20030248 (2).pdfDATE RECEIVED T EXPIRES
CITY OF EDMONDS
us� PERMIT
ZONE
NUMBER
CONSTRUCTION PERMIT APPLICATION
FOWNCER 0NAhME
JOB SUITE/APT#
ADDRESS
I
ME OF BUSINESS
7N-717i f (A tl, - -)
PLAT NAME/SUBDIVISION NO.
LOT NO.
I
LID NO.
MAILING ADDRESS
NAME
77—
DDRESS
x
CITY
ZIP
ZIP
LID FEE $
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street Use Permit Roq'd
Inspection Required
TELEPHONE EXISTING � PROPOSED Sidewalk Required
Cr*�i � Underground
7� REQUIRED DEDICATION- FT Wiring required
METER SIZE &LINE mystem
MJV 0=ther the 8109 MYSt4kIR
omflariflasus f Wh
TELEPHONE
NAME
ADDRESS
_)d
Of y
CITY
_19 0_nA--,1
o
Z17
TIEPHI
I.V
STATE LICENSE NUMBER
PROPERTY TAX ACCOUN
NEW
ADDITION
REMODEL
7"
1:1 REPAIR
E] DEMOLISH
GARAGE
CARPORT
(TYPE OF USE, I
NUMBER
OF *
STORIES
DESCRIBE WOR
PARCEL NO.
RESIDENTIAL
COMMERCIAL
El MULTIFAMILY
13
GRADING
0
TANK
Wo
ciRETAINING
ROCKERY
i OR ACTIVITY) EXPL
BE DONE
HEAT SOURCE
PLAN CHECK NO:
MBER OF I
REMARKS
J asse
FIRE �REVIEWED BY
DATE I CHECKED BY
PLUM
/ MECH
COMP
NCE 08
OF USE
CHAN
SIGN
I
EiFENC
FT)
I
x
T
0 HE
FIRE SJINKLER
FIRE A
RM
imDAM
z
a
z
W
tu
M
rL
'59 -IWrECTION I BOND
VAFXE OR CU VORELINE a"D1§9 E
EO'D POSTED
I I ONO 1$
SErA REVIEW SIGN AREA HEIGHT
CO L D PR S
EXP MPLEN EXEMPT LOWE Ix ED ALLOWED I PROPOSED
L T C0%1RAGE n C=QA1- Ks (Fr.)
0 - I
ALLOW D ONT SIDE REAR FRONT UR SID REAR
z
rs
a B jr L velit c0=4!11111.
T
PAti DAT .
P1 *Mh"ffl'ArW%W E
Ro E C
REO'D PRO EDf
U ejkr�M:INA
ed UMC 81.
U es e spa; 11 It
N
� ; 11111
Iiiiiiiiiii,000011IF
CHECKED
OCCUPANT 4
GROUP
CRITICAL
AREAS
S ECIA ECIIOI%IAJA4
I
OCCUPANT
LOAD
N MBER,
U
SE
zi
REMARKS
ROr2R INSPECTIONS PER UB.0
108/FINAL INSPECTION REG-D
M
�17
VALUAMON
—Description
FEE
Description
FEE
19141 Check
State Surcharge
%
I ILOT SLOOE %
06ding Permit
City Surcharge
Plumbing
qn
VESTED DATE
Mechanical
THIS PERMIT AUTHORIZES 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
PERMIT APPUCATION: 180DAYS
PERMIT LIMIr I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review Plan Chk. Deposit
'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 Fire Inspection Receipt #
ALL CLAJMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. 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.0 Recording Fee Receipt #
I 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 This application Is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPL.OYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged in space provided.
WORKMEN'S COMPENSATIPJPIOU�ANCE AND RCW 18.27. OFFICIALS SIG ATUR DAT
R 17 1
DATE SIGNED
SIGNATU�E AFIOW OR (425) r
I - 4/4-- 4
71 e 7,; �
20 ATE
%7 V 771-02 RELEASED BY C
ATTENtION- EXT 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 YELLOW - 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
I I
z
0
1
0
171
--I -n
rn
ITI
0
—i (-)
0 C:
—4 F,
X rn
M Z
C) --I
C
Cn
o -n
n
--I
M
M M
0
0
0 M
C C/)
r. Cn
ITI 0
Z 17-
X
z
--i
3:
Cn
z
0
A
0
IT!
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ..................... . .
-FOUNDATION:
Footing ......................
Pie r/Porch,
Slab Insulation ..........
PLUMBING:
Underground .............
Rodgh-.in ...................
. ....... I Flhal . ......
Commercia
HEATING:
Gas Test ..................... '03
GasPiping .................
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 .................. ffiv\
Y-KI t
200 w
z
0
4
0
ITI