20000482.pdf'DATE 111[7,e
J�C
1 1 1 PERMIT EXPIRES
us PERMIT
ZONE
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION ,DDR
70, q
E;�
.1, AW17 LID NO,
"I f7 MiRiTIL H0114E PI -AT NAMEiSUBDIVtSION NO, LOT NO* LID FEE S
MAILING ADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP ww&-, I'.0.
C 96tq RiRDAI-E AVE— 81
CITY ZIP TELEPHONE EXISTING — PFGl.EEQ—
RIOU"IDDIOIOATIO — IT
'�()MONC6,WN %)-o PAV REQUIRED
NAME METER SIZE I LINE SIZE I NO, 01 111TIRES G
YES
0 NO
ADDRESS REMARKS
YNEF=I4TFACT.M 1ES101,1BI&E 10H EROSION IONTROUI)FAINAGE
iCITY ZIP ITILEPIONE
AME
NAME
1.
ENGINEERING REVIEWED/DATE
m ADDRESS
A G
0
17b- LAKI& (3ALLINC7U COA
- t S�L` LAK-6
... . . . . .............
FIRE REVIEWED By DATE
-----TT
CITY ZIP
C, T
F
ElEP..N.
0
z-Dmboo� , wA 120)-t
jH!j—nt72-0P-
Apr , CU
SHj7rA OR A1111
S Num.E�
A TE ICENSENUMBER
T�
SERA REVIEW
COMPLETE EXEMP;l
exp I/
SIGN AREA
)ILLOWED jfll
I PROPO
<& 11
ALLOWED PROP�SED
Pf
C)cx n-j-!A j29
EL NO.
Wtrou 60(
PLUMBINGIMECH
LOT COVERAGE
ALIOWI�,7POIED
.
REQUIRED SETBACKS (FT)
FIONT�JA FEAR
PROPOSED SETBACKS IFT.)
FRONT UPSIDE REAR
C)MPLIANC R
I AIIA
C] ADDITION 0 CHAN3E.F`UIOE
PARKING I
HEaO
LOT AREA
IEWEI BY 6A
C3 REMODEL
10
REPAIR GRADING CYDS 0 1 _ X FT)
REMARKS N
OTHER
DEMOLISH TANK C3
w Aut (wj
E3GAR P.GRET E3 R ��ING-Ll t RENEWAL
CA R E
B21
0 ITYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
Typ CRON
NUMBER
OF
N,,,,,, OF
DWELL M.
UNIT.
IIHIIAL
AREAS R N
NUMBS
S ECIAL "PECTOR JAREA
REQUIRE'. Ej YES
F
L..-UPAN I
A.
_STORIES
DESCRIBE WORK TO BE DONE
REMARKS
R-MA K.
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQT
0
P PLAN CHECK FIE
N CHECK
HEAT SOURCE
LOT SLOPE %
BUILDING
'U
'G`NG
PLUMBING
FL MEIN.
PLAN CHECK NO: C4
VEST U A7i
L
MECHANICAL
-E"HAN IA
�l
q-,(1
NOTES THIS '...IT COVERS W .. To
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
A C S I N ON T. .,
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION OM,THE EPOUBLIC
NY . T.-CT. E F "IGL
8 Ul E
WS gg � TO WULLRE.LUR
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC ) IN LL
:1 SEPARATE PERMISSION,
GRADINGIMLL
. 'N."'LL
A.
STATE SURCHARGE
PE AMIT APPLICATION: IOU DAYS
. PERMIT LIMIT, I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
w 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEMS, ASSIGNS AND SUCCESORS
w I.L 'Ill —
IN NTEREST� AGREES TO INDEMNI5Y DEFEND AND HOLD HAR.— D
E
2 EDMONDS. WASHINGTON, ITS OFFICIA.LS, EMPLOY ES,ANDAGENrSFFOM ANIAN
IF A LCLAIMS FOR SAM OF WHATEV R NATURE. ARISING DIRECTLY OR INDIRECT LY
I
I FROM THE ISSUA CE OF T IS PERMIT, ISSUANCE Or THIS PERMLf,SHALL MOT BE
9 DEEMED To MODIFY, WAIVE REDUCE ANY REQUIREMENT OF ANY C TY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY S ABILITY TO ENFORCE ANY ORDINANCE PROVISION
NK_T.TALAV.UNTCUC
LAN;SCAPI �.
LINDSCAPAG
INSPECTION FEE
PLAN CHECK DEPOSIT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE OULY AUTHORIZED AGENT 01
I AD LATING CONSTRUC,
THE OWNER. FEE TO COMPLY WITH CITY AND STATE LAWS REGUWILL BE EMPLOYED
TION. AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSO
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'j C�M INSURANCE AND RCW I8Z1.7
CALL
FOR IN SPECTI,
W �FATION
ME DATE SIGNED
L
(425)
771-0220
ATTENtION 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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX
VALUATION
T11,, ,1111-11FIl 1� IM V po m, unt 1.,gnod by
olh—I 1, hil-I DIDI: y:tiF.11 F"
I—P, 11 r—U-
FFICIALS SIGNATURE TI
�4 /.-A - 1 -11
ORIGMAL-FILE YEL�OW-INSPECTOHI
PINK - OWNER GOLD - ASSESSOR
Z
0
4
M
c
m 00
-40
Oc
-L M
0 -n
m M
0
0
c
M 0,
z
J)
z
m
, M
FINALPRO
TO:[�:
DATE:
MEMO TO-. PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE
PROJECT
Y
SITE ADDRESS- cx
PERMIT# _______----l)ATE INSPECT
DESCRIPTION OF WORK TO BE INSPECT
A field inspection was conducted to determine compliance with approved plans. Final approval denotes tha t
to the granting of:
there are no objections from the above signed Department
_____--Yinal approval of the described work
_______-----Yerfbrmance Bonds associated with the project may be released
FINAL PROJECT APPROVAL
—GRANT
_GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
I
_FAILED FINAL INSPECTION - OUTSTANDING ISSUES
2.
3.
_RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
ocaprvi.doc.l:temp:bldg:forms6/98
z
9
0
0 M
ca
M 0
-40
0 C
-49
M
z
0-4
C 5
O"n
M M
a @
0
0
C ch
90
0
X
-4
X
z
V
Vi
z
0
4
0
M
RECORD OF INSPECTIONS
m m
c
-----------
Cil PERMIT EXPIRES
PERMIT
CITY OF EDMONDS ZONE
UMBER
SUGEIAPT.
Ax-
CONSTRUCI I ION PERMIT APPLICATION 'A'DORESS
OWNER NAMENAME OF SUI§ NESS
_VIL'o Y� 1411"I/DAAMATIC HOME (4LT-CTIV�s
r
PLAY NAMEISUBDIVISION NO�
LI NO.
LID FEE$
MAILING ADD EBB
96tq f;iRDALF_ AVE.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIREDDEDICAT11 N_ IT
6
a
a
0
PAV REQUIRED
CITY ZIP T L PHONE
"P0mON[)5,WA 0 0- 1) -
7
NAME 7-ob -53s- 1317
ADDRESS
METER SIZE J LINE SIZE NO. OF FIXTURES
YES 0 NO 0
REZARNS—TRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
TELEPHONE
a.
NAME
5NO
iE k 1,,14
DATE
ADDRESS
Qil� LAK-6 13 A L L I N tj _le-k WAY
FIRE REVIEWEDW W M DATE
CITY ZIP
-&DMbrIV!I , wA J�o_t�
I TELEPHONE
I �tq - nr?
VA I CE OR CU
14
SHOR7NE OR ADS#
1 A
-
INSPPUON
_efjEtSOQ NO
0
80"
ED
I
TE LICENSE NUMBER
09
$EPA REVIEW
COMPLETE Ej��
XP
SIGN AREA
ALLOWS ED
HEIGHT
ALLOWED P ... ?S"
PARCEL NO, 6(D
!.Npj/ C] PLUMBtNG/MECH
r FNEW
cl COMPLANCEOR
0 ADDITION CHANGE OF USE
n REMODEL
0 REPAIR 0 GRADING CYDS 0 (DX FT�
r-1 DEMOLISH 0 TANK o OTHER
R,TAINN. WALL RENEWAL
o GARAGE cl G.KEG'
jaARPORT
LOT COVERAGE
ALLOWEk /PR
1A
REQUIRED SETBACKS IM.
S E REAR
W
PROPOSED SETBACKS (FTJ
FRO UR SIDE REAR
I IVIA
PA
F...D
K NO
I ED
q IEWEDBY bATE
EMAR
c�
(TYPEOF SS.BUSINESSO R ACTIVITY) EXPLAIN:
gq-,Tflt-
CHECKED BY
TYP 0 NST UCTION
0 C.UPA
G, U"j
I
NUMBER
OF
STORIES
NUMBER OF
0
UnELLING N/,4
CRITICAL
AREAS P N 14
NUMBS
SPECIAL INSPECTOR
REQUIRED C] YES
AREA OCCUPANT
LOAD
DESCRIBE WORKTO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'l
Z 1"Ll P1
PLAN CHECK FEE
W u u,-;
HEAT SOURCE GLAZING a*
LOT SLOPE %
BUILDING
ILA. CHECK
r BE, b. Ua-
PLUMBING
q 67 ill xe
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t:l BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
ETC.) WILL REQUIRE
GRADINGIFILL
DOMAIN (CURBS, SIDEWALKS, DRIVE , MARQUEES,
El WARYS
SEPARATE PIE MISSION- —
STATE BUF..AP..
PER IT APPLICATION: 180 DAYS
PERMIT LIMIT, I YEAR * PROVIDED WORK IS STARTED WITHIN 18D DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Y.
-APPLICANT, ON BEHALF OF HIS 08 UER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
!e�ttr� .-FGE
IN NTEREST� AGREES To INDEMNIFY' DEFEND AND HOLD HARMLESS THE CITY OF
I" FROM ANY AND
LANDSCAPIN
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS
A INDIRECTLY
ALLCI-AIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
INSPECTION FEE4
RECEIII
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT $HALL NOT BE
PLAN CHECK DEPOSIT
OF C
DEEMED OR REDUCE ANY REQUIREMENTo ANY ITYORDINANCE
olN`ANYFY WAIVE
RECEIPT
R`Y' DINA
NORLIMI WAYTHEC S�ABILITY7 ENFORCE ANY R NCE PROVISION
T
TOTAL AMOUNT DUE
IHERE ACKNOWLIDGITHAT:H D THIS APPLICATION. THAT THE INFORMATION
A E."
APPLICATION APPROVAL
o"lEl AG
D ENT OF
,T, A D NIHE OWNER OR T.�A U'LY AUTH
Give'lo I Y CORP. THAT A
ANDSTAT, W FE.ULATINBC.Ia�TFuac-
CALL
a ,, 1 ant I signod by the
Tbn� IPPI-tala 11 a.1 I I
Fall ., pa,d. and
THE OWNER I A- omp "
EToC Ly """ CITY THEREBY. NO PERSON WILL BE EMPLOYED
TION; IN DOING THE WORK AUTHORIZED
,g od,,t 10, hisalal galy: ad
B"d Id,dipt I'a .�1a,dYl.dg.d in ap ... p—ded,
AND
WASUI
IN VIOLATION OF THE LABOR CODE OF THE STATE OF NGTON RELATING TO
FOR INSPECTION
WORKMEN'�COMP
t INSURANCE AND HOW 1 BZ7�
?!IPAI 6TION
, )A
(425)
OFFICIALS SIGNATU,�E DATE
SIGNATU
oxjl�5dl AGENT)
f
E SIG ED
E
771-0220�
EILE E
ATTENtION
IS UNLAW A U ILDING OR STRUCTURE UNTIL
FUL TO U P1
SH,s'l'E`E'lUl
FXT 333
7 -0221
i
IT
A FINAL INSPE CTION EAND APPROVAL OR A CERTIFI-
ORIGINAL -FILE YELLOW INSPE TOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNE rOLD-ASSESSOR
z
0 m
C
,a i ,
0
0 'c
m IT!
z
0 _n
m M
0
o
C
20
X
z
-4
X
z
0
0
m