20000187.pdfDATE RECEIVED
0-mmona�
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
IER NAME/NAME OF BUSINESS
, I I
Edth
CITY
NAME
CITY
NAME
C, Tp
ADDRESS
J-1/ /
TELEPHONE
[PERMIT
EXPIRES ol - 12-
...
PERMIT
240 1-87
ZONE
NUMBER
JOB
TI#
ADDRESS
fj'ITE/AP
PLAT NAMEISUBDIVISION NO,
LOT No.
LID NO,
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL
STREET MAP
EXISTING — PROPOSED
REOUtREDOEDICATtCN—
FT
METER SIZE
SIZE
NO, 01 FIXTURES
PEGUIR 0
J_.LINE
I
YEPRV
5 NO 0
--REMARKS
—.11—TRAO.TOR
R-PCINSIBLE FOR EROSION CONTROUDRAINAGE
w9v
_Jr FIRE IIEVIEVV�- By
DATE
-5 01 `0 1 't_Ls_—Z
—'1 -3 'v
j
I
VARIANCE OR GO
RELINE OR ADBN
INSPECTION
REGO
E3YE ONO
I 'BOND
OSTED
MATE LICENSE NUMBER
0
'A G V EW
BE I
-TE "T
COMPILE EXEMPT
MPLET
FALLOWSD�PRoposeD
----SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED , PROPOSED
ROPERTY TAX ACCOUNT7PARCEL NO,
2- -7
63 -1 (1:0
A
'�_ /
Exp
0 NEW
R<E.I.ENTIAL
LUMtSING
ILL.
LOT COVERAGE
LOW. P.EEG
11OU111111SETBA KS
FRONT SID RE A(FRr
E
pqo1ollD lT8ACKS 11,1
FRONT URSIDE PEAR
C] ADDITION
COMMERCIAL
0
COMPLIANCEOR
EOF USE
CHANGE OF USE
G
FIXING I
PROVIDED
LOT AREA
LOT All
PLANNING REVIEWED By DATE
Ee"REMODEL
0 APARTMENT
0 SIGN I
GEa D I
C] REPAIR
0 GRADING CYDS
n PENCE
X FT'
( — X FT)
A.KS
A Ks
n DEMOLISH
n TANK
E IT
ci OTHER
GARAGE r-1 RETAINING WALL 0 RENEWAL
EW
0 CARPORT
LAIN:
CHECKEDB
P
Ty'
N N
GROUP
ICIE 0 CORA)
NUMBER
U BE OF
OWELURN.
IICAL
EAS
AR'
SPECIAL I
AREA OCCUPANT
LOAD
OF
STORIES
UNITS
NUMBER
REQUIRED 0 YES
Dy.I.ES-.r;a-yONE
t-
REMARKS
p .. R.S..NSPECTo
P`RD.&SS INSPECTIONS
PER UBC 1081FINAL INSPECTION REO'
J J I r I 417h L-
I
PLAN CHECK FEE
HEAT SOURCE
LOT SLOPE %
BUILDING
�2 a i
r
PLAN CHECK NO:
r"T'D
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS EAMIT COVERS WORK TO
BE DONE ON pRWATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRAD;NGIFILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS . MARQUEES, ETC.) WILL REOUI RE
3 SEPARATE PERMISSION.
UACHARGE
PER IT APPLICATION: 180 DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WIT HIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERM MORE INFORMATION
-APPLICANT ON BEHALF OF HIS OR HER SPOUSE� HEIRS, ASSIGNS AND SUCCESOSS
ENG. INSPECTION FEE
IN INTEREST AGREES TO:NDEMNIFY. DEFEND AND HOL D HARMLESS THE CITY OF
AND
LANDSCAPING
FFICIALS EMPLOYEES, AND AGENTS FROM ANY
INSPECTION FEE
'ECTLYOR INDIRECTLY
PERMIT SHALL NOT BE
IF ANY CITY CADMAN E
PLAN CHECK DEPOSIT
ROINA
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
0
CALL
TION. AND DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOY
OF WASHINGTON RELATING TO
FOR iNSPECTI,
IN VIOl_ATII`N OF THE LABOR CODE OF THE STATE
0
WORKMEN 'S COMPENSATION INSURANCE AND RCW 18.27.
7
(425)
771 0220
EXT 333
ATTENTION
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. LEC SECTION 109
FAX
�198
VALUATION I FEE
Thil IPPlil,_ I, , paf�jj by Iho
BuIdiq 011i-I ' _�."D.pbty: .�d F 110 p1lb. ,d
''pl i. ,%—Ildgld m SP PIOWdZd�
I;CIASIGMATURi DA E
ELEA$ED By
ORIGINAL - FILE YELLOW INSPECTOR
PINK - OWNER GOLD - ASSESSOR
z
m
a m
c
MO
0
80
c
m IT!
z
IC)
ca
0
-n
mm
0
0
C
c co
M 0
z
z
0
m
FRAME IS LESS CLEAR THAN TAIS NOTICE
NOTI.
CE: IF THE DOCUMENT IN THIS
IT IS DUE TO THE QUALITY OF THE DOCUMENT.
-- -----------
0310N SV IVAO,8ddv mlummEM
C13AI303a G-:3 le"y
Iny It/I Olt �od -V m
W1,11L 1W V1,09
V'tVl-yyflp 171V9
f/m - �v -j jjjnq3)� 31)VW NOI)Iddv
w Aollyy MOOK AWWW"ll '"j, NIJ)YYW Amw3 Jo Q�
'N 17tnhj. ','I ja vNvjfld V �j 't;s �;,pp - S,411 �jjr)jl VMA�
.Vwjqd V , M "V '14 .ti, H 40014 �'LQPIOI YA09VAWV
N ?714R-L "bw Ja
'14-0 lflL Qk 119-9S -Jv
40 37:0,06 Vih m U. 'Z� -N
0165 4a -jNnWNA7 '�-lq omy dq avb�M
TMO 'V Hul"� (71v� -Jo kh �"qd-j1v 'Nr)faww(n
p _011-6TW - 3fama GNV lOtWNO
9 'ONVJ 'P;S-ON— V03 3191SNOdS31d Sl 101%�
lk A 0 Nal;qvd 141v- dpotiv 4A, f 7MIA97 01
sl -9N :1)WINOZ
V3uinwu NOLLO�iciSivi
pot
1,0l qf
V - 401 Lot
a )AV
401
'All
mpd
qp VHI g
,,SRgq'Qj n.n 9
-00
Ik
FINAL PROJECT APPROVAL FORM
TO: -
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE-
---ENGMERING DIVISION DATE__!q_[3&0
PLANNING DIVISION DATE—
SITEADDRESS— lo.
PERIV11T 0__ULE3'�_ADB#________DATE INSPECTED —
DESCRIPTION OF WORK TO BE INSPECT
A field inspection was conducted to determine compliance with approved plans. Final approval denote I s, that
there are no objections from the above signed Department to the granting of:
Final approval of the described work
GRANT FINAL PROJECT APPROVAL
____GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
__yAILED FINAL INSPECTION - OUTSTANDING ISSUES,
2.
3.
—RE-INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
ocaprvl.doc.l:temp*bldg:fonns6/98
z
9,
0
0
M
C M 0
0
-40
0 C:
-4 C
= M
M z
0-4
-Z
0
n
M M
a
0
0
q
C
M 0
Z r-
z
z
M
_7
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ............
Pier/Porch .................
Retainlrig Wall ...........
z
-4
Slab Insulation ..........
0
M
PLUMBING:
Underground
In
Rough -In ...............
0110
Commercial Final
-4 C)
0 C:
HEATING:
ID
Gas Test ..............
M Z;,
10-1
i
a
Gas Piping .............
LP - 400
Equipment
comrnerc at Final:
0 -n
EXTERIOR SHEATHING
M M
NAILING ..........................
0
.0 17n
FRAMING ...............
ca:
FIRST FLOOR FRAMING
M C)�
z
INSULATION _ ................
Floor Insulation
Wall Insulation ...........
Z!
I
Ceiling Insulation
SHEETROCK NAILING
Z�
SPECIAL INSPECTION
ITI
MISCELLANEOUS
FINAL APPROVAL FOR
VVI 'z
OCCUPANCY
- - — ------- 7
x -Nl�
PERMITEXPIRES 943-
... PERMIT
CITY OF EDMONDS ZONE S-/' NUMBER 210187
CONSTRUCTION PERMIT APPLICATION jOB CBS UITVAPT�.
ADDS
OWNER NAMEINAME OF BUStN Ss PLAT NAMEISUBDIViSION NO, LOT
LIO FEE S
MAILING ADDRESS
7 W#,gj ?/
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PRCPOSED�
REOUIRED DEDICATION— FT —
0
P.— R , d 0
0
0
0
C
CITY ZIP
'I g 0 �TELEPHONE
E—dm
Ice&
NAME
METER SIZE I LINE SIZE NO- OF FIXTURES
'Rl EQUIREO
YES 0 NO 0
ADDRESS
REMARKS
OWNSAICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP
TELEPHONE
N NAME
ME
c 's
IDDA
ENGINEERING REVIEWEDIDATE
m SS
s-
WA L4
FIRE REVIEWED By DATE
z
1
z
0
M
0 rn
c:
C)
0
0
c
-4 C
3: m
-4 :
2
r
65
0 n
Cl ZIP
TY
0 Z_#ITELEPHONE
*ZJ-- 7 37-
VARIANCIS .. CID
SHORELINE OR ADSX
INSPECTION
0 YREUD
ES 0 NO
BOND
POSTED
EXPIRATION LATE
LI ;sT // p
6 14� TO#
E�7
... L— .1
SERA REVI EW
COMPLETE I EXEMPT
SIGN AREA
ALLOWED I PROPOSED
HEIGHT
ALLOWID'..., PROPOS D
PROPERTY TAX ACCOUNT RCEL NO.
7 -1 633 o n -s- elir()
NK-DENTIAL 'J�r, PLUMBING
C3 ADDITION C] COMMERCIAL c3 C MPLIANCEOR
C ANGE OF USE
APARTMENT f7
5KR MODEL SIGN
I
f GRADING I X M
�p FENCE
REPAIR X m
OTHER
DEMOLISH TANK -ac
GARAGE 0 RETAINING WALL
CARPORT 0 RENEV�L
RCCKERY
LOT COVE ACE
ALLOWED PROPOSED
REQUIRED SETBACKS (F7Fj
FRONT SIDE REAR
PROPOSED ETBACKS(FT)
FRONT URSIDE HEAR
—DATE
PA FIXING L
REDD DED
I PROVI
AREA
4
PI-AMNINGREVIEW11.1
ql'
i A
4�
Q O's mm v =to
(TYPE OF USE. SU INESS OR ACT—) EXPLAIN:
42--,
CHECKED BY
YP N TSUC ON
c s 0 PAN
GROUP
3
11
5
m m
0
c: mci)
mo
Z
NUMBER
OF
C' 2—.
WE 1.1%
S
UN'%
AREAS
N
FStPECIJ� NSPE
EGO �qR
YES
AREA OCCUPANT
LOAD
_STORIES
DESCRIBE WORK TO BE DONE
k/M. i�-
REMARKS
PROGRE 'AILA�' IONS PER UBC 168/FIN�' 'NSPFCT'nM RFn'D
PECT
f-win, a ra P) i,-,
In P Ift -fluel I 'ClAekid"e, -F�r 2=
z
Uf
VALUATION
FEE
PLAN CHECK FEE
z
LOT SLOPE I
BUILDING
PLAN CHECK NO:
PLUMBING
MECHANICAL
m
PERMIT AUTHORIZES ONLY THE WORK NOTED. TH S PERMIT COVERS WORK TO
R THOR'Z
THIS PE M
I:: BE DONE . PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
P E P
DO A IT AD
BE DON' ON R' V AT
DOMAIN CURES I S. MARQUEES, ETC.) WILL REOUIRE
2 SIDEWALKS, DRIVEWAY
EV
IN I U "S C
M 0 a S'
SEPARATE PERMISSION,
GRADINGWILL
RCHAAGS
PERMIT APPLICATION: 160 DAYS
P"T
ERMIT LIMIT'. 1 YEAR PROVIDED ORK IS STARTED WITHIN 100 DAYS
P P L R EA.-
SEE BACK O� PINK PERM11 FOR MORE INFORMATION
S CK
ENG. REVIEW FEES
rTHIS
�APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIR% ASSIGNS AND SUCCESORS
C LF OF
IN INTEREST. AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
I T� 'I FEES To'
i" S
2 EDMONDS, WASHINGTON, IT OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
I TON I
ALL CLAIMS FOR DAMAGES ' ATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
G
L LA M OFWH
m FROM THE ISSUANCE OF THIS PERMIT SSUANCE OF THIS PERMIT $HALL NOT a
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITYORDINANC&I
NOR LIMIT IN ANY WAY THE CITY'S ABIUTY TO ENFORCE ANY ORDINANCE
I. T Y W Y
ENG. INSPECTION FEE
LANDSCAPING
INS ECTION FEE
LAN ECK DE OSIT
REC IPT
TAL AMOUNT DUE
EA T�l�APPIII�ATION:T.AT,TbHEINFOP�AITION
I HERE Y ACKNOWLEDGE THAT I HAVE R 0 ZTT'00"
lIVEN I COSPECI AND THAT I AM THE OWNER. OR THE DULY AUTH RIZEO 2
T H E OWN E R, I AD RE E TO C OM PLY W ITH C I TY A N D STATE LAWS JASEOGN) VLATINBPECEM SLTORYUEC�
TiON AND IN DOING THE WORK AUTHORIZED THEREBY, NO PEI AL P
IN VIOLATION OF THE LABOR C DE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27,
T) 1111 SIGNED
APPLICATION APPR OVAL
Thl. M - P—" 'I" "F"d by lh'l�d
CALL ftll-g 014-W �' ��,[ F— — d.
0
Npt I, ..k.—'Ad'._ 'p— p—,d.d.
FOR INSPECTION
OF OAT
(425) /--
-3 -13-
771-0220 ATE
RELEASED By
MENTION
EXT 333
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- ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. LJBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR