS
YBAP*
SIEE BACK OF PINX PERMIT MR MORE INFORMATION
Frig, Inspeci
Fire RevieW
Plan Chk. Deposit
'APPUCAWW. ON BE F F His OR HER SPOUSE. HEIM, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND "BID IIARMILE11 THE CITY 01
AND AGENTS ROM ANY AND
Fire Inspection
—
15/
Receipt #
EDMONDS WASHINGTON. ITS OFFICIALS. EMPLOYEES.
ALL CMMir FOR DAMAGES OF WHATEVER NATURE ANSING DIRECTLY OR INDIRECTLY
PERMIT. ISSUANCi OF THIS PERMIT SH,U_I_ NOT BE
Total Amt.
Due 01,15
FROM THE ISSUANCE OF
DEEMED TO MODIFY. WAIVIE�Oa REDUCE My REQUIREMENT OF ANY CITY ORDINANCE
Lands-PeInSP.
iffid
C NOR LIMIT IN ANY WAY THE Cnya ABILITY 10 ENFORCE ANY ORDINANCE PROVIS10-
Recording Fee
Reasp! #
HAV DEAD THIS APPLICATION: THAT THE INFORMATION
I HERESY ACKNOWLEDGE THAT E
PLICATION
APPROVAL
GIVEN IS CORRECT. AND THAT THE OW EN. OR THE DULY AUTHORIZED AGENT OF
� AM
IN, .0- pjWJgIby!h.
THE CMNER. I AGREE 'to COMPLY WITH CITY'AND STATE LAWS REGULATING CONSTRUC-
CALL
md.roe=.Vd. a,d
ly: .
TION, AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
P.
IN VIOLATION OF THE
WORMEITS COMPEN N I U CE AND RM I B 27.
(425)
OFFI EIG DATE
Sic R7�ow . 0 AGE"
ril
DATE
2" 71
1 _wla"
RELEA
ENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
BEEN MADE AND APPROVAL OR A CERTIFI- � �11.YILLQW - N'PEC'Dn
A FINAL INSPEC TION HAS
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OVINER - GOLD ASSESSOR
GREEN ACCOUNTING
D4102 PRESS HARD -YOU ARE MAKING 5 COPIES