20030118.pdfATE RECEIVED
PERMIT EXPIRES
A
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINA.L11,1111IM"i. f3
MAILING ADDRESS
CITY
ITILEIHONI
NAME
ADDRESS
CITY ZIP
IT11EPHONE
NAME
de
ADDRESS
TILEPHO E
STATE LICENSE NUMBER EXPIRAT
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Way
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PROPERTY TAX ACCOUNT PARCEL NO.
c,06191/610c) I C6
0 NEW RESIDENTIAL PLUMBINGIMECH
C MPLIANCEOR
ADDITION COMMERCIAL CHANGE OF USE
CM REMODEL rl MULTIFAMILY rl SIGN
REPAIR GRADING c F NCE
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rl DEMOLISH TANK OTHER
GARAGE RETAINING WALL F RE SPRINKLER
FIREALARM
CARPORT MOCKERY
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(TYPE OF USE, BUSINESS OR A 2 IN:
NUMBER OF
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UNITS
NUMBE 8
DESCRIBE WORK TO BE DON'sz,
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ET
VESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PER MITCOVERSWORKTO
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HE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2
0 B'D I WILL LIRE
MAR U 15, ETC.
OMAIN (CURBS. SIDEWALKS. DRIVEWAYS 0 E I WILL REQUIRE
SEPARATE PERMI SSION.
MITAPPLICATION: ISODAYS
PERMIT LIMIT I YEAPRE-PROVID D WORK IS STARTED WITHIN 180DAYS
SSE BACK OF PINK PERMIT FOR MORE INFORMATION
"APPLICA4, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS . AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE'CITY OF
IDMONIII, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS MOM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY ORIAINDIRECTLY
FROM THE ISSUANG OF THIS PERMIT. ISSUANCE OF THIS PERMIT SH LL NOT BE
DEEMED TO MODIF)� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.�
R BE THA HAVE EAD APPLICATION. THAT THE INFORMATION
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No '. T W ON THE GULY ALTHDRQED AGE]
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WN11 I AG116 TO COMPLY WITH CITY AND STATE LAWS REGULATING CON
��DANG � GOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPILOYED
I , OLAn.. OF THE ROR CODE OF THE STATE OF WASHINGTON REILATING TO
WORKMENS COMPENSATION INSURANCE AND Row 1&27.
SIGN
OAT' SIGNED
G
ZAE PERMIT
kl!�Iy NUMBER _,L,/,a7
08 SUrTEIAPT#
OGRESS 1h11
PLAT NAMEISUBDIVISION NO. LID NO.
LID FEE S
PU LIC RIGHT OF WAY PER OFFICIAL STREET MAP F�w
EXISTING — PROPOSED —
REQUIRED DEDICATION— FT
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METER SIZE I LINE MY 0. OF 11.11REE MY REQUIAED
YES E3 No C3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
I,- - /I - .1 - __ — . � . I I
[RE REVIEWED BY
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$EPA -REVIEW SIGN AREA HEI HT
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:OMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
IF
LOT COVERAGE REQUIRED SETBACKS (FT-)TPROPOS - D - SETBACKS (Fr.)
LLOWED PROPOSED FRONT SIDE REAR I FRONT LJR SIDE REAR
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GROUF��
�PECIAL INSPECTION
[3 JARIA OCCUPANT
tEOUIRED YES LOAD
MARKS
ROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
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$ F
Description FEE Description FEE
Plan Check State Surcharge
Building,Permh City Surcharge
Plumbing
Mechanical :ZQ
Grading
Engr. Review
Engi. Inspection
Fire Review PlanChk.Deposft
Fire Inspection It Receipt #
Landscapeinsp. Total Amt. Due
Recording Fee Receipt #
APPLICATION APPROVAL
CALL 'ThIalippketdit in red. p—in until lig.d by th.
at ding Offidial of heddir Deputy: and Fees are paid,
FOR INSPECTION —alp, I-Flun-ledgid! 1-pad, p—lded.
OFF Cii S [ON DATE
(425) ��Ai
771 0220 .5ace�PED BY ' DATE
A17ENTION Ej" 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOYi - lNilPEC16F
CATE OF OCCUPANCY HAS BEEN GRANTED. LED SECTION 109 PINK,OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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[RE REVIEWED BY
REOD 1C.TSO
1E3YEs 1314pis
$EPA -REVIEW SIGN AREA HEI HT
NE'
:OMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
IF
LOT COVERAGE REQUIRED SETBACKS (FT-)TPROPOS - D - SETBACKS (Fr.)
LLOWED PROPOSED FRONT SIDE REAR I FRONT LJR SIDE REAR
So PARKING fTpj�jTr MW
0 PR.VIDj VE "AT'
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nNA Riffa 111 11=1 11112PIM....
......—AFROWS SHALL NffF
HECKED BY TYPE OF CQ
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I;rACTION Ff� 00 UP
GROUF��
�PECIAL INSPECTION
[3 JARIA OCCUPANT
tEOUIRED YES LOAD
MARKS
ROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
��, / — J, ,.4- ",,� // 1.
$ F
Description FEE Description FEE
Plan Check State Surcharge
Building,Permh City Surcharge
Plumbing
Mechanical :ZQ
Grading
Engr. Review
Engi. Inspection
Fire Review PlanChk.Deposft
Fire Inspection It Receipt #
Landscapeinsp. Total Amt. Due
Recording Fee Receipt #
APPLICATION APPROVAL
CALL 'ThIalippketdit in red. p—in until lig.d by th.
at ding Offidial of heddir Deputy: and Fees are paid,
FOR INSPECTION —alp, I-Flun-ledgid! 1-pad, p—lded.
OFF Cii S [ON DATE
(425) ��Ai
771 0220 .5ace�PED BY ' DATE
A17ENTION Ej" 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOYi - lNilPEC16F
CATE OF OCCUPANCY HAS BEEN GRANTED. LED SECTION 109 PINK,OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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$ F
Description FEE Description FEE
Plan Check State Surcharge
Building,Permh City Surcharge
Plumbing
Mechanical :ZQ
Grading
Engr. Review
Engi. Inspection
Fire Review PlanChk.Deposft
Fire Inspection It Receipt #
Landscapeinsp. Total Amt. Due
Recording Fee Receipt #
APPLICATION APPROVAL
CALL 'ThIalippketdit in red. p—in until lig.d by th.
at ding Offidial of heddir Deputy: and Fees are paid,
FOR INSPECTION —alp, I-Flun-ledgid! 1-pad, p—lded.
OFF Cii S [ON DATE
(425) ��Ai
771 0220 .5ace�PED BY ' DATE
A17ENTION Ej" 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOYi - lNilPEC16F
CATE OF OCCUPANCY HAS BEEN GRANTED. LED SECTION 109 PINK,OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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A17ENTION Ej" 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOYi - lNilPEC16F
CATE OF OCCUPANCY HAS BEEN GRANTED. LED SECTION 109 PINK,OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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Underground .............
Rough -in ..............
,Commercial Inell
'HEATING'
as TeS
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Gas Piping .............
Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ..................
FIRST FLOOR FRAMING�..
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..................
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