20030167.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER
,�AME/NAME OF BUSINES
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MAILING ADD IESS
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CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY ZIP ITELEPHONE
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ADDRESS
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CITY Zip TELEPHONE
STATE UCENSE NUMBER EXPI TION ATE BU
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PROPERTY T4X ACr
QOUNT PARCEL NO.
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NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
El CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE X
( FT)
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
F RE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
0 NUMBER NUMBER OF CRIT1CAL
a OF DWELLING AREAS
10, STORIES 4� UNITS '71 NUMBER
DESCRWE WORK TO BE DONE
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HEAT SOURCE GLAZING % I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPUCATION: 180 DAYS
PERMIT ILIMIM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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 AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION_Qf_1HE LABOR-MDE OF THE STATE OF WASHINGTON RELATING TO
WORKfifftr--v.COMPEWATIONINSUFMNCE AND RCW 18.27.
AGENT) DATE SIGNED
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PERMIT EXPIRES L
USE PERMIT
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NUMBER
JOD
ADDRESS
sUITE/APT#
7 J <�
PLAT NAME/SUBDIVISION NO.
T
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP APPFGVGd U
RW Permit Roq :;ad
street U80 Perm R&q'd
EXISTING - PROPOSED
impaction Required 13
Sidewalk Required 13
REQUIRED DEDICATION- FT
___r___T1NE
Underground
Wiring required 0
METER SIZE
SIZE JNO.
OF FIXTURES
I PRV REQUIRED
YES L3 NO 13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
BY DATE
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VARIANCE OR CU
SHORELINE OR ADB11
INSPECTION I
BOND
REO'D
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POSTED
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BEIRA REVIEW
SIGN AREA
HEIGH
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED
PROPOSED
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LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT
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PARKING
LOT AREA
PLANNING REVIEWED BY
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REO'D PROVIDED
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REMARKS
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OCCUPANT
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REQUIRED [] YES
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REMARKS
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PROGRESS INSPECTIONS PER USC
1108/FINAL INSPECTION REO'D
VALUATION
$ C,
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Oumbing (11V
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
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,1l,425)
771-0220
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Foos are paid, and
receipt -is acknowledged in space provided.
0 IC S AT ATE
RE AS r)*E
AITENTION Off 1 33 6 1 1) ---�
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL ILL_-j
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- f - INSPECTOR
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 ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final ......
HEATING:
GasTest ....................
GasPiping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................ MIR
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
'SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
jaA
OCCUPANCY ..................
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER14AME/NAME OF BUSINESS
____ A 1,ene 1— 6: - -
MAILING ADDRESS
0 AZI-1-
CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY
ZIP ITELEPHONE
PERMIT EXPIRES
USE PERMIT
ZONE
NUMBER
JOB SUITE/APT#
ADDRESS
PLAT NAME/SU BDIVI SION NO.
NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Street Use Permit Req'd
EXISTING - PROPOSED--
inspection R8QUirod
Sidevialk Required 13
REQUIRED DEDICATION- Fr
Underground
Wiring required 13
METER SIZE
LINE SIZE
OF FIXTURES
PRV REQUIRED
F_�O.
YESM NO [3
REMARKS z
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
11
NAME BL # -�— 6C;5?_� rlz�
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ADDRESS
FIRE REVIEWED BY DATE Lu
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CITY TELEPHONE rL
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STATE LICENSE NUMBER E)
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3RO UNT PVUO.
00/6
NEW RESIDENTIAL
L�.j ADDITION E] COMMERCIAL
[-] REMODEL MULTIFAMILY
REPAIR GRADING CYDS
DEMOLISH TANK
oGARAGE RETAINING WALL
CARPORT ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
-r- 75-old-t
NUMBER NUMBER OF
OF DWELLING -2.qg*
STORIES T11,1UNITS IF-0 V
DE!2� BE DONE
HEAT SOURCE GLAZING %
PLAN CHECK NO:
riON
ATE
VARIANCE OR CU
SHORELINE 08 ADB#
INSPECTION
BOND
Et
3
L,,PECKEI3-5VX
qb�d. I
1__�
I
REO'D
I 13YES 6116
POSTED
$
( u,�
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
1 0
,
rV r—
I
EXP
MECH
LOT COVERAGE
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
PLUMBING /
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJRSIDE REAR
COMPLIANCE OR
A/C,
/W_
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CHANGE OF USE
SIGN
PARKING
REO'D PROVIDED
LOT AREA I PLANNING REVIEWED BY
DATE
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FENCE
( X FT)
REMARKS
No
OTHER
V V
oFIRE SPRINKLER
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F RE ALARM
AREAS
NUMBER
Ll A) 6,
LOT SLOPE %
VESTED DATE
CHECKED BY
LPE CUIQRUCTION
OCCUPANT
GRO
SPECIAL INSPJLTION AREA
REQUIRED IM
9"MA
OCCUPANT
LOAD
I
REMARKS
PROGR C 108/FINAL INSPECTION REO'D
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VAWATION
$ _�j j2d".
Description
FEE
DescriptIon
FEE
Plan Check
State Surcharge
4(
Building Permit
City Surcharge
MupqSng (nLyj
Mechanical
THIS PERMIT AUTHORLZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPILICATION: 180DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTVI OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapeinsp.
Total Amt. Due
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
=Recceipt
Recording Fee
0
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
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-
CALL
This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid, and
IN VIO P14,015-1 ID OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
recelpt-Is acknowledged In space provided.
�E ��B�O
for TI �NCE AND RCW 18.27.
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ATTENTION Off 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 YELL.6w - INSPECT04RM�
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CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSI
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GR E E N- A C C OLIN TING
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IMAGE EVALUATION
TEST TARGET (MT-2)
APPLIED IMAGE
1653 E.MAIN STREET
ROCHESTER, NY 14609
TEL C7163 482-0300
FAX C716) 288-S989
Precislon IIVL4GI=- Products & SerAces
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