20030090.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
: 6 co 77 F i. r- t/ R
MAILING AD RESS
1600!l 73',-,P 4vF 4,/
CITY ZIP
6- V "'z 960 4IT111PI10111
]ON
PERMIT EXPIRES -7
USE PERM T
ADDRESS
PLAT NAMEISUBDIVISION NO,
LID NO.
UD FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
S"..' P-
EXISTING - PROPOSED-
REQUiPEDDEDiCATION- FT
-10d
METER SIZE
LINE I�E--[7;7�
PSI REQUIRED
I
1YE1 E3 NO 0
REMARKS
CONTROL/ RAINAGE
III BIDS
CITY ZIP
ITELEPHONE
NAME
No oe v-1 fl, -Ir K
NG REVIEWED By BE ACCERED DATE
AODRE15
FIRE REVIEWED By
DATE
ZIP
TELEPHONE
W"
VARtAtZEOSCU
S ELINE OR ADB�
171'
INSPECHOI
0Y
STATE ICENSE NUMBER EXPIRATION DATE
1-7/ PAV - 5'/E� I-F
CHECKED BY
$EPA REVIEW
COMPLETE EXE-111
JREUG
WRIVIE
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLO!I!:. _1_:�CPOSED
PROPERTY TAX ACC LINT PARCEL NO.
ri NEW 0 RESIDENTIAL Ec.
CWT. OVERAGE
ALL LO E C PROPOSED
REQUIRED SETBACKS IFT.1
PROW SIDE REAR
PROPOSED S TOACKS (FT.)
"PO'd E
FRONT UP SIDE HEAR
0 'PL A OF
ADDITION COMMERCIAL rl CHANGE OF USE
rj SIGN
REMODEL R.LL"A"S'
---
ARK
P 4
0
ING LOT
DIVIDED
F.VI'DYE.
AREA
PLANNING REVIEWED BY
REPAIR 0 GRADING Cyca E3 FENCE
i x Fri
REMARKS
IT=
DEMOLISH 0 TANK rl HER
WE 360-ryl,
View- III, Ova 1i fale
GARAGE [3 RETAININGWALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
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S-YPE OF �1 , BUSINESS PLAft
0110 11
1 11 BY ITYPEIM
UCPN
�OIAC.TNITY"
HUM R
NU118IR DWELLING
OF UNITS
STORIES
;PECIAL INSPE CTION JAREA
SECURED 0 YES
'27�
10,
LOAD
DESCRIBE WO I RK TO BE DONE I Pal
.......... .
REMARKS
PROGRESS INSPECTIONS PER UBC I 081FINAL INSPECTION REO'D
F7
LUATION
IVII-66
$
Description
Description
FEE
Description
FEE
0 4- 7- A- &--r5
Ian Check
Plan Check
State Surcharge
HEAT iaou-� a-,-- - LOT SLOPE
u, g rmIt
Building Permit
B rldne
I P
City Surcharge_
VO: VESTED DATE
PLAN CHF
Plumbing
- f 114�
Mechanical
THIS PERMITAUTHORIMSIONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
I= B DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2
M DOMAIN ICURSS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
Engr, Review
PERMIT APPLICATION: 180 DAYS
PERNIFTLIM .11 YEAR - PROVIDED WORK IS STARTED WITHIN 180DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'�Sgr In ... Van
'APPLIC AT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON ITS OFFICIALS, EMPLOYEES, IN AGENTS FRO ANY AND .,I Fire Inspection
ALI CLAIMS FOR DAMAGESOFWHATEVER NATURE, ARISIN'G'DIRECTLYORMINDIRECTLY
FRO THE ISSUANCE OF SAIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED 0 MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp.
T IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE fROVISION.-
NOR LIMIT ,
Recording Fee
Plan Chk. D2psft
Receipt N
Total Amt. Due
Receipt #
I HEREBY ACKNOWLEDGE TH�T I HAVE READ THIS APPLICATION; THAT HE INFORMA TION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
TION; AND IN DOING THE WORK AUTH081ZED THEREBY, NO PERSON WILL BE EMPLOYED
t,,, VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
APPLI ` CATION APPROVAL
Thi.ppfin j-1-1 X p-It-til IIIpini by th.
CALL G.'Idliig Offii,I.I.Ihi�jhi,l D�puty:.,Kl F-- P.Id,
FOR INSPECTION .1p, I-k-t.dpil in spaco rX.0ded,
1
WORKMEN-SROMPENSATIONLNSURANCE AND ROW 16,27.
SI ATURE NER DATE S GNED
112--45-02
(425)
771-0220
0 F,Cj IGT DATE
� I I
'RELEASED BY
A7ENTION
EXT 1333
IT IVUNLAWFUL TO USE OR OCCUPY A BUILDING 08 STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI.
ORIGINAL - FILE YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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UjNDATION:.:.
F60+ ..........
wall
Pier/Porch .................
Retaining Wall
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in
Commercial Final
HEATING:
Gas Test
....................
fy)
Gas Piping ...............
Equipment . ................
Commercial Final
EXTERIOR SHEATHING
NAILING ....................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Coiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...............