20000004.pdfDATE RECEIVED
I IPERMITEXPIRES
CITY OF EDMONDS
USE P RMIT
ZONE N'UMBER '-()'0 ON
JOB SUITE/APTI
ADDRESS
CONSTRUCTION PERMIT APPLICATION
at�NLRNAMEINAME OF BUS NESS
PL.AT NAMEISUBOIVISION NO,
LOT NO,
LDN
T_
/bn�O�Y (kild
EE S
L�C'O
MAIUNGADDR SS
E3
'RA4
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
00
I
5-o 112 (As+ . Lso
EXISTING — PROPOSED
d
cl
CITY ZIP
owls 01TELEP
RECUIREDDEDICATiON— FT
NAME
METER SIZE
LINE SIZE
XTURES
PRY REQUIRED
-Yoe- (f�-L
I
YES 0 NO 13
AODRAS
42w2y icl -7 --)o' Ll Ll D, A� UJ f,4
REM KS
NER/CONTRACTOR RESPONSIBLE FOR EROSION CONTR01-1DRAIN GE
ENGINEERING REVIEW501DATE
ADDRESS
AtAAm-
m
FIRE REVIEWED BY DATE
ZIP
Sal 144- urt_
dly
VARIANCE OF CU
111OPELINIE OR ACE1
_q#_ Z6,9
INSP CTICI
RE
0 YE.QL(-o
BOND
POSTE
—D
STATE JtENSE NUMBER EXPIRATION
s kN 4111
11
�b
CHECKED
Q3
C SERA REVIEW
Co. EXEMPT
EXP
SIGN AREA
PROPOSE
ALLOWED 0
HEIGHT OPOSED
ALLOWED PH
PROPERTY JX ACCOUNT PAACEL NO.
it, in
NEW C3 RESIDENTIAL PLUMBING I MECH
LOT COVERAGE
AL SED
REOUIRED SETBACKS IT
FRONT SIDE REAR
PROPOSED SETBACKS (FT)
FRONT UR SIDE EAR
JK COMMERCIAL C MPLIANCE OR
El ADDITION CHANGE OF USE
[3 REMODEL APARTMENT SIGN
RE
DED
0 REPAIR GRADING CYDS F NCE
0
0 DEMOLISH TANK C3 OTHER
'ARAGE RETAKIFN.RING WALL RENEWAL
ARI.RT 80C
p
_ClG
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKEDOY
ITYPEOF ONTTRUCjTON
IJ
]CODE I CROUP
0 ZA��
NUMBER
OF
STORIES
IU"IER 11
WELL N.
UNITS
CRITICAL
AREAS
NUMBER
SPECIALEIDNSPECTOR
!REOU R E] YES JAIRIA
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG'
+D VC&ACe-
AbS has 10-1�
---VALUATION
FEE
OK FEE
PLAN CHECK FEE
PLAIN
L 0 T S L 0 P E '
HEAT SOURCE GLAZING I LOT SLOPE %
BUILDING
E S T E D A T E
PLAN CHECK 140,t�C� 11ESTED DATE
PLUMBING
M 'CHANCAL
R M I T C 0 V E R S W 0 R K T a
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
T 0 N H T E P U - L I C
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
RAO 'G
GRADINGIFILL
T C W L L E U I
DOMAIN (CURBS. SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.1 WILL REQUIRE
S'
__ ----
SEPARATE PERMISSIOW
7
STATE SURCHARGE
'AT. ""C"
PERMITAPPLICATI N: ISO DAYS
:
W I T N A Y S
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEE$
E REVIEW
R A T I N
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
AN S UC ESORS
ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
S 'G
�S
W
END INSPECTION FEE
;APPLICANT.
H A R ES E T. E ITy OF
N INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY I
ANY AND
FROM ANY AND
R.
'76
jh
'D AGENT S
EDMONDS. WASHINGTON, iTS OFFICIALS. E PLOYESS. AND AGENTS
3 DIRECT LY OF IND' RECTLY
ALL LAIMSFORDA AGESOFWHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
C V
S ERM A NOT E
I P IT S. LL
THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
RECEIPT
RE EIFT
C
PLAN CHECK DEPOSIT
m FROM THE ISSUANCE OF
T o, ANY-ITY OF., NANCE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Y OF., C P G I
0 NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
RE
RECEIPT
C
TOTAL AMOUNT DUE
2
I HERESY ACKNOWLEDGE THAT I HAVE READ T111S APPLICATICIN: THAT THE INFORMATION
APPLICATION APPROVAL
A PLI AT
I I Y UT�.RZE. G T . -
GIVEN CORRECT: AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT Or
S
T�hlsofp[�Pli,'j,. 1 . p.1 u�jil �igl.d �y
'.7
P
RUC
,S R ULATI . C. T U.
E. N N S R
THEOWNER. I AGREE TOCOMPLY WITH CITY AND STATE LAWS REGULATING CONST
E F OY U
OY'D
EMPL E
CAL L
CALL
B"I d, g .,hj,jD.puty:lldF d—d
RED WILL
TION;ANDIN ONG THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE
I TO
A I TON HE L T,
THE STATE OF WASHINGTON RELATING TO
0 1 Sp
FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF
WORKMEN'S COMPENSATION INSURANCE AND RCW 10.27.
OF�lc SIG RE DATE
T S, ED
E (OWNERQWXMT-J� A E �D
5
(425)
111 2- ou
7711 0
-0220
REL ASEP By
_jq'�
""MMT10�N
A
EXT 333
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFL
ORIGINAL VILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
519.
z
0
rn
'4 '5
vi
0 m
cc
m 0
-q 0
0 C
X M
M z
CIO
0 -n
n
m m
0
0
c:
c
M 0
Z
X
z
rj)
z
9
0
IT!
FINAL PROMCI APPROVAe
TO:
DATE:
MEMO TO: PEMET COORDINATOR, BUILDING DIVISION
FROM: _----YIRE DEPARTMENT DATE.
P z
ENGINEERING DIVISION DATE—
LANNING DIVISION DATE-(e�0 P
M
M
PROM CT L->)r C-- L-a 0
-40
0C
SITE ADDRESS
MM
z
PERI,nT Qcr)c�4 ... ADB#_-----DATE INSPECTED— io i
DESCRIPTION OF WORK TO BE INSPECTED— Q
0
n
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: M M
0
0
inal approval of the described work 02 q.
9 co
rn 0
erformance Bonds associated with the project may be released Z
M
>
GRANT FINAL PROJECT APPROVAL z I
M
CD
—GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED z
0
0
1 M
FINAL INSPECTION - OUTSTANDING ISSUES
2.
3.
________RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
ocaprvi.doc.l:temp:bldg:fonns6/98
0,
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall..........................
PledPorch .................
Retalnirig Wall ...........
Slab ln�ulatlon ..........
PLUMBING:
Underground .............
Rough -in ..........
Commercial Final
HEATING:
Gas Test ....................
Gas Piping .................
Equipment ..................
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ..................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Calling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
1,9D
OCCUPANCY ..................
43
z
0
0
ITI
rn.
ITI 0
00
C
z
M
ITI Z
,0-4
—Z
0 -n
-n;o
-4-
3:9 - "
m rn
0
0 F
n
M 0
Z
zi
0)
m
rn
7_ 7
FT
ATE RECEIVED
PERMIT EXPIRES 2
U USE
ZONE
S2
PERMIT
CITY OF EDMONDS
NUMBER
SUITE ITI
�U
CONSTRUCTION PERMIT APPLICATION ADDRESS
JILR NAMENAME OF BUSINESS
�C,
PLAT NAMEISU
L NAMEI
h
B DIVISION NO.
D
LOT NO*
LON
LID FEE S
ILING ADDRESS
(90 lq(c7A,,A'.S,0
PUBLIC RIGHT
G
EXISTING
TIN
OF WAY PER OFFICIAL STREET MAP
PROPOSED—
P 0 POSE
R
111CP Al.1
0
SM-1 B-110 0
u. ...d
.Y ZIP
ONE
JoLcrds 11 -1 REQUIRED OED(CATIO — W"% ,
Y7LI - - TNo_
MEIER 51ZE UNE S111 0, PRV BEGUIRID
ME YES Cl NO E3
a Cea4��
I REMARKS
'10
0
I ADD SEE
L)
�A
T ZIP
_�q II, ('a I _I Tl(
Seke A
\, -�� kN
4),
s
c
ROPERTY
T PARCEL NO.
NEW
E] RESIDENTIAL
C3 LVMBING I MECH
ADDITION
COMMERCIAL
C MPLIANCEOR
13 COHANGEOFUSE
REMODEL
APARTMENT
I.-
*
REPAIR
FENCE
o GRADING Cyos X FT)
0 DEMOLISH
TANK
OTHER
GA:RkE
0 CARPORT
r-1 RETAINING WALL
F.CXERV�
C] RENEWAL
TIVITY) EXPI.AIN:
NUMBER
NUMISR OF
TAI.CA.L
E
OF
OWELL N.
AR .
STO IES
UNITS
NU . E
DESCRIBE WORK TO BE
DONE
z
FIRE REVIEVVEDBY
DATE
IT!
VARIANCE OR CU
SHORELINE OR AOBN
INSPECTION
BOND
I P
74'?
_g!RND
.2!TE.
m
M a
SERA REVIEW
C M PT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
EX
_7
I
�E. SETBACKS FT,
PROP.r
0
0 c
-1
'm
LOT COVERAGE
REOUIRED SETBACKS (F7)
A��CISED
FRONT SIDE BEAR
FRONT L.EGE BEAR
Z
i
z
c,: _z
PARKING LOT
IDED
IDED
AREA
NNING FIEVIEVVE0
El
Faa_�
L Lloci�
11
X4
OlICKEDBY JTYPEOl
-TPECIALtNSPECTOR
REQUIRED C] YES
REMARKS
a
UBC 1081FINAL
0 CUPANT
GROUP
0 m
n
m A
0
C cl)
9 co
M 0
EQ'D
5
M
z
--I
FI)
z
\n 0
VALUATION FEE d
0
PLAN CHECK FEE
HEAT SOURCE LOT SLOPE% B ILDING
PLAN CHECK N06IIC� PLUMBING
IVESTED DATE MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRU CTION ON THE PUBLIC GRADINGIFILL
SE C.
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUE , ET I, WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATI N: 180 DAYS
3 PERMIT LIMIT. I YEAR . PROVIDED WORK IS STARTED WITHIN 100 DAYS END. REVIEW FEES
SEE SAC K OF PINK PERMIT FOR MORE INFORMATION NO. INSPECTION FEE
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDISWAS"INGTOM ITS OFF CIALS. E PL.YEES, AND AGENTS FRO. ANY AND
M
A A.Ei OFWKATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY RECE I -A Issi
LLC
"'. F.RGA. IS
FROM THE ISSUANCE OF THIS PERMIT. SUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
T OF ANY CITY ORDINANCE
DEEMEDT MODIFY, WAIVE OR REDUCE ANY R QUIREMEN
NOR LIMIT otN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' PT
TOTAL AMOUNT DUE
E THAT I HAVE READ THI S APPLICATION THAT 7 HE INFORMATtON APPLICATION APPROVAL
I HEREBY ACKNOWLEDC
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DL)rLYRAUTHoHfZED AGENT OF
T' u�ld vg b, II,.
AND STATE W ECULATING C D
THE OWNER LA� � ONSTRUC
WILL BE EMPLOYE
CALL
E�.I d1la ��d F111 .,, PlId.
IN IIA.H.ETEIT'g,.MPL�UWITH�CITY
TIOM AND " R.�A TH �EDTHEREBY. NO PERSON
CObE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
1PI 11 11--d9ld sp.., plll.d.d.
IN VIOLATION OF THE LABOR
WORKMEN S COMPENSATION INSURANCE AND RCW 27�
OFFI SSIG TUBE DATE
Sr E (OWNS AG
DATES NED
(425)
1-.4
7 -0220
71
RELE S DBY 0 TE
EXT 333
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTAJETT,,W471-0221
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIF
-
ORIGINAL FILE YELLOW INSPECTOR
A FINAL
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER GOLD - ASSESSOR