910802.pdfy
r r_ , r.,, I„J,Ai 1,.1. fifr f'v.'{, Ill,.I .! .. »S.r,. �!Pt r,!'
a
SE PERMIT
• 911 `R i
CITY . . . L
u NUMBER
CONSTRUCTION PERMIT ..
,3{
w,l
OWNER
• • Ali
�J
_e
Le
xl •MAILING ADDRESS
fit
y
I PUBLICWAYPEROFFICIAL..•.. ■
riPROPOSED
• ■
IEXISTING REQUIRED DEDICATION
a �' ■
• i 1
it
ft1it
it.
jl ADDRESS-i;
n iF
4=ii it
TELEPHONE f • j
? its
.li
X1931 • .
ADDRESS ::
.cA
•NO.OF FIXTURES
Ilka`STATE LICENSE NUMBER!I
IT
SIGN AREA SEPA REVIEW
COM
ALLOWED PROPOSED XEMPT
-iasements l,
Legal es ripti Fool of Property include a I
iSHORELINE
to
t t •EXP
ii I.ARIANCCE •
tni !'a
,
y,l � tit
ySETBACKS FEET
oil
•COVERAGE
4
r
•SIDE REAR
s!t Tax Account Parcel
is
■
Y ■ .� ii
AD
DIALTER COMMERCIAL MECHANICAL
■
I REPAIR El SIGN
■ ■
. yr-... .. '. :e ..I r . A -
lot.'. ,.:...rn f .....
lit- GRADING FENCE Ant
f 1!
DEMOLISH ■ • ■ it
tolh
REMODELSPECIAL UPANCY
GARAGE OCCU
TI: REQUIRED
of YES
F WOOD STOVE/ RETAINING WALL/ it:
-i`I INSERT ROCKERY El RENEWAL IREMARKS
• • •. ACTIVITY) 1
Sly NUMBER • • . EXPLAIN;
NUMBER • • 1$
ut:DWELLING
F ST
i r^,UNITS ii
like • IL
rrr.' u
1
* i � iy, i fl ,: 11.dr� t e. .tli : v. .. .. ,u, 1... ?+.. .nx:,.,,, - ..:.rn•;. i,.v . o s tr ' tj1+f..T���
t.
tool PLUMBING
Plan Check PIO. MECHANICAL
This Permit covers work to be done on private property ONLY. GRADING/FILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission. STATE SURCHARGE
Permit Application: 180 Days
STORM DRAINAGE FEE
Permit Limit: 1 Year" Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and Ell INSPECTION FEE
in successors in interest, agrees to indemnify, defend and hold
'LOU harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
iwhatever nature, arising directly or indirectly from the issuance PLAN CHECK DEPOSIT
0 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 City's ability to enforce any ordinance TOTAL AMOUNT DUE
provision."
I hereby acknowledge that 1 have read this application; that the
information given is correct; and that I am the owner, or the duly ATTENTION
authorized agent of the owner. I agree to comply with city and THIS PERMIT
state laws regulating construction; and in doing the work authoriz- AUTHORIZES
ed thereby, no person will be employed In violation of the Labor ONLY THE
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED
tion Insurance. INSPECTION
�IG�SIGNATff E (0 NER OF AGENT) DATE SIGNED} DEPARTMENT
TY OF
6C�-O l0 it _ l / EDIMONDS
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, UBC
CHAPTER 3.
102.87
CHAPTER 3.
1na.a7
CALL FOR
INSPECTION
771=3202
1 ,
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.
FFI I 'S SIGNA RE DA E
ELEASED a DATE
ORIGINAL
— File
YELLOW
— Inspector
PINK —
Owner
GOLD —
Assessor 4
PINK — Owner GOLD — Assessor
r:
C
CITY OF EDMONDS M ZONE
CONSTRUCTION PERMIT APPLItO]VATION JOB
OWNER NAME/NAME OF BUSINESS ADDRESS
PERMIT
NUMBER
Cx t f-k Y "UML UC0UN4YIIUN L:HtCK SUBDIVISION°NO.
OILING ADDRESS \'
t 0 1 ( �� PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
rY I VIP TELEPHONE UMBER
^ EXISTING REQUIRED DEDICATION
ME PROPOSED
REMARKS
CITY ZIP (TELEPHONE NUMBER
NAME
Se.1 :A��ccS
ADDRESS
CITY ZIP TELEPHONE NUMBER
REMARKS
STATE LICENSE NUMBER
piCe ription of Property - include all easements
•
ixrgal Desc
17
ilb i;
�Y Ilj
• r41 •
u VARIANCE OR CU
ui
w
0
q a SETBACKS - FEET
Co
uy FRONT SIDE
Tax AccountNo.
,A
In
■
, El
DENTIAL PLUMBINGilk
as ...�ADDIALTER El •MECHANICAL
r1i
APT. BLDG.
REPAIR SIGN
MMERCIAL
GRADING FENCE
DEMOLISH CYDEl
IMIL
POOL
_•,
REM
• •O.00AR },
INN
91
SUITE/APT N
to NO,
TESCP Approved ❑
RW Permit Required ❑ >
Street Use Permit Req'd O
Inspection Required ❑
Sidewalk Required ❑ (D
z
LU
w
z
z
w
s•F
REVIEW, BY
NO. OF FIXTURES
1 4
SEPAREVIEW
•: •
•'• • COMPLETE
SHORELINE N
EXP
PLANNING REVIEW BY GATE
HEIGHT LOT COVERAGE i r
Z
REAR Z
a.
TYPE OF CONSTRUCTION f
tr . A/ R�--.. •OCCUP
WOOD STOVE/ RETAINING WALL/ ❑YES GROUP
INSERT ROCKERY El RENEWAL REMARKS em
' z
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN; PROGRESS INSPECTIONS PER UBC 305
a_
2
U
�i, a • NUMbth Ul-
DWELLINGyl
�. ,.UNITS
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
ICA.• •
' rj3
1 � � r 'Ja ia,d,, 4Y. e, vxy r r� A 3k'+.LNft , .n �.tv:, .f •. :- cur+ >t.,..r.
4 O IAY
alcj 10926M
PLAN CHECK FEE
/ BUILDING
(P S
rjt.44,e4�1 �{, PLUMBING
Plan Check NO. MECHANICAL
This Permit covers work to be done on private property ONLY. GRADING/FILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission. STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year'- Provided Work Is -,Started Within 180 Days STORM DRAINAGE FEE ,
"Applicant, on behalf of his or her spouse, heirs, assigns and ENG. INSPECTION FEE '
N successors 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
i whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
° nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that the
Information given is correct Akd•thaf I am-ihe owner, or�,ENTION
authorized agent of the owner. I agree to comply with city and THIS PERMIT
state laws regulating construction; and in doing tMe work authoriz, AUTHORIZES
ed thereby, no person will be employed In violation of the Labor ONLY THE
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED
r lion Insurance. wsPEcnoN
SIG E (OWNER O AGENT) DATE SIGNED DEPARTMENT
^_ 1 ^ p' CITY OF
lu.- � T l• 1(/ t EDMONDS
OCCUPANr'
LOAD 71
APPLICATION APPROVAL 114,
3
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.
IQIAJ,'S SIGNATJrJRE DATE
N,�`}rv�hr"17'.,:fi.G:':�I�.Iy�?`iit�k 3;}.'4xi?:N'{�itf Y{r �it�:lvitt77kS�'ait;4fj�l�.tt;�k�l�; }yyh (r 1s��<f ^�l>�4z"�f'^ar•w4',i ..st�!YY'�G,(�1ii ;�id 'r
ft iFh �, Y. T• i � •• ATTENTION
• • .
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771 =3202 ORIGINAL File YELLOW Inspector. i
A CERTIFICATE OF OCCUPANCY
CHAPTER 3,
r 8
' Owner GOLDAssessor
�.r \
$kl
A ,
0 T ICE
t.
TO PERMITTEE AND/OR OWNER
❑ PARTIAL APPROVAL
,
❑ VIOLATION K„ C
CORRECTIONS REQUIRED
PERMIT 9
NUMBER L < '
p :
JOB ADDRESS % f C ® � p
1V
❑ PNO ERMIT AAIT STOP ND MAKE WORK COMPLY WITH REM
BUIVE LD NG LAWUCHON OR S*
CONSTRUCTION IS NOT IN ACCORDANCE WITH APPROVED PLANS
j ❑AND PERMIT - STOP WORK. MAKE EXISTING WORK COMPLY WITH t
APPROVED PLANS AND PERMIT OR REMOVE IT.
r; ❑ STOP WORK - UNTIL AUTHORIZED TO CONTINUE BY INSPECTOR.
CORRECTIONS LISTED BELOW MUST BE MADE BEFORE WORK CAN 1114
BE APPROVED,
j ❑ WORK DESCRIBED BELOW HAS BEEN INSPECTED AND IS APPROVED.
CONTACT INSPECTOR AND Ud
RECALL FOR INSPECTION.
❑ ARRANGE FOR APPOINTMENT•
4
S ;
,
Ilk ;P
Si
ikk
THE ACTIONS OR CORRECTIONS INDICATED ABOVE ARE REQUIRED WITHIN
i DAYS OR PENALTIES IMPOSED BY LAW MAY BE APPLIED.
FOR INSPECTIONS CALL: 771-3202•
- PL
❑ BUILDING DIV.
❑ PUBLIC WORKS
INSPECTOR
CITY OF DATE ❑ FIRE DEPT.
a
EDMONDS.
�;. Htkk
r,
Gas Test
Gas Piping .. .
r Equipment
CF
�.
FRAMING ...... .. ..
14
INSULATION ............
SHEETROCK NAILING ... b
SPECIAL INSPECTION ...
FINAL APPROVAL ..--'�� ��. •9�
FOR OCCUPANCY
I' •
tk
It
kkf
a
i
,� ...
�,.