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[PERMIT EXPIRES IKIJ4101_1
CITY OF EDMONDS
OSE PERMIT
ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS /1/0
SYITEIAPT#
OWNER
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LOT NO.
LID NO.
MAILING ADDRESS
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LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Pe'"t Required
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TELEPHONE
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NAME
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METER SIZE
LINE SIZE
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NO. OF FIXTURES
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PRV REQUIRED
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ADDRESS V
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP ITELEPHONE
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NAME
ICBL01
ADDRESS
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ZIP
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TELEPHONE
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STATEkJCENSE NUMBER
EXPIRATION DATE
BY
DA - \A - 34c i - 10 C-P PP 7:E2
lot-
2ROPERTY TAX ACCOUNT PARCEL NO.
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NEW
RESIDENTIAL
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ADDITION
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CHANGIE OF USE
REMODEL
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SIGN
REPAIR
GRADING FENCE
CYDS ( — X FT)
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL FIRE SPRINKLER
1:1 ROCKERY El FIRE ALARM
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE Lu
VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
REO'D POSTED
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SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
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PLAN CHECK NO: - - I VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 160DAYS
PERMIT LIMM I YEAR - PROVIDED WORK 15 STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORT
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 MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABIL17Y TO ENFORCE ANY ORDINANCE PROVISION.,
L
I HEREBY ACKNOWLEDGL 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 OF THE LABgQ CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSA)Q&QN�IURANCE AND RCW 18.27.
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SIGNATURE
(OWNER *AGE119". DATE SIGNED
1 1-711019 S
INSPECTIONS PER USC 1108/FINAL INSPECTION REO'D
$ ;—"^A �-
Descillption
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscape Insp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
771-0220
APPLICATION APPROVAL'
This application Is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt Is acknowledged In space provided.
0
IA GN DATE
dIFLEAsED
BY __13ATE
AITENTION M 13:33
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 !�INS'PEC'�OR
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:
Undergroun,d
.............
lj�
Rough -in ...................
Co'mmercial Fina
A ING:
T
Test
.",Gas .....................
'Gas Pl0lhdr,,
.................
;,,t;:Equipmentr� . . . . . . . . . . . . . .
�C&nriierciil Fi 1. ......
na,
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EXTERIOR G�HEATHING
NAILING ...................
FRA ................
MING
:'FIRST, FLOOR FRAMING...
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INSULATION ...................
Floor I sulation .........
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Wall Insulation .............
Ceiling Insulation
...
SHEETROCK NAILING
..
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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CITY OF EDMONDS
ZONE NUMBER
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CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS 1,4()
SyITE1APT#
2fO Id 70
OWNER NAMEINAME OF BUSINE88
e'hhr,hav, Thoi,5b
PLAT NAMEISUBDIVISION NO. LOT NO.*
LID NO.
15
MAILING ADDRESS
LID FEE $
1
(:�e
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_�T MAP,
PUBLIC RIGHT OF WAY PER OFFI611AL &E
YESCIP Approved
RW Permit Required
CITY ZIP TELEPHONE
I 'L�' I
EXIMING— PROPOSED
Street Use Pennh ROO
inspection R*qL&ed
Sidewslit Required
Lq4tiw"CL
REQUIRED DEDICATION— Fr
Undergrounct
Wiringrequirod CI
NAME
METER SIZE LINE ;jj7 NO. OF FIXTURES
PRV REQUIRED
Co Lqv�
YES El NO 13
R Ktu I
ADDRESS
&.0 6 q f-t4 Atxjoij
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY ZIP ELEPHONE
AIWUAAkTIAN�1�04 1419-00-670(,
NAME CBL#
SCALUJ" Lim
ENGINEERING REVIEWED BY
DATE
ADDRESS
2 I&L( PAS+
7W
CITY ZIP TELEPHONE
FIRE REVIEWED BY
DATE
L��ptKwvo& jq0 3& q?5-- -j-75_,jq00
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111c
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VARIANCE OR CLI SHORELINE OR ADBN INSPECTION BOND
STATE ILICENSE NUMBER EXPIRATION DATE REQ POSTED
113YES 1$
DA - V i - _Ss I — I o 5 Av 7-oq
ext"k
&CO
PROPERTY TAX ACCOUNT PARCEL NO. 40 j) q.T, V F — 00
SEPA REVIEW SIGN AREA
COMPLETE EXEMPT ALLOW ED P"
HEIGHT
ALLOWED PROPOSED
XP ,
NEW RESIDENTIAL PLUMBING/MECH
'
LOT COVERAGE REQUIRED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT URSIDE REAR
ADDITION COMMERCA L COMPLIANCEOR
N (I NC_
A14
CHANGE OF USE
REMODEL mui.TIFAmiLy SIGN
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PARKING LOT AREA PLANNING REVIEWED BY, DATE
REOD PROVIDED
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11140 1 5101
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GRADING � CYDS FENCE
REPAIR X Fr)
_
REMARKS
OTHER
DEMOLISH TANK
RE
[]..GARAGE, TAINING WALL FRE SPRINKLER
0
CARPORT ROCKERY FIRE ALARM
4,&,.
(TYPE OF USE, BU§INESS"OR ACTIV" EXPLAIN:
Pieb F-40 FFI 66--e-,
NUMBER NUMBER OF CRITICAL
OF DWELL NG AREAS
RIES UNITS NUMBER
DESCRIBE WORK TO BE D014E
A DC A4 ISIA)� UAlt, 1A)F lt'L_ 000)e
A DO 0_01WIP04 C>OAL j D&MO tv
HEAT SOURCE G �N I LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTV ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS'
PERMIT LIMIT! I YEAR - PROVIDED WORK 15 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 OnDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVE 15 CORFIECT� AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE MER. 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 OF THE LABgkCODE OF THE STATE OF WASHINGTON RELATING TO
WORKMENS COMPENSA
,30UJ,NSPRANCE AND RCW 18.27.
SIGNATURE (OWNER OKA09halif DATE SIGNED
-7 0
CHECKED BY I PE OF R CTION CODE, CGUPf
GROUP
SPECIALINSPE ION AREA OCCUR
LOAD
REQUIRED [3 YES
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPEC
$ 7— N t, A -
Plan Check
Bui Iding Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
F�E E
Description
State Surcharge
City Surcharge
Plan Chk, Deposit
Receipt #
Total Amt. Due
Recelot #
REO'D.
IVA
WAR
APPLICATION APPROVAL
This appilcallon Is not a permit until signed by the
CALL Building Official or histhat Deputy: and Res are paid, and
R INSPECTION receipt Is acknowledged In space provided.
'. .0 0 N -DATE
IAO �IA
%-FAr- 5)
771-0220 —REPAsED BY dATE
r I
ATTENTION '' EXT 1 3 1 V �/ I,, . , " /-
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
RIGINAL-FILE YELLOW -'INSPECTO
PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
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