20000196.pdf�EXPIRES�
[PE--o
USE
__RMIT
PERMIT
!2()()j-jb
IDS
CITY OF EDMONDS
'ON'
ME p(l
NUMBER
I
CONSTRUCTION PERMIT APPLICATJIONADDRESS
JOB
JOB
6 15,-j
AtA)
SUITFJAPTR
OWNER NAMEINAME OF SUB A -SS
el,4 Ho&,w c,
PLAT NAME/SUBDIVISION NO.
PL
I LOT 11,
L 11
It-
k
D FEE S
L:D
IF MAILING ADDRESS
It
-r�f I pa /�,VFH , .5" ,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
------
11 0— PAOPOSED�
TES 1ARI.e.
A. P.Ine, F-Ind
R.n..e
els— 1,
CITY ZIP ITELIPHONE
(4915) 771- 5Z5-6-&
F -110 —
REQUIRED DEDICATION—
'U LINE SIZE
FT —
NO.OFIIXTURII
L..,in,und
Yew,,
PAV REQUIRED
NAME
EMARKS
I
YEE C3 No 0
CITY
NAME
_tFlE FIEVIEWEDRY
DATE
STATE LICENSE NUMB IT l.__. I --------- -
0 NO
/9_0
1, A
SEPAREVIEW
SIGN AREA
HEIGHT
ALLOWED PjPOSED
POP TY X ACCOUNT PARCEL NO,
-73 000 L/
CC) MPLI71 I EXEMPT
ALLOWED PROPOSED
(10"1 41
0
-o' vir
,
- 000-Ro
EXF
NEW RESIDENTIAL
FnI P MBINGIMECH
T COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FO PROPOSED SETBACKS IFTI
FRONT SIDE REAR FRONT UR 'BE RUR
M I]
Fj ADDITION COMMERCIAL
!0APARTMENT
o COMPLIANCEOR
CHANGE OF USE
tVA
5 0
A PLANNING REV ED BY DATE
0 REMODEL
SIGN
PARKING
EaD PROVIDED
REaD PROVIDED
LOTAR
0 REPAIR o GRADING CYDS
F NOE
0 X _FT,
AR S
14
0 DEMOLISH 0 TANK
o OTHER
�p
\J
o GARAGE 0 R NINGVIALL
CARPORT RZE
0 RENEWAL
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
CHECKEDBY
TYPEOFCON R CTION
col 0 CUPANT
GROUP
N
NUMBER Ull" OF
CWELUN.
"A'
,
CAI`E S�'.
SPECI ALINIPE OR
AREA
OCCUPANT
LOAD
OF UNIT.
STORIES
A UN.
REQUIRED OCYTES
DESCRIBE WORK TO BEGONE
PLAN CHECK FEE
HEAT SO E GLAZING %
LOT SLOPE %
BUILDING
PLAN CHECK NO:
VESTED DATE
PLUMBING
"'St
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 ( ..... SIDEWALKSI DRIVEWAYS, MARQUEES, ETC-) WILL REQUIRE
SEPARATE PERMISSION
URCHARGE
PE MIT APPLICATI Th ISO DAYS
PERMIT LIMIT. I YEARRPROVIDEDWOO K IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK Ol� PINK PERMIT FROR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS� ASSIGNS AND SUCGISORS
....... _110- IFEE
IN INTEREST, AGREES TO :NDEMNIFY. DEFEND AND HOLD 144RMLESS THE CITY OF
ANY AND
LANDSCAPING
�DMONDS, WASHINGTON, TO OFFICIALS. EMPLOYEES, AND AGENTS FROM
DIRECTLYOR INDIRECTLY
INSPECTION FEE
ALLCI.IIIMS FOR DAMAGES OFINHATEVER NATURE. ARISING
THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
I FROM THE ISSUA CE OF
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN AN Y WAYTHECITY' S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
DUSLY AU=IZED AGENT OF
THE OWNE,86
GIVEN IS IT ECT, AND THAT I AM
SOTATHE
IAGRlETl=.PLYWIlHCI At NSTRUC
THE OW CO A LAW AEG 4 Go -
NE R
CALL
- E
TION; AN. IN DO AD THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOY D
OF WASHINGTON RELATING TO
FOR INSPECTI,
IN VIOLATION OF THE LABOR CODE F THE STATE
WORKMEN'S COMPENSATIO NS CE AND RCW 18.27,
U J�j
N
N D
(425)
n
(1
771 -0220
EXT 333
ATTENTION
IT IS UNLAWFUL TO US - O-j _U'Y A U'L.'NG OR STRUCTURE UNTIL
E
771-0221
A FINAL INSPECTION HAS . EN A.1 AND APPROVAL OR A CERTIFI-
E�
CATE OF OCCUPANCY HAS EEN GRANTED. UBC SECTION 109
FAX
5198
VALUATION I FEE
PTW�— If I �) t> —
��* 8 �9,010)
APPLICATION APPROVAL
This lePlile's, �s he, . phnnIt tenth signed bY the
Building Offilill , thsMor Depny: Ind Fee, in Paid. end
_0ith is Fin—IthIgId in P.. puld.d.
FFII ATUR' DATE
C "&K
S SIG ATU"` -?//-3 k
ELEAS By IT DAtE
-�1161b&
ORIGINAL FILE YZU` EbTOR
I �R LLOW ''NSP
PINK - OWNER - GOLD . A.SEE..R
z
0
m
3:
m
rn 0
0
0
c:
Z
cl)
0
--I
m M
a
0
o
c:
A
Z
;u
z
z
9 : ,
0
FINAL PROJECT APPROYALYDIRM
TO:�
DATE:—
MEMOTO: PERMIT COOpDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DATE—�
FROM:
z
9
ENGINEERING DIVISION DATE�
3
M
___yLANNING DIVISION DATE-2 I �/Z
In
C
en
PROJECT—E4
m 0
0
80
SITE ADDRES
C
--i K
M M
M Z
9 & _DATEINSPECTED
ADB#-2sa-12�---
jo -i
z
PERNRT
-4
DESCRIPTION OF WORK TO BE INSPECTED
CD
0 -n
as conducted to determine compliance with approved plans Final approval denotes that
A field inspection e signed Department to the granting of
there are no obiections from the abov
m M
0 rn
VFinal approval of the described work
0,
OM
C: a)
erformance Bonds associated with the Plroj-t msY be released
In 0
Z r-
FINAL PROJECT APPROVAL
z
a:
_--jGRANT
FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
co
z
GRANT
0
Mily 2000
In
ECTION OUTSTANDING ISSUES I (�s
AILED FINAL INSP C17Y op CTR.
r
2.
3.
OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
---RE -INSPECTED
ocaprvl.doc.l:temp.bldg:forms6/98
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACK$ .....................
FOUNDATION:
Footing......................
wait
Pler/porch .................
Retainirig Wall ...........
0!
-4
Slab Insulation ..........
M"
PLUMBING:
Underground ............. -i -n.
5 �N'
Rough -In
M
Commercial Final M
0
_4 0
HEATING:
IT11
Gas Test .................... M ZC 1 R,
Gas Piping .................
Equipment .................
0 MR
Commercial Final 0, MR
EXTERIOR SHEATHING
IT!
NAILING ..........................
—FRAMING, ........................ 0 R
C: W:
FIRST FLOOR FRAMING... C m
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Z
Coiling Insulation
SHEETROCK NAILING
z
SPECIAL INSPECTION 0.
0
MISCELLANEOUS ..........
FINAL APPROVAL FOR 8�(30
OCCUPANCY ..................
. owfti�-
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMENAME OF BUSINESS
. .........
MAILING ADDRESS
-7-HIP"D
c
CITY ZIP
g ITIIII"IN177/
_5Z5_
'rbxmlb,�� Feod-
NAME
A RGSS
DD=
CITY ZIP ITEIEINONI
le
EXPIRATION D CF
f 6 00
PERMIT EXPIREP
'ISE
PERMIT 2o—,G:-LG6�/
ZONE
NUMBER
JOB
ADDRESS 11,6 -5y-d Avt�A),
]TEMPT#
L ot
PLAT NAME/SUBDIVISI.N .0.
LOTW
LID NO,
LID FEE S
-Appl-0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
7ESCP
11
00
EXISTING - PROPOSED�
-P.- B-s- 0
0
REQUIRED DEDICATION-
PT
METER SIZE
INE EIZ
L e
NO- OF MIXTURES
PIV BOOMED
ryE R
D
YES 0 NO 0
I ZMARNS-TA-TOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
FIRE REVIEWED By
DATE
ST ATE LICENSE NUMBER
-
%- z000 -
arfES CJNO L_Lo
c, I ? C--V,�) 2 -!) L
K-
SEPARSVIEW
co MPLETI I EXEMPT
E. v,,'
SIGN AREA
ALLOWI PROPOSED
ED
I I c, 41 —
HEIGHT
ALLOW D PROPOSED
E
. I
110 4 .1,q�
PRolyj TAX7C-COUNTPARCEL NO. I
3 - 000-,201— 0 00Y
7,
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
NEW 0 RESIDENTIAL C] PLUM81NG / MECH
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UPSIDE REAR
ADDITION C MERCIAL C3 COMPLIANCE OR
CHANGE OF USE
[�MAPARTMENT
I
NA
-FO
PARKING
RE
N71NG REVIEW BY DATE
LOT AR77L7N
I
07 TM T 0 SIGN
0 REMO DE �L�7
EM
0 FENCE
REPAIR GRADING CYDS X FT)
REMAR.�KS�., '-1
14
n DEMOLISH n TANK o OTHER
o GARAGE n RETAINING WALL 0 RENEWAL
CARPORT
(TYPE OF USE. BUSINES;��CTIVITY) lXPI.Aft
CHICKED lY
TYPE OF CONITRU TI.N
-C-
0 PANT
GROUP
NUMBER NUM5EROF
CH11 I AL
A S
� PECIAEINSPECTOR
�PE.ML,
AREA
F MELLING
0 2
STORIES UN.-
N BER
I EQU R � 0 YES
LOAD
- FCU
DESCRIBE WORK To BE DONE
REMA KS
PROrRPSS INSPECTIONS PER URIC 1081FINAL INSPECTION REO
PLAN CHECK FEE
HEAT SOURCE GLAZING I LOT SLOPE %
BUILDING
PLUMBING
DATE
NO:
VESTED
PLAN CHECK
MECHANICAL
THIS PERMli-AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DON, ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
GRADINriFILL
DOMAIN 'CURBS, SIDEWALKS, DRIVEWAYS , MARQUEES, ETC,) WILL REQUIRE
URCHARGE
SEPARATE PEOISSION.
PERMIT APPLICATIO ; 180 DAYS
PERMIT LIMIT 1 YEAR* ROVIDED WORK IS STARTED WITHIN 180DAYS
P
END REVIEW FEES
SEEBACK OF PINK PERMIT FOR MORE INFOR ATION
P POP HIS OR HEFt SPOUSE. HEIRS, ASSIGNS AND SUCCFSORS
PLTIE`,AENT�,oANlR`EE`SLTO
ENG. INSPECTION FEE
;�N INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
TS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
INSPECTION FEE
FWHATEV5R NATURE, ARISING DIRECTLYOR INDIRECTLY
BE
R
PERMIT SHALL NOT
FANY CITY ORDINANCE
PLAN CHECK DEPOSIT
RDIMANCE PROVISION.'
R
TOTAL AMOUNT DU
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE KIP RMATION
GIVEN RRECT, AND THAT I AM THE OWNE R� OR THE DI ��-Y AUTHORIZED AGENT OF
I' Co ONSTRUC-
AND STATE LAWS REd%TING C
CALL
THE OWN 'R' I AGREE TO COMPLY WITH CIT
TION; AND DIN THE WORK AUTHORIZED THEREBY, No PERSON ILLBEEMPLOYED
IN D ING TO
GTHE
FOR INSPECTION
IN VIOLATION OF LABOR COG E�F THE STATE OF WASHINGTON RELAT
WORKMEN'S COMPENSATIO%NSUFA E AND RCW 18.27,
IGN
(425)
,;OWNER T IDA
oa_
r
7,71-0220
EXT 333
ATfENTION
IT IS UNLAWFUL TO USE OR - y A BUL NG OR STRUCTURE UNTIL
771-0221
FINAL NSPECTION HAS 131I)ECNUlplA.E AN(D)'APPROVAL OR,A CERTIFI�
A
CAT : OFIOCCUPANCY HAS BEEN GRANTED. UBC SECTION 09
F
FAX
m
/ I le) (-,> —
APPI ATION APPROVAL
um" �v -
jj�, olf,i.1 ., hj� O.puly: -d F- .. P.,d.
PLP, wl.dg.� i� �p p,-d.d.
ORIGINAL.FILE YELLOW-INE-1
PINK - OWNER GOLD - ASSESSOR
z
0
i 3:
a m
m
0
0
c
3: M
M z
0 -n
x m m
0
o F.
C (D
c co)
0
z
Z
m