20000284.pdfUS' PERMIT
CITY OF EDMONDS ZON NUMBER
�Z Z ol JfIJAPTI
CONSTRUCTION PERMIT APPLICATION JAoD`GRESS to(
US
OFEDMONDS Zo
'ON PERMIT APPLICATION JAG
N
a
DO
E
RE
S
C
N
PE
U
N`
BE
R
O'C
OWNER NO OF;9jlN SS
T T N.-
PLAT NAMEISUBDIVISION 1`10� LOT 11, __I LI N
F W 9 A) i TO /? LID FEE $
MAILING ADDRESS . . 1 -1—
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAI
:Z2Zldf PRO
EXISTING — PROPOSED—
ITY Z TELEPHONE SWk R-1.1
1p
so6 IF TON
REQUIRED DEDICATION— FT —
-TU. B
OF
�pllj AM D PRV REQUIRED
NO
NAME YES 13 No C3
R F A FILE
E.A.
QWH,P,,C CTGF 'EBPOS, L
ADDRESS QWNERtCONTIACTOR RESPONSIBLE FOR EF.SoN CONT,
R EROSION COMTROUDRAINAGE
ICITY ZIP 11ELEPHONS
A E
NAME A147 I-169-L J_/0/l/ C 0'
ENGINEERING
EN.'N.EE
REVIEWEDIDATE
FIEVIEW.DIDATE
ADDRESS
FIRS REVIEWED By
DATE
CITY ZIP TELEPHONE
W.4
W
VARIANCE OR CU
F .... .
SHORELINEO ADDI!, INSP.E.G�JON
TATE LICENSE NUMBER
S STATE LIC;�SENU
PBOND
G OSTED
Iff my S ONO
0
i�
AREA HEIGHT
SEPA REVIEW
COMPLETE EXEMPT
SIGN
D X,61D ALLOWED ROPOSED
A I P jt;.
27
FXP
S."EN"A
RESIDENTIAL
WN.W 0 0 LUMBINGIMECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT,) PROPOSEE
FRONT SIDE REAR FRONT UPSIDE REAR
z
COMMERCIAL o COMPLANCEOR
COMMERCIAL
0 ADDITION CHANGE OF USE
3 G� �FA-TMENT
REVIEWED BY D E
A
0 REMODEL 0 APARTMENT
PARKING LOT
REDD I PROVIDED
AREA
PENCE
0 REPAIR 0 RADII. GYDS 0 Y, FTI
AE.AFsS
0 DEMOLISH 0 TANK o OTHER
'AGE 0 R
0 CAARFF.PT FIETAKIN�INYG WALL 0 RENEWAL
(TYPE OF USE, BUSINESSO EXPIN�
KEDBY TYPE FCO)gUCTION
.. IUIPA.�b
R. F
I _,UM E, NU118EII CRITICAL
DWELLIN
E, S
FEECIALIN PECTOR AR A
OUIRED
IS N .. EF
S,0.7UNITS
YES
0
DESCRIBE WORK TO BE DONE
REMARKS z
PROGRESS INSPECTIONS PER USC IOSIFINAL INSPECTION REO'D
5 77 19S I IV/l/_
UdC-D hvr- 15"Ck
1461c,of/v!� t* J ff - 4//4-1-
,PRILL&P At lv4l-LS-
S*-rt4 05 t4170 67L&C-0 IYVI—
VALUATION FEE
PLAN CHECK PEE
HEAT SOURCE L GAz�j LOT SLOPE %
BUILDING
ED DATE
PLAN CHECK NO:
P MENG
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. TH S PERMIT COVERS WORK TO
LIC
DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBlRE
GRADING, ILL
BE
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS' MARQUEES, ETC.) WILL REDD
SEPARATE PERMISSION*
C
E SURCHARGE
PERMIT APPLICATION 180 DAYS
PERMIT LIMIT. I AR " PROVIDED WORK IS STARTED WITHIN 180 DAYS
YE
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
;APPLICANT
N NTEPEST� AGREES TO IN EMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
NO ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
I To
LANDSCAPING
INSPECTION FEE
ED MONDE, WAS"
WHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
"S 0"
All -A A. A ERMI7
I-SU NICE OF THIS I SH LL NOT BE
PLAN CHECK DEPOSIT
RICEIL[t)
H 'S�IIANGE OF THIS I-Mll
__y A.VP OF REDUCEANY REQUiREMENT.FANYC TY.FDINANCE
ROMANCE PROVISION.'
TOTAL AMOUNT DUE
0
'HEREBY THAT HAVE READ THIS APPLICATION; THAT THE INFORMATION
X
AC No�`Er
APPLICATION ArrRO AL
�
OWNER, OR THE DULY AUT40MIll
GIVEN Is ,.PPECT, N.T.AT A. THE ED AGENT OF -
:
PLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CA LL
TTis Wfis.bos is -I I POrml , IIINg ds Y
8�i,dmg Offied or hiu,�G, Deputy: "d F .. .. P�'d
REETOCO
TH'OWM'R 'Aon"TOCO
T,GN AN,,N.0,,q.THEW. K AUTHORIZED THERED1 NO PERSON WILL, BE EMPLOYED
RELATING TO
FOR INSPECTION ipt is .�WL.dpd m ip— pid.d�
IN VIOLATION OF THE LABOR CODE OF THE ICTWAT'l.11 IAIHINGTON
D TE
Z,
OFFICIAL LURE
(425)
771-0220
RELE E E
EXT 333
FULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
ITISUNL
HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW - INSPECTOR
ASSESSOR
A FINAL INSPECTION
CATE OF HAS BEEN GRANTED� UBC SECTION 109
FAX
PINK - OWNER GOLD -
OCCUPANCY
F1 AL PROJEC! APPROEI��
TO: Ise-
-DATE:
MEMO TO: PERMIT coORDINATOR, BUILDING DIVISION
FROM: DEPARTNIENT DATE—
. —ENGINEERING DIVISION DATE—
C-14MANNING DIVISION DATE
PROJFCT—`�� )z'l
SITE ADDRESS—QL3—�-
PERAUTO ADB#__-------DATE INSPECTED —
DESCRIPTION OF WORK TO BE INSPEC
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
Ociinal approval of the described work
______--performance Bonds associated with the project may be released
_GRANT FINAL PROJECT APPROVAL
-D
_GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTE
1.
FINAL INSPECTION - OUTSTANDING ISSUES
1.
2.
3.
_______RE -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
ocaprvl.doc.l:temp.bldg:forMS6/98
z
9
0
0
C m
M 0
0
80
C
:0 C
Mm
z
C
o
- n
x
M M
a 6
0
0
C w
C (n
M 0
C/)
z
0
M
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall.................
Pier/Porch .................
Retaining Wall ...........
Stab Insulation ..........
PLUMBING:
m"
4 "n J�f'
-4
Underground .............
M
Rough -in ...................
IT!
0
-10
0 C:�
Commercial Final
HEATING:
M
Gas Test 7..
> Z
Gas Piping .................
Jr i'l
Equipment .................. .
Commercial Final
M M
EXTERIOR SHEATHING
0
NAILING ..........................
0
0 Fn
FRAMING .....................
C: 0),
(n: I
Tol
FIRST FLOOR FRAMING...
1
INSULATION ...................
Floor Insulation I
Wall Insulation ...........
Ceiling Insulation
z
SHEETROCK NAILING
SPECIAL INSPECTION
rn
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..............
100 0 PERMIT EXPIR ES
US 200284
CCI PERMIT
CITY OF EDMONDS
ZO'NE
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB fTEMPTa
ADDRESS �Z 7 b 17 1-hkAA 01
OWNER NAMEdNAmE OF BUSINESS
f:IA 14 1111 R-OWIT14RE
PLAT NAME/SUSDIVISION NO�
LOTNO.,Id,
L�D NO,
MAILINGADDRESS
L 0 FEE S
y
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
lEb.1 ARF—d 0
Pan,
ba. . .: 11.11�1 11.1 a.
la"Pl—a-aad
CITY ZIP �ILIPHONE
�vm qp(,)2
EXISTING — PROPOSED —
REQUIRED DEDICATION— FT —
d""" F 0
wulla;111-1.1.
REQUIRED
NAME
METER 51ZE
LINE III
OF FIXTURES
PRV
YES 0 NO CJ
ADDRESS
REMARKS,
OW NERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
Z
CITY ZIP ITILEPHONE
7�
NAME
EN INEERING PEWEWED/DATE
IF ADDRESS
AAmu-m
FIRE REVIEWED By
irE
ZIP
TELEPHONE
a.
6 v w i r i.,
w,9
VARIANCE OR CU
SHORELINE OR AG�
STATE LICENSE NUMBER EXP IRATION
co
A_W_ 4
X
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
Aq6lED
HEIGHT
ALLOWED PROPOSED
..........
EXP I
6,
,
W�EW
0 RESIDENTIAL
0 PLUMBINGIMECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE HEAR
PROPOSED SETBACKS (M.
FRONT UPSIDE HEAR
ADDITION
VCO.MERCIAL
o C MPLIANCEOR
CHANGE OF USE
0 REMODEL
C] APARTMENT
G 0
M REPAIR 0 RADIN CYDS 0( X FT)
F.A.Xd
OTHER
C] DEMOLISH 0 TANK
o GARAG T 0 g N WALL RENEWAL
CARPOR R
(TYPE OF USE. BUSINESS E�Yl lXPL
r\ P c, ?,:�C��,
CHECKEDBY jT:nEJCO
I Gel —A 0 OU PAN�b
GROUP
I t
IlKfIOT101
C
NUMBER
OF
UM ER
N of
DIN LUNG
CRITICAL
AREAS
ISPECIAL NSPECTOR
IREQUIREDE]YES
I
A
JARE OCCUPANT
LOAD
STOR
U NITS
NUMBER
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
XV S 7_44,2S IVI.41-
'61 iMG-L) ly;ro tW_1(, 07;
maTc/4 w!� f-"oj�u wi-4 ea
PRI LL C-0 . l)V Molt-LS L&72�tS
r-rtll DS INTL> L74&6-0
VALUATION
FEE
z
0
m
r A
m 00
80
MITI
10
0 1
m m
103 vi
0
c:
z
z
PLAN CHECK FEE
z
HEAT SOURCE G-1103 I LOT SLOPE %
9
BUILDING
0
,TED DATE
PLUMBING
MECHANICAL
m
THIS PERMIT AUTHD IZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS , MARQUEES, ETC.) WILL RED UIRE
GRADINGIFILL
SEPARATE PERMISSION.
2�AEURCHARGE
PERMIT .11.DATIO ; 11H) DAYS
PERMIT LIMIT. I YEAR . PROVIDED ORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HSIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
IN INTE E T, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
R S
LANDSCAPING
2 EDMONDS, WASHINGTON� ITS OFFICIALS, EMPLOYEES, AND AGENTS FRO ANYAND
m
lLCLAlMSFOFtDAMAGESOFWHATEV5R NATURE, ARISING DIRECTLY OR INDIRECTLY
INSPECTION FEE
"IT5
FRIG M THE ISSUA CE OF THIS PERMIT. ISSUANCE F THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY R OUIREMENT OF ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
IRE
��,5 6 0
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
R CEIPT
TOTAL AMOUNT DUE
I /$7(DL/ I
I HERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
T E OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
Th"s ,t a peabit dMila,gaDd by th,
TPON: AND IN DOING THE WORK AUTHORIZE THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
Buil diag Olkiml , h,,fh$, DOPat, and Fall ,a V,d. and
FOR INSPECTION ia ka.wI.d9.d.n.p.b. panad-
I WORKMENS COMPENLATION INSURANCE AND RCW 18.27.
D E
SIGNATURE(OW RORA
(425)
;oFWFIGURE
JU
771-0220
'A Eil Kv/
ATTE qT I
EXT 333
IT IS UNLAVrFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE - YELLOW - I NSPECT
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
FAX
PINK -OWNER - GOLD -AS SESSORoR