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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
U SE
ZONE E
JOB
ADDRESS
PERMIT EXPIRES
PERMIT
NUMBER
SUITEIAPT#
�5 612
.:2.Z -
Ale-1 / -6
/-7
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
MAILING ADDRESS
LID FEE S
.013V'
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Street Use Permit Rect'd
CITY
ZIP
TELEPHONE
EXISTING — PROPOSED
Inspection Aequi.red
Sidewalk Requ r d
E6'.)Inn nv/
I 75 &/ q0
REQUIRED DEDICATION— FT
Undotground
wiring required
NAME
METER SIZE
LINE SIZE
I
OF FIXTURES
I
PRV REQUIRED
YES 13 NO E3
ADDRESS
CITY ZIP ITELEPHONE
NAME
CBL#
W
0
ADDRESS
2�800
7101-tid
CITY
P�70
TELEPHONE — q7oc
IZ6 & 7,9 2
STATE LICENSE NUMBER
EXPIRATION DATE
CHECKED By
W14SW57S
9,7oocw
PROPERTY TM ACCOUNT PARCEL NO.
1:1 NEW
)!�,FIESIDENTIAL
PLUMBING / MECH
1:1 ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
[3 REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING CYDS FENCE X FT)
1:1 DEMOLISH
E3 TANK
OTHER
GARAGE
CARPORT
[3 RETAINING WALL FIRE SPRINKLER
ROCKERY FIRE ALARM
(TYPE OF USE. BUSINg$4
OR ACTIVrIy) EXPLAIN:
REMARKS
OWNER/Cl
ENGINEERING REVIEWED
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP I
13 NUMBER NUMBER OF CRITICAL
0
S1OF DWELLING AREAS
STORIES 1�7_ 1 UNITS NUMBER
DESCRIBE WORK TO BE DONE I
a--� n It I s ru r /,) a
L
eV 4 rr-� M A-V IVA 6
00 0
4T SOURCE GLAZING % LOT SLOPE %
ez 15 1 1
CHECK NO: I VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMITAPPLICATION: 160DAYS
PERMIT LIMIT! I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
N INTEREST. AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT HE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT., AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLAT ON OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN!S COMPENSATION INSURANCE AND RCW 18.27.
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D I PRC
REMARKS
CHECKED BY 17YPE
DATE
DATE
SHORELINE OR ADB# I INSPECTION BOND
LREO'D POSTED
11YES ONO 1$
SIGN AREA HEIGHT
At LOWED - PROPOSED I ALLOWED . PROPOSED
Lu
M
rL
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT URSIDE REAR
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B or L vent connectors
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Eon �ue�fngappiiancer,.41x
SPECIAL INSPECTION JAREA
REQUIRED 0 YES
OCCUPANT
GROUP �
OCCUPANT
LOAD
REMARKS I 'K,
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 9
VALUATION
Description
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 #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
(425)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.
F�l AL,1 SI N URE DLkTE
WAB/ N
E L DATV—
ATTENTION EX 1 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
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION%
Footing........... ..........
'Wall ...........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Cormercial Final ......
HEATING:
Gat Test .......... * ..........
ng ..................
Gas Pipi
Equipment .................
Comme.rc.iqIjF.jna4..`,..'.'
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
0000,
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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
LPERMIT EXPIRES
'USE PERMIT
ZONE NUMBER
JOB SUITE/APT#
ADDRESS
�je,l / �b L a V A:��
I'l,
/ /( 17
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
MAILING ADDRESS
4,16 � I
.0 �, .3
1'!,/
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Street use Permit Rsq'd
F—ITY ZIP ITELEPHONE
NAME
ADDRESS
CITY ZIP
ITELEPHONE
EXISTING — PROPOSED Inspection RequLred
Sidewalk Required
REQUIRED DEDICATION— FT underground
401,10 Wiring required
.17. 1 WE SIZE NO OF FIXTURES PRV REQUIRED
a
YES 13 NO 13 z
z
REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
NAME CBLN
WaL.(D (U)a51w(1k)1 :F/,mA
ADDRESS
2_E3oo Thor4dy1_-&__"
CITY ZIP TELEPHONE
S lep '(44 le So 4o 7,8 2- � /00
STATE LICENSE NUMBER EXPIRATION DATE
*24/(,/,O� '�p
W74Sq1457,5 qqj06Cd 4"w
PROPERTY TAX ACCOUNT PARCEL NO.
NEW ��RESIDENTIAL PLUMBING I MECH
ADDITION COMMERCIAL COMPLIANCE OR
13 CHANGE OF USE
REMODEL E] MULTIFAMILY SIGN
[3 REPAIR E3 GRADING
CYDS
FENCE X
( FT)
DEMOLISH TANK
OTHER
GARAGE RETAINING WALL
CARPORT ROCKERY
FIRE SPRINKLER
F RE ALARM
CrYPE OF USE, BU OR ACTIVITY) EXPLAIN:
NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
jn4ail s lia c
rl-� _,Z6-V V86eO
_BLIP
(Ro, Ono
f I . f -A
IlT* SOURCE GLAZING % LOT SLOPE %
CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMM 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 CLAJMS 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 CITYS 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 AUTHOnIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
BE
ENGINEERING
FIRE REVIEWED BY
DATE W
BE
W
ACCE"ED M.
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
BOND
REO'D
POSTED
OYES 13NO
$
SEPA REVIEW
_I
SIGN AREA
HEIGHT
COMPLETE
EXEMPT
ALLOWED
PROPOSED
ALLOWED
PROPOSED
EXP
I
I
,
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPCSED
FRONT SIDE REAR
FRONT UR SIDE REAR
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—LOf AREA FP_L7N_NING REVIEWED BY ____ DJE
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REQ't rtimlw 6r
L vetit C01mectOrs
CHECKED BY ITYP= I Cox — OCCUPANT
q]z GROUP �z
SPECIAL INSPECTION __rEA OCCUPANT
REQUIRED [] YES LOAD
REMARKS
PROGRESS INSPECIN�MFWU C 108/FINAL INSPECTION REG'D
L -
VALUATION
$
Description FEE Description FEE
Plan Check State Surchaarge
Building Permit City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt N
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt N
APPLICATION APPROVAL
CALL
This application Is not a permit until signed by the
Building official or I;Islher Deputy: and Fees are paid, and
FOR INSPECTIO14
receipt Is acknowledged In space provided.
FF16ALSSI N URE DATE
771-0220
'RELEASED BY DATIE,/
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
0 1 4/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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