20000003.pdfDATE RECEIVED
I Cl q PERMIT EXPIRES
US
USE PERMIT
P E R M
N
S
CITY OF EDMONDS
NUMBER_7-"",'
U M E
IC AT
CONSTRUCTION PERMIT APPLICATION
ION_
9
'Ao0`CFESS 2 P.
AD D R E S `
2
ITEIAPT.
as,
,
OWNER NAME/NAMEOFBU I
So L, N o Ij 17- �' Is v -I- L_ 0 c
"A a ' I '0�_
V 0
PLAT NAMEISUBDIVISION NO.
P T N A M 'S U
'7
LOT No
LOT
LID NO.
U. FEE S
MAILING ADDRESS
P
AY E
PUBLIC RIGHT OF WAY PER OFFICIAL
P I G L I P H T 0 F W
T .
STREET MAP
TREElo.A
LET P
'S
(3
9 IV 3L9- -7 lb-kl- 4L)o
sIIL..PqII 0
CITY ZIP
-
T S
EXISTING — PROPOSGD�
N ,0
E X PR POSED
S
R
.1-
U. X.u.
�TELEPHONI
F
T'. _ T
N _ FT
REQUIRED DEDICATION FT —
A E U R E D E 'C A
.5TER SIZE
.,Z'
LINE SIZE
NO. OF FIXTURES
NO OF
P V REQUIRED
NAME
V�OFISIMA
YES 0 NO 0
- K.
I: ADDRESS
REMARKS
R EMA
.NS,.,E FOR ER SION C.NTN.0UDRMNA.E
OWNERICONTRAOTOR RESPONSIBLE FOR EROSION CON TF[HuuumAINAGE
OWNEWCONTRACT.R RESP.N .,E FOR EFO,
0
�_A 0
CITY
CITY
tufccc-x-,
REVIEWEDIDATE
tNAME,,
ENGINEERING
ADDRESS
DATE
—TIP
V, WED BY
FIRE REVIEWED BY
ITY
C CITY
TELEPHONE
9 90?,0
VARIANCE OR CU
SH
BOND
STATE LICENSE NUMBER E-IFIATION DATE
STED
U) I 6c-
SEPA REVIEW
SIGNAR5A
HEIGHT
fEL NO
pROFEAWU tboUg
061/ oz
'OMrE EXEMPT
AL PROPOSED
ALLOWED 'D
tp
LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SETBACKS IT
0 NEW
RESIDENTIAL
0 PLUMBING MECH
ALLOWED PROPOSED
���R
FRONT UPSIDE REAR
0 ADDITION
COMMERCIAL
o COMPLANCE R
CHANGE OF USE
PARKING
IEWED
BY 0 e
0 REMODEL
APARTMENT
1A SIGN
ID
11 ED
GRADING CYOS 0 FENCE
C] REPAIR I _x _,T)
C] DEMOLISH TANK cl OTHER
GARAGE
C3 CARPORT 0=2! WALL RENEWAL
op (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY
TYPE OF CONSTRUCTION
ICOD
0 CUPANT
GROUP
i AIW I c /I-
5
if t- I -v i
NUM E OF
ITICA
��-,vk-,_
AREA
I
OCCUPANT
NUMBER
OF
U a 10
A RA %
�tL
SPECIAL INSPECTOR
REQUIRED
LOAD
o STORIES
C] YES
DESCRIBE WORK TO BE DONEC 0/f:5 7AU C 7- e
REMARKS
OGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG
VALUATION I FEE
PLAN CHECK FEE
HEAT SOURCE GLAZING
LOT SLOPE I
I ILOING
PLAN CHECK No: q
�VESTEDDATI
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CURBS. SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: � YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
' -
ENG. REVIEW FEES
S EE BACK OF PINK PERMIT FOR MORE INFORMATION
L SIGNS AND SUCCESORS
;AFPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. AS
N E-ALF OF H
TO I DEPEND AND HOLD HARMLESS THE CITY OF
_F
ENG. INSPECTION FEE
S :NDEMNIFY.
I I T S
N NTEREST. AGREE
0 ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANYAND
WASHINGTON
1 1671
EDMONDS, -
ALLCILAIMS FOR DAMA-EiI OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
m CLA, Fo AD
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
I W CE ANY REQUIREMENT OF ANY CITY ORDINANC
Y . MVE 0
DEEMED TO MODI Fy. WAIVE OR REDD
C PROVISION"
E
RECEIPT
0 'T IN Y LITY TO ENFORCE ANY ORDINAN
OR LIMI AYTHE YSABI
T IN ANY , Y THEC,
NOR L AN A
TOTAL AMOUNT DUE
0
I HEREBY ACKNOWLEDGE THAT AVE R5ACHIS AppTl CATIULN, I TA HAT T"lINF RNIATION
AGENT OF
AP
GIVEN 15 CORRECT, AND THAT: AH M THE OWNER 0. E D UTHORIZED
CITY AN6 STATE LAW S REGULATING CONSTRUC-
CALL
T,
THE OWNER. I AGREE TO COMPLY WITH
TION AND IN THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
d, g 01
DOING
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE ANDRCW IS .27.
OFF] IA
SIGNED
(425)TE
771-0220
R EA EDI
-
EXT 333
W OCCUPY A BUILDING OR STRUCTURE UNTIL
�FILA USE OR
MADE AND APPROVAL OR,A CERTIFI
771-0221
NAN N HAS BEEN
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 09
FAX
5198
5-76 1 7 9' __L�
PLICATION AP
�!R AL
d ""I"
P.,
111 hill- DOPItY: I jd
.pt I, .,k,.Wlodg.d � 1g, P-ld-
[GINAL'FILE YELLOW INSPECTOR
PINK OWNER GOLD -ASSESSOR
z
0
0 m
c
rn
0
80
c q.
rn
M Z
10--i � I
c
0
n
-4
m M
0 V5
0 F
0 n
cm 0)
I
M 0
Z f-
Z
z
9
0
m
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE —
ENGINEERING DIVISION DATE-
-���PLANNING DIVISION DATE
PROJECT a
SITE ADD]
PERMIT #__2:�M_MaADB#—DATE INSPECTED —
DESCRIPTION OF WORK TO BE INSPECT
A field inspection was conducted to determine compliance with approved plans. Final approval. denotes that
there are no objections from the above signed Department to the granting of
/--Yinal approval of the described work
—performance Bonds associated with the project may be released
—!!!�—GRANT FINAL PROJECT APPROVAL
_GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
I .
_-YAILED FINAL INSPECTION - OUTSTANDING ISSUES
1.
2.
3.
_RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
ocaprvi.doc.l:temp-.bldg:forms6/98
01
7M
SM,
rr, 0!
0 01
M
rz�
ca
'0
mTW
J-
0
0 n
�md
Z::
a
m
J.-
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch ................. .
Z'
Retainlrig Wall ...........
0
Slab Insulation ..........
1171
PLUMBING:
-1 n
-4
Underground
M
Rough -in ...................
M 0
0
-10
'A
1
Commercial Final
HEATING:
M z
Gas Test ....................
a 2
Gas Piping .................
Equipment .................
0 -n
n
Commercial Final
J
:C r.
rn 171
EXTERIOR SHEATHING
a ro
NAILING ..........................
0
0 f7
n
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
z
Wall Insulation
:7
Ceiling Insulation
SHEETROCK NAILING
z
SPECIAL INSPECTION
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...............
FAR
I
"Zln I � -7
PERMIT E�XPIRE
PERMIT
ZoN 200003,/
CITY OF EDMONDS NUMBER
'S
joa UITE/APTI,
LICATION jA.D.. R E S S
CONSTRUCTION PERMIT APPLICATION ADDRESS -7& 1"' kK
_7:]
.
PI -AT NAMEIsUBDIVIStON N LID NO�
T NAMEI�U.D V to
OWNER NAMIINAME OF IUSINES� oc"e-l-j- As: .0,
So V
vm z IZ-0 LID FEE
MAILING ADDRE s TESG
PUELIC RIGHT OF WAY PER OFFICIAL STREET MAP D
[3
EXIST No - PROPOSED- o
CITY
RE.UIRE.DEDI�-'.�- IT
'0 . o
No o' FIXTURES PH REQUIRED
j NAME ES NO C3
Y E3
�jj AUk+iTFRr-T5
[REMARK !:ff=
S
ADDRESS OWNERICONTRACTOR RESPONSIBLE FOR EROSION rONTROUDRAINAGE
�- % oz,- s, 09 (1 ja �0-- A-7 0
CITY ZIP ELEPHONE
4UA,rr V'�-"wj 651 3(00 IL/7-lq 0311/
NAME WlLC6)1-1 ENGINEERING
ADDRESS
FIRE REVIEWED BY
CITY ZIP TELEPHONE
J) I L e- Q C- * 111V 6Z 0 12- - I Cl 1-4-11
RO P E R�Tt; tUUdgf E L NO k2l�
60102-
NEW
R
I
[3 PLUMBING I MECH
ADDITION
AL
C:::,A
�
C MPLIANCEOR
cl HANDS OF USE
REMODEL
0 APARTMENT
% SIGN
C3 REPAIR
GRADING CIDS
E] 5 NCS
( _ X FT)
DEMOLISH
TANK
Ei OTHER
ci GARAGE
CARPORT
ROCKE
C] RETAINE WAI.L..
FENEV0AL
(TYPE OF USE. BUSINESS
OR ACTIVITY) FLT N
NUMBER
ICAL
OF
N-UMLL'N'
R' EAS
STORIES
UNIT S
NUMBER
DESCRIBE WORK TO
BE DONE
60w5maer
DATE
VARIANCE OR CU
INSPECTION
RE -1)
I BOND
POSTED
YES (3NO
$ERA REVIEW
COMPe� TE EXEMPT
SIGN AREA
AUffED PROPOSED
HEIGHT D
ALLOWED
I
�OP�l
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PHOP�OTS6D SETBACKSJFT.)
ALLOWED PROPOSED
FRONI,_$IDE-.BFAFt
FRON UPSIDE REAR
�.AT2
-----]TYPE OF C,
CHECKED By ONSTA
CODE I OCCUPANT
crj�j GROUP
CCUPA17T
rSPECIAL INSPEC- R FL.AD
ED
REQUIRED n Y5S
R HE",
EMARKS
Q lNQPPC-.TinNS PER UEIC 10BIFINAL INSPECTION REQ
I /U/17/2- /- 1-4 " , L— I gl'- t- " 141z'_ 44- 1
VALUATION I FEE
PLAN CHECK FEE
HEAT SOURCE
BUILDING
PLAN CHECK NO: 4,o5
q . L:E. DATE
PLUMBING
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 MA GLEES, ETC.) WILL REQUIRE
SEPARATE PER�IssIGN.
MECHANICAL
GRADINGIFILL
:STATE SURCHARGE
PERMIT APPLICATION: IIIDDAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK iS STARTED WITHIN 18D DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. REVIEW FEES
2
j
10
ENG. INSPECTION FEE
'APPLICANT ON BEHALF OF HIS OR HER SPOUSS. HEIRS. ASSiGNS AND SUCCGSORS
IN S EST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
DINT FIS 6-71
E MOND WASHINGTON, ITSOFFICIALS, EMPLOYEEI.ANq AGENTS FROM ANYAND '=;wl
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE 01 THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMI I IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- TOTAL AMOUNT DUE
RECEIPT
R CEIPT
AT � HAVE READ THIS APPLICATION. THAT THE INFORMATION
I HEREBY ACKNOWLEDGE TH APPLICATION APPROVAL
GIVEN IS CORAECT� AND THAT A THE OWNER. OR THE DULY AUTHORIZED AGENT OF
M
THE OWNER I AGREE TO C WITH CIT AND STATE LAWS REGULATING CONSTRUC- CALL B. It, ol Iffil It "I- P.-I
o"PLY Y hw- D.Puly - I-- p"d. "d
TION, AND IN DOING THE WORK AUTHORIZEDTH�REBY, No PERS N WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION -I. p-Id.d.
ORKMEN'S COMPENSATION INSURANCE AND RCW 'a .27. oFlI IAL NA , 1 4-
4All NER IN E SIGNED (425)
771--0220 1 A ED7Y DATE
TI N' EXT 333
T'
S RLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 YELLOW INSPECTOR
rFINAL INSPE CT ON HAS BEEN MADE AND APPROVAL OR A CERTIFI ,CRIGINAL� FILE
NA, .P r
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR
,,mS
Z
0
:j -'
0
m
a m
IT! 0
80
c
m m
z
ca
0-11
m m
0
0
0
c
M C)
Z r-
z
9
35