20050742.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAMEINAME OF BUSINE
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NUMBER
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AESCRIBE WORK TO BE DONIm,
PERMIT EXPIRES
PERMIT
UMBER
10.
ADORESS10-i 0, o - '5 t -
FLAT NAMEISUd.ION NO LOT NO LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
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REQUIRED DEDICATION FT U=11111�1111_
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PRV RECHIRED
YES 13 NO C!
REMARKS
OWNEMCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED By DATE
VARIANCE R C. SHORELINE ORQ�81 INSPEC I N SERA
REGO
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cAi,_ ZONE SIGN AREA, HEIGHT
WAIVER 13 1 A"."O. _E
STUDY 13 t`41A 9-N ?. - I N 1A I -a-- I z
LOT COVERAGE REQUIRED SET8 CK HIT) P OPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FIR NT UPSIDE REAR
.)o /.I N IS' 1131 15' N D C)/1 fA "1'61-6
C.DPARKING A I P1.ANNI1GR1VEwE?.Y DATE
PROVIDED LOTARE
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T)jFF IONSTRUCTION I CODE 0 CUPANT
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SPECIAL INSPECTION I CONSULTANT IAG�;,7
REQUIRED 13 yes I OCCUIN J I
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Description
De s c r IT
to
FEE
Description
FEE
P n C h a c
State Surcharge
VESTE DATE
_HFAT SOURCE LOT SLOPE% VESTED DATE
P in
Building Permit
'd
,47
city surcharge
PLAN CHECK NO: CS - ?SLJ
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in I IT
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Base Fee
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THIS PERMIT AUTHORIZES GINLY THE WORK NOTE THIS PERMIT COVERS WORK TO
T
Mechanical
M echari-S'
G ad
Grading
Ing.
BE DONE ON PRIVATE PROPERTY ONLY. ANY ONSTRUCTtON ON THE PUBIC
D IVE I L
E ONMAIN JCURBS, SIDEWALKS, DR WAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSIOW
PERMIT APPLICATION: SEE ECDC 19.00.0051A�(51
R Via w
Engr. Review
Inspection
Engr. Inspection
SEE B PERMIT LIMIT. SEE ECDC 19.00.005Ajt6l
SEE BACK OF PINK PERMIT FOR MORE INFORMATIQN
'APPLICANT, ON BEHALF 01 HIS Oil HER SPOUIE, 1111111, ASSIGNS A"O SUCCESSORS
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Fire Review
7-..7GoP.S,,
IN INTEREST, AGREES TO INDEMNIFY, 0 FEND AND HOLD HARMLESS THE CITY OF
EDMONDS , WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt III
DIRECTLY N RECTLY
ALL CLAIMS F R DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDI.ECTLY
. __ B.ALL HOT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
LBndscapeInSPr
Total Amt. Due -o5
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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Recording Fee
I Receipt # 2141t I
INEREBYAC NOWLEDGE THAT I HAVE REA. THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE OULY AUTHORIZED AGENT OF
T,,,s VpP.. r., . p.—I N4 O.q_ b, I .
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
Off,,W,, -he, DIP.ty Ild p,dd
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
P—dd
IN VIOLATION
WORKMEN'S COMPENS�ffNCIE AND NOW 13.27.
RE DATE
NT�, I I DATE SIGNED
(425)
idga= I (21S010,"T__
771-0220
RELEASE. BY
ATTENTION
EXT. 1333
tAk
ITISUNLAWFULTOUSEOROCCUPYA BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
ORIGINAL -FILE - YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. USC109 I IBC110 I IRC110.
PINK -OWNER - GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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CEIVED
JUL 0 8 2905
CITY COPY PERMIT COUNTER
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION: V
Footing ..............
wall ..............
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Pier/Porch ...............
0
Retaining Wall
Slab Insulation ..........
—i -n
PLUMBING:
M
C:
Underground
In
0
0
Rough -in ...................
C:
Commercial Final
M
IT
HEATING:
z
GasTest ....................
'Gas Piping
0 -n
-n ;a
Equipment .................
x 9
M M
Commercial Final
a Y)
0
EXTERIOR SHEATHING
0 M
NAILING ..........................
Q 0
FRAMING ........................
Z
FIRST FLOOR FRAMING
;a
INSULATION ...................
>
z
Floor Insulation
-4
3:
Wall Insulation ...........
z
Ceiling Insulation
SHEETROCK NAILING
0
M
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..............
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