20030727.pdfDATE RECEIVED 6
CITY OF EDMONDS
CONST RUCTION PERMIT APPLICATION
Ell VAME/NAME OF BUSINESS
I % . - . ( A A
15
MAILING ADDRESS
CITY
we
NAME
ADDRESS
CITY
ADDRESS
'M
ZIP I TELEPHONE
ZIP
M,
Li I
LICENSE NUMBER
EXPIRATION D
'ITY TAX ACCOUNT PARCEL NO.
NEW
RESIDENTIAL 9f
PLUMB
[j ADDITION
0 COMMERCIAL
o
COMPL
CHANG
REMODEL
APARTMENT 0
SIGN
REPAIR
GRADING o
FENCE
CYDS
I
[3 DEMOLISH
TANK
OTHER
Ej GARAGE
CARPORT
o RETAINING WALL
ROCKERY
REN
ITYRE-OF USE. BUSINESS OR ACTIVIM EXPLAIN:
I \2 4 C
NUMBER
NUMBER OF
L
CRITICAL
OF
03VWELLING
AREAS
RTORIES
Ut
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
Ai km tit -e-
15Le. Wo -&bA
PERMIT EXPIRES
'USE
ZONE
PERMIT
-7
NUMBER
/---
JOB
ADDRESS
SUiTE/AP`T#
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP ApWoved
RW Parmit Required
EXISTING
Street Use Peffnh Req'd
Sidewalk Required
REQUIREC Dq)%Vffl�-� Vent-CQ&MeCtPr%M;.—,u,dsd
METER Sl
Ereadulriidwl
NeImbiarrmigEsp
I mileu ""
ileated si)*A�& UMC 831
. 1.01 E 3 NO
D 1UU0 C-76,1S 12) Ila
1. U
HEAT SOURCE T---6LAZING % LOT SLOPE %
PLAN 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 (CUR1111% SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPILICATION. 180 DAYS
PERMIT ILIMM I YEAR - PROVIDED WORK IS STAKMD WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
1APPLICAIA 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
R THE ISSUANCE OF TH13 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 AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEffS COMPENSATI CE AND RCW 18.27.
1qjNATL*E (OWN O;Rflz;6 DATE SIGNED
1XI , T, ff IF ., n
REMARKS
REVMD/D
r ATE
Electrical Pe t from
FIRE REVII&VED BY ---DATE W
........ .. cc
M
VARIANCE OR CU SHORELINE OR ADBO INSPECTION PBOND
REO'D OSTED
13 YES 13 NO
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE . EXEMPT ALLOWED . PROPOSED ALLOWED . PROPOSED
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS SEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
10/01
CHECKED BY JTYPF21061�N _I OCCUPANT Ll r;7
GROUP
ff/ T-2
SPECIAL INSPECTbRTAREA OCCUPANT
REQUIRED [j YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REaD
VALLIATION $
FEE
Plan Check
Building
Plumbing
FEE
Mechanical
Grading
Recording Fee
Engr. Review
City Surcharge_
Engr. Inspection
State Surcharge
Traffic Mitigation
Plan Chk Deposit
Fire Review
Receipt #
Fire Inspection
Total Amount Due
LandscapainspT.
r7Receij 7t#
APPLICATION APPROVAL
CALL
This application is not a permit unfil signed by the
Building Official or his/her Deputy: and Fees are paid. and
FOR INSPECTION
receipt Is acknowledged In space provided.
OFFICIALS SIG'AxURE TE
(425)
e�IK
71ii z
771-0220
RELEASED BY DATE
Off 1333
771-0221
ORIGINAL - FILE - YELLOW - INSPECTOR
FAX
PINK - OWNER - GOLD - ASSESSOR
I
1�(
I NOR
z
0
M
rn
%J r-
Ic
M
z
V)
0 -TI
M M
0 rn
a
En
z
M
ING I MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS IFT)
FRONT SIDE REAR
I
PROPOSED SETBACKS (FT)
FRONT LIRSIDE REAR
I
IANCE OR
E OF USE
PARKING
LOT AREA
PLANNING REVIEWED BY DATE
RECYD
PROVIDED
I
X _ FT)
REMARKS
EWAL
L 0 1
L It
I d,
t
It I,
41-1 RECORD OF INSPECTIONS
LINSPECTOR DATE APPROVED
I d, I
r
L L to
SETBACKS L r
T
tL
I F
L. FOUNDA"nONO
'd
L� L Footing
L
0 0 a 0 G 9 d 6 4 0 6 0 0 a 6 6 0 V 0 S 6 9
Wall L
L I p L I r
Pier/Porch
0 1
L
Ret3lnln Wall m
9
I LN J44 L. JIL
I t I - ' L L
d I L I
I r L �L L
L r slab Insulation ILI
IL,
9*8464 r
L,::. fL + L "I mni
L OSGOOD
PLUMBING*,
L 4 L I m
.1
ground m
Underi
F q I
I. le
r
n
L LIS r , Roughftl
PI L 0
ILI
L It L. Commei6lall Final L L L
' ' ' , L '
i� 'd nr I ;
L I HEATING@' L I
11, 4 'It' I III I L 6 .1 r, 1, 0 �L , 'Z I �fr I I- I I I I I
d I z
L L L MGM L L L 'r I W
I
L L L L 1 1. L L 'Gas Test.
L p I L I
+ L j
4
1, d I
LL 1. - . Gas Pipinq L t..
11 P. I L rf r L 4 . I t* r I
j 1; W11 II
I I r I. I . I Z
+ r . f I I L
�4or, S 0 L
dI I I I L L
I . . 1. . - ' L
4 1,
I I I . r _ L I r . L I I I I I , Z I L
Lp,
OWING L
r _'L r L nal, L I
L r 1 -1 r . r LCommercial FI L .. i,
I . . I L I
L t4
I r . L +
L EXTERIOR SHEATHING 4. 1 1. p
I r , d
L 6 .,1 NAILING Moslem c:
L
9 od 01 8'
4 j FRAMING
It
4 tI — I
t L L ' . , r I I -W I *
t I F1 4 r .1 . Lp j t,' 4
IRST�FLOOR FRAMING
I It I . . . . . . I 1 4 4
t
I t d d N%k
f
I :I It- INSULATION MONOSSON -
I p
IS I
000000
Floor Insulation
I . I . I. . I -
.4 L. I,+ �.N p
;s
111t. i tp._I!T1t 11, Wallrinsulation go; Oo 0 a 9 0 6 r
I'll 1: �� 'L 1 +1 .1 .+ I I I I .�I _._ L L I . ... L t. -
IV r ?p
A z
None,
4, 1 r Ceiling Insulation r r
II Ip r
t
Ir NAILING Goo, 4 1 0
SHEETROCK OGG r r to I L I, I lz,.
r r Ir M,L
I
:L r
L sea 4 r
SPECIAL INSPEcwnON r t 11
I I.. .
L I p
F r I. d
4 r SCELLANEOUS
M I
FINAL APPROVAL FOR
1, r
-OCCUPANCY
0
1 L
I I t . I
r r I Itd� r
L
7cP 7&1. r
Nn
ATE RECEIVED
Y 7ERMIT EXPIRES
IOFP
USE PERMIT
CITY OF EDMONDS ZONE
NUMBER
CONSTRUCTION PERMIT APPLICATION JOB sunVAPT#
ADDRESS
9AWER NAMEINAME Of� USINESS le
% it PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
Me �2" mwc±s:
MAILIN. 0% .. tati LID FEE 6
TFSW APPMV$d
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW ftM* Raq*W
1i Ave-, �6( 1* SU" U" PWMR Reld
CITY TELEPHONE EXISTING — PROPOSED wukw B
REQUIf&EDICAT
, j�W_=
IeAMDO&S q(�O?_Lp 1q2_S-69-Ha34-9 fi*," , _,& 0ni 01
ADDRESS
CITY
ZIP ITELEPHONE
t . I I IV--- __ _v - CBL,'
ADDRESS 4,zj j
Ob tain Electrical Permit frm
M
M
aw v,,( FIRE DATE
Zl� TELEPHONE Zi5r I Labor & Indus
Se az:� U LO I VARIANCE OR CU SHORELINE OR ADS# ' INSPECTION BOND
UATE LICENSE NUMBER EXPIRAnON DATE C POSTED
2 [3 YES 13 NO
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. ................... COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSEW',
:T-7 04� 1� 00 EXP
REQUIRED SETBACKS (Fr.)
LOT COVERAGE PROPOSED SET13ACKS (FT)
j3NEW RESIDENTIAL PLUMBING MECH ALLOWED PROPOSED FRO SIDE JR FRO L/R SIDE PAM
IK— Ix % *, "L 11 ( .
[j COMPLIANCE OR
13 ADDITION 0 COMMERCIAL CHANGE OF USE
PARKING LOT AREr INO SWEWED gY DATE
TIrA1111
REMODEL APARTMENT SIGN i� REQ`D I PROVIDED
REPAIR GRADING CYOS [3 FENCE
FT) REMARKS 7
C] DEMOLISH 0 TANK OTHER
4
GARAGE RETAINING WALL
CARPORT ROCKERY [3 RENEWAL
CIACKED By jTyp7n= I OCCUPANT
GROUP jg��
NUMBER NUMBER OF CRITICAL
'OF DWELLING AREAS SPECIAL INSPECTOR JAREA OCCUPANT
STC UNITS NUMBER REQUIRED LOAD
[3 YES
DESCRIBE WORK TO 13E I ONE
I wmmom
[I=
A&
fVALLIATION $
PER UBC I 08/FINAL INSPECTION RECVQ.
FEE
FEE
t0ak) CNI)XV-1-55-1
91PIN
Plan Check
---mo
HEAT SOURCE GLAZING % LOT SLOPE,t
Building
PLAN CHECK NO: VESTED DATE
Plumbing
Mec6anical
THIS PERMIT AUTINORRIES OMY THE WORK NoTm Two, PERmrT covESs WORK To
ft BE DOME ON P;UVATE PROP11M ONLY. ANV CONSTRUCTIOH ON THEI PUBLIC 1*
Grading
Recording Fee
DOMAIN (CURIBS, SIDEWAUUN DRIVEWAVS, MARQUEES, O'C.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
City Surcharge -cc
PERMITAPPUCA79ft ISO DAYS
PERMIT UMIM I YEM -PROVIDED WORK IS STARTED WITHIN 180DAYS
EngnInspection
State Surcharge
BER BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
;APPUCJkNT
N INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHIWTOk,1T8 OFtCIAa. EMPL6YEES, AND AGENTS FROM ANY AND
Fire RevleW
Receipt #
ALL CLANS r*R DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE 168UANCE OF THIS PERMIT. ISSUA14CE OF THIS PERMIT SHALL NOT BE
Fire Inspection
Total Amount Due
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY C17Y ORDINANCE
NOR LIMIT W ANY WAY THE CITYS AINLRY TO ENFORCE ANY ORDINANCE PROVISION."
Wm�
Landscapelnsp.
Receipt #
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
OMEN 18 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
TNs application is not a permit until signed by the
TION; AND IN DONG THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building OMclal or his/her Oeptity: and Fees are paid, and
receipt is acknovAedged in space provided.
WOPXUEN13 COMPEECE AND RCW 10.27. 1
OFFIC S11ZGTURE DftyTE
NATUIOE( SIGNED
(425)
_fl�z
771-0220
RELEASED BY DATt-
A717TENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORMINAL-FILE - YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FM
PINK - OWNER - GOLD - ASSESSOR
10/01
INNE
z
0
4
0
m
am
C
m
80
C
3� K
m m
z
0 _111
n
M M
065
8 Fn
C
M C)
z
9
0
m