20000272.pdf[PPE�RM�I�T�EXPIRES��
us, PERMIT
1027:4
CITY OF EDMONDS NUMBER
—
SUITUAPTN
CONSTRUCTION PERMIT APPLICATION 'AOBHESS
L4
074AII��IIZAIIN SS FLAT NAMEISUBDIVISION NO,
44 HA C.'50
"D No,
UD FEE S
7� �
M� ADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
0
CITY EXISTING — PROPOSED
ZIP PHONE q4q VC REQUIRED DEDICATION— FT �
C'02�3
t 2
U—N-
_JTEL
_jFW;jT=l FIXTURES
NAME
u \1 I-- REMARKS
PRY REQUUI D
YES E3 No 0
ADDRESS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP
_ AA!T��
ENGINEERING REVIEWEDIDATE
ADIDRISI
DATE
CITY ZIP TELEPHONE
—EXPIR.I.N
IANCE OR CU SHORELINE OR ADS# jN$pjC_TjoN I P BOND I
REOD
—1-0 By
STATE LICENSE NUMBER
:!2
SERA REVIEW SIGN AREA EIGHT
COIPL E EXEMPT LLOWED PROPOSED ALLOWED PROPOSED
11PROPERTY PARCEL NO.
47 z' - 0 (2 -
21 LY)3
EXP
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
t'aNEW K RESIDENTIAL 0 PLUMBINGIMECH
ALLOWED PROPOSED FRONT SIDE.. REAR FF T URSIDE HEAR
0 ADDITION 0 COMMERCIAL c3 COMPLIANCE OR
CHANGE OF USE
is 7D sy DATE
0 REMODEL C3 APARTMENT [3 SIGN
PARKING LOT AREA
REO'D PROVIDES 60
[3 REPAIR 0 GRADING CYGS 14 FE
X L(D FrI
A S
o OTHER
n DEMOLISH C3 TANK
0 GARAGE 0 RETAINING WALL 0 RENEWAL
CARPORT
ITYPE OF USE, BUSINE!!7ACTIVITYI EXPLAIN:
cHECKEDBY T EOFCWZTRUCTION Go"
-I,
NUMBER N E OF CAI TIDAL
ieel,4�_
SPECIAL INSPECTOR AREA
OF DWELLI G AREA S
LO ko
REQUIRES [3 YES
U NUMBER
STORIES U I
DESCRIBE WORK TO BE DO,F
REMARK'
PRO GRESS INSPECTIONS PER UBC 1081FINAL INSPE TION REQ'D 3.
Eg-f-CT cW1111;k ii�c
VALUATION
FEE
PLAN CHECK FEE
LOT SLOPE %
BUILDING W
ED DATE
PLUMBING
MECHANICAL
OTED PERMITCOVEA WORKTO
IERMIT AUTHORIZES ONLY THE WOSK NN
BUC
E DONE ON PRIVATE PROPERTY ONL . A YC6NISHTIRSUCTION ON THE PU U
MARQUEES, ETC.) WILL RED IRE
GA!
OMAIN (CURBS, SIDEWALKS, DRIVEWAYS,
:3 SEPARATE PERMISSION.
PERMIT APPLIUAIIUN:
m PERMIT LIMIT: I YEAR PROVIDED ORK tS*S'TA'R^TEt) WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK O� PINK PERMIT FDA MORE INFORMAIRON
;A PLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
P E CITY OF
FEND AND HOLD HARMLESS TH
NCEMN'C
ENG, INSPECTION FEE
LANDSCAPING
REST AGREE
N NTE `.T�o
Z eGMONOS.WASHtNGT , :T F, 12EEIOPLOY�ES, AND AGENTS FROM ANYAND
INSPECTION FEE
AL 1AGEiiOFWHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
- LCLAIMSFOR A
ISSUANCE OF THIS PERMIT SHALL NOT BE
RECEIPT
PLAN CHECK DEPOSIT 0
x FROM THE ISSUANCE OF THIS PERMIT
TO MODIFY, WAIVE OR SEDUCE ANY REQUIREMENTOF ANY CITY OROINANC Il
9 DEEMED
0 NOR LIMIT INANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,
RECEIPT i?
TOTAL AMOUNT DUE
PPL `"=TAH THE "'ORMATION
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS A I.C�A
UAT
0 THOR'ZE. A.
GIVEN I RRECTA THAT I AM TH1,0WIlE.116 FIT DUL
Co A CO�ENT OF
S NOC..,Ly.,,. STATE LAWS REGULATING STRUC�
Th. P—il P� 1.�. p.,d. nl
CALL
CALL D-%"Y��
IT
THE OWN I AGREE TO Y
ER HE WORK AUTHORIZED THEREBY, No PERSON WILL BE EMPLOYED
TION: AND IN DOING T
RELATING TO
Build,�g Olki-I
FOR INSPECTION ipt I, 1-1wD 90
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN'S �FPENSATION INSURANCE AND HOW 18,21.
N OAI E SIGNED
OFFICIALS SIGNATURE
(425)
_F21-60
771-0220 RELEA By OAT E
ATTENTION
EXT 333 6 z
L TO USE OR OCCUPY A BUILDING OR STR LICTU RE U NTI
L 771-0221
IT I S UNLAWFU
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW IN PECTOR
- ASSESSOR
A
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX PINK - OWNER GOLD
5�8
z
0
a m
c a i ,
m 0
80
C
-4
m m
c
E:
0
-4
ME . !�
mm
0
co Fn
c co
M 0,
Z
;a
z
z
0
m
FINAL PRWECT APPROVAL FORM
TO:
DATE: ---
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM:
-FIRE DEPARTMENT DATE_
L= ENGINEERING DIVISION DATE ///00
V m—"
PLANNING DIVISION DATE—
SITEADDRESS MTh1Mo(- Ar
PERMIT # ',26020 ----ADB#-DATE INSPECTED-�-�
DESCRIPTION OF WORK TO BE INSPECTED �P A A 117re
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:
--Final approval of the described work
erformance Bonds associated with the project may be released
—GRANT FINAL PROJECT APPROVAL
—GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
—FAILED FINAL INSPECTION - OUTSTANDING ISSUES
2.
3.
_RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
octiprvl.doc.l:temp:bldg:fomis6/98
z
9
0
m
5i
C: m
MO
0
80
C
-q K
mm
mz
0 -n
'n
m M
y 0)
0 r-
0 M
a 0)
9 ch
M 0
Z
-4
z
-4
M
W
z
9
0
m
THAN THIS NOTICE
NOTICE 10 THE 666UMENT IN THIS FRAME IS LESS CLEAR
IT IS DUE TO THE QUALITY OF THE DOCUMENT
5101,7 04UL
3
IM4
L-.�7
f
PA -.S 1"
ATE RECEIVED 13-
EXPIRES
_PERMIT
USE PERMIT
ZONE
CITY OF EDMONDS
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB SUTEIAPTH
ADDRESS
0 A I
PLAT NAMSISUBDIVIS?ON NO.. -No.
LID NO,
LID FEE $
N . If6 ADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
=_. 13
— Foll— D
S'_t P—lo.10 0
I
CITY ZIP ITELEPI
HE J,V
061qq
EXISTING — PRO
RE.UIRE..E.ICATIO�— FT
0
o.lu .
NAME
METER SIZE
I LINE SIZE I
NO,O11tXTURE1
PRV EQUIRED IF
YES 13 NO 0
ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSIO CONTROUDRA INAGE
CITY ZIP
LEPHONE
NAA
ENGINEERING REVIEWEDIDATE
ADDRESS
Z
FIRE ROFEWED By DATE
CITY Zip
TELEPHONE
MIAMI Tfr-f%
0
FIANCE VAirt,
1�
SON
KID ITY
STATE LICENSE NUMBER EXPIRATION DATE CHEC ED By
V IVIME
22�
POST
COMPLETE EXEMPT
AREA
ALLOWED PROPOSED
A
HEIGHT,
ALLOWED PROPOSED
PROPER�4y T PARCEL NO.
EXP
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
R,
T4POSED SETBACKS
F 6NT UPSIDE REAR
0
NEW
0 PLUMBINGIMECH
ALLOWED PROPOSED
RPROVIDED
,,,T
0 Or
�A.DITIK)N
0 COMPLIANCE OR
CHANGE OF USE
M,
PARKING
LOT AREA
LOT,
IEWED BY DATE
A
0 REMODEL
APARTMENT
SIGN
PEO'D
'E!; X
0 REPAIR n GRADING C,GS I FTJ
R
RE;MA KS
0 DEMOLISH TANK OTHER
GARAGE r-1 RETAINING WALL 0 RENEWAL
'T 0
O"n
m
z CARPORT L` ROCKER
TYPE 0 RPO
(TYPE OF USE. BUSINE��AOTIWIII 1111IN:
FU 'U1INE A
CHECKED BY
HCK'
Ty E OF PTRUCTIO N
m m
LOCA,
NUMBER NUMBER OF
BF I
OF DWELLIN G
CRITICAL
AREAS
SPE-A LINSPECTOR
S
T
0
I UNITS
TO 5S
S TORIES
NUMBER
RPECI JAREA
E-U�r
SQUIRED YES
0
00
DESCRIBE WORK TO BE DONE
REMARKS
F,
c
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
r.
A
EKIECT r-fixT,
S�
z
VALUATION
FEE
z
9
PLAN CHECK FEE
SOURCE GLAZING I
LOT SLOPE %
BUILDING
LO
0
m
PLAN CHECK NO:
MECHANICAL
I THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
LKS, DRIVE S, MARQUEES, ETC.) WILL REQUIRE
WAY
GR�DINCVFILL
DOMAIN (CURB$. SIDEWA
SEPARATE PERMISSION.
400 S RCHARGE
PER IT APPLICATION: 180 DAYS
PERMIT LIMIM I YEAR. PROVIDED WORK IS STA TED W ITHIN ISO DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
P PUCA.T, ON BEHALF OF HI! OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
;A
N INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY .1
R2�A,,NYAND
LANDSCAPING
2
0
EDMONDS. WASHINGTON, ITS OFFICIAL% EMPLOYESS� AN AGENTS
AULCLAIMS FOR DAMAGESOF WHATEVER NATURE, ARISING DIRECTI IY
ISSUANCE OF THIS PERMIT $HALL NOT BE
INSPECTION FEE
PLAN CHECK DEPOSIT
FROM THE ISSUANCE OF I HIS PERMIT
REDUCE ANY REQUIREMENTOF ANY ITYORDINANCE
IR8CEiPT
0
DEEMEDTO MODIFY. WAIVE OR
ORUMITM Y'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
, ANYWAYTHECIT
RECEIPT
TOTAL AM LINT DUE
IHERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
I OF
C UTHORr
GIVEN IS CORRE T. AND THAT I AM THE OWNER, OR THE DU�Ly A ZED AGENT
. .....
THE OWNER. JAGRES TOCOMPLY WITH CITY AND STAT LAW R�.UITIHG.N.TPUC.
PERSON WILL BE
CALL d110,01filioll, hj,ho, O.p.1y: old Poll 110 oall
TION. AND IN DOING THE WORK AUTHORIZED THEREBY. NO ENIPLOYED
THE LABOR CODE OF THE STATE OF WASHINGTON HE ATING TO
FOR INSPECTION
IN VIOLATION OF
WORKMEN'S INSURANCE AND RCW 18.27.
OF ICIALS SIGNATURE ATE
��PENSATION
DATE SIGNED
(425) qh�b
7?_00
771-0
ELEA BY 'ATE
_kI7TENTION ukXjtrXT 333
OR STRUCT��AN
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING UR
IL
IL 771-0221
A FINAL INSPECTION HAS'BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE - YELLOV� - IN;PECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX PINK - OWNER - GOLD - ASSESSOR