20000592.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
�
o
CITY ZIF TELEPHONE
fdM,r\CA,n -J�QJO
NAME
CITY
PERMIT EXPIRES I �
us PERMIT
ZONE NUMBER 200592—
JOB SUITEIAPT#
ADDRESS 7H
FLAT NAMEISUBDIVISION NO. LOT NO. LID' NO,
LID FEE S
TEIIP App—d
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
S".= All-lR'lRl,Iq d
SED
�T'
REQUIRED DEDICATION— FT
I, E
METER SIZE I LINE SIZE NO, 01 IIXTIRII p I lEOUllED
YES 0 No 0
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR ER01111 CINT117;A121_
IC
lllt3)A -1-D Av, er-v,-+1-ec-4
\ ( ) ( li V"-�
ENGINEEPIN
)DRESS
-2-12-
FIRE REVIEWED By DATE
ZIP
TELEPHONE
/T
j
S_ . -o
VARIANCE 09 CU
SHORELINE OR ADS.
INSPEC ON
R EQ'
0 YES No
ED
OSNTE-
IP
TATE LICENSE NUMBER EXP;IRAT;ION DATE
CHECKED By
I'C * _3' o/
IV, �qL �L / / ID,
SEPA REVIEW
COMPLETE I EXEMPT
E.,
SIGN AREA
ALLOWED I PROPOSED
P—Hr
ALLOWED , PROPOSED
,WgW No� 3
_jAlFC4lllbbj _ 0003
1- 00
LOT COVERAGE
ED SETBACKS (FT)
PROPOSED SETBACKS (FT)
RESIDENTIAL
NEW RESIDENTIAL [:3 PLUMBINGIMECH
[:3
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UPSIDE HEAR
ADDITION COMMERCIAL o COMPLIANCE OR
C.MME C'AL -HAN
CHANGE OF USE
GEOF
PARKING
LOTAREA
LOT A
DATE
0 APARTMENT SIGN
krREMODEL 0 APARTMENT 0 SIGN
REO'D I PROVIDED
1PI-ANNINGREVE—ObIl
XUR.E
FEN. E
aREPAIR C] R—N. CY.. FENCE
FT)
, � FT)
MARKS
FEMAFK�
DEMOLISH TANK o OTHER
C3CARAG C] R=RINYG WALL 0 RENEWAL
GARI.ET
ITYPE I OR AOTIVITYI EXPLAIN;
CHECKED
E;PE
TYPE40 Tl�UCTIONI
Ty'E;'CON
-.CUPA-
GROUP
NUMBER
NUMBEROF
C .... A
T
AREAS
A, I
I SPECIAL I�
AREA
OF
STORIES
UWELLIN
U G
NITS
"
NUMBER
R
REQUIRED Y.,
LQ�CDPANT
10
DESCRIBE WORK TO BE DONE
�FEMAPK.
PROGRESS INSPECTIONS PER UBC 108/FINAL INS PECTION REQ
P GRESSNSPECTIC
RO
I f. I " i<-n'!r LA)CA IrO604 ll
VALUATION
PLAN CHECK FEE
HEAT SOURCE GLAZING % LOT SLOPE %
BUILDING
PLAN CHECK NO: �VESTII DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE W RK NOT D. IS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU.UC
GRADINGIFILL
DOMAIN JCUREIS, SIDEWALKS. DRIVEWAYS . MARQUEES. ETC.) WILL REQUIR
:1 SEPARATE PERMISSION.
I=
STATE SURCHARGE
2 PE IT APPLlCATIoN: 180 DAYS
RM
P K I
PERMIT LIMIT. I YEAR - ROVIOED WOR S STARTED WITHIN 1.0 DAYS
ENE. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
"" "" 'UCCESoF
P' ON BEHALF OF HIS OR HIER SFEO�DE EI.R.ILAS.I
T THE CITY F
�N
;APPLICANT,
I, INTEREST. AGREES TO INDEMNIFY. DE . F.LE.S
EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
LANDSCAPING
INSPECTION FEE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLIOR INDIRECTLY
RE IPT
PERMIT SHALL NOT BE
�F ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
)RDINANCE PROVISION
RECrIPT
TOTAL AMOUNT DUE
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
AGENT OF
APPLICATION APPROVAL
GIVEN IS CORRECT, A D THAT I AM THE OWNER. OR THE BILLY AUTHORIZED
I AGREETTOCoMPLY WITH CITY AND S ATE LAWS REGULATING CONSTRUC
CALL
T t . p.—t -0 .,,.d by
THEOWNER.
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO P EPSON WILL BE EMPLOYED
RELATING TO
FOR INSPECTION roceipt is acknowlodge .... P.V-d.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN S COMPENSATION INSURANCE AND RCW 18.27.
OF ICIALS SIGNATURE E
ATE SIGNED
(425)
71Z4
771-0220
DATE
EXT 333
ATTEhflON
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
FINAL NSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE - YELLOW INSPECTOR
A
cATE OFIOCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK OWNER - GOLD -AESEE-R
519"
Z
0
c m
rn
--Io
00
c:
-4 K
X M
M Z
10-4
Ol
m
m
T
c')
M 0
co
z
0
m
I low
k"O
A
51
-ky
KLO
k
I
R
9th Avenue
Site Plan
1" 20
JUN 0 11999
OE'ELrOPM'NT SERVICES r
'ITY OF EDMONDS
FINAL PROJECT APPROVAL FORM
REdaysf)
SEP 2 1 M TO:
ENOMMNG DATE:
MEMO TO: PERM[IT COORDINATOR, BUILDING DIVISION
FROM: ---FIRE DEPARTMENT D E.
—10
cuzuAk ---�ENGINEERING DIVISION DATE-n5lb—b
V
---YLANNING DIVISION D
PROJEC
SITE ADDRESS
PERMIT # ADB#
INSPECTED —!Lk --
DESCRIPTION OF WORK TO BE InWNSPEC n� e
A field inspectio ed to determine compliance with approved plans. Final approval. denotes that
there are no objections from the above signed Department to the I granting of:
____----Yinal approval ofthe described work
___-----Yerformance Bonds associated with the project may be released
RT MkpLZ 4 qiu
frs vwe�
K—GRANT FINAL PROJECT APPROVAL -RaN AL
__---�GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
1.
2.
3.
_______L_RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
6caprvl.doc.l:temp:bldg:forms6/98
z
9
0
P
=i 9n
C rn
M a
--40
00
C:
--I K ,
X M
M z
--i
z
-1
X.
0 -n
T
M
u Cl)
0 r-
0 M
C
M 0
Z
z
-4
3:
U)
z
.0
0
m
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall...........................
Pler/Porch .................
Retainirig Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in .................
Commercial Final
HEATING:
Gas Test ....................
Gas Piping ..................
Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling insulation
SHFETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
,P-eA owl 2,V0001,
Z
0
0- M
M
—40
C
X M
z
jo —4
a
1111 M
0
0 Fn
C C&
M CO)
IV C)
z
ca
ITI
6
RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
9 yl 10'.
�NG ADDRESS
n z- - 'n
CITY ZIP
MIMI
1/0 7/2- S W -
TE;Pmo-i
LICENSE NUM EFL EXPIRATION
w,v,-,- *344C;� 1121
0 NEW
C] ADDITION
qrRE....L
REPAIR
DEMOLISH
E3 GARAGE
CARPORT
RESIDENTIAL C] PLUMBING / MECH
C MPLIANCE OR
E] COMMERCIAL CHANGEOFUSE
PARTMENT
FPERMITEX91RES
us PERMIT
ZONE NUMBER
IOBREES 206_ L7p,,&
TEVAP
ADD E m
PLAT tNAME)SUBDIVISIOH NO 1. LOT No, LID NO,
LID FEE $
PUBLIC RIGHT OF WAY PER OF51CIAL TREET MAP
.T
IS POS�C=
EXISTING PROPOSED-
0
U_
IT ulT,_"
'T
RE UIRED DEDICATION
E T R SIZE I I EZ� _V
E NE NO. OF FIXTURES PRV SOURED
Y Y S.
ES 13 No
REMARKS
�;g� ------- E FOR EROSION CONTROUDRAINAGE
<,,/, 114;,Azds OIL-vellic'(1m,
FIRE REVIEWED BY
DATE
VARIANCE 08 CU
SHORELINE OR AOB0
INSPECTION
SOND-
By
REO 'D
OYES ONO
POSTED
SERA REVIEW
SIGN AREA
HEIGHT
ALLOWED PROPOSED
COMPLETE EXEMPT
ALLOWED PROPOSED
I
FXP I
LOT COVERAGE
REQUIRE" SETBACKS (FT.)
PROPOSED SETBACK$ (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR
FRONT UR SIDE FEAR
I
-By
PARKING
LOT AREA
PLANNING REVIEW7. DATE
REGO PROVIDED
A SIGN
IENOE
I X IT) REMARK.
C] TANK ci OTHER
[3 RETAININGWALL RENEWAL
FOC�ERY
S OR ACTIVITY) EXPLAIN: llECKEOlY ITYPEOICIN
NUMBER OF R A ?5��
0 "RC L SP CIALINSPECTOR JAIII
DWELLING AREA EE
NS S QUIRED C] YES
UNITS NU ER R
DESCRIBE WORK TO BE DONE
If
z
0
0 m
C: 0
m 0
0
m
10
z
0-11
n
m M
0
0 Fn
C co
r. cl)
M 0
Z
;u
z
Q)
z
PLAN CHECK FEE 9
HEAT SOURCE GLAZING I LOT SLOPE % BUILDING 0
m
PLAN CHECK NO: JV11TE1 DATE PLUMBING
MECHANICAL
.,..PERM,; AUTH.ORIZES ONLY THE WORK NOTED. THIS PERMIT r.GvEAS WORK TO
EDON ON VATE PROPERTY ONLY. ANY CONST.IJDTI...NTI-IE PUBLIC GRADINGIFILt-
W
2 ETC.) WILL REQUIRE
:I DOMAIN CURB% SIDEWALKS. DRIVE AYS, MARQUEES
SEPARATE PERMISSION. STATE SURCHARGE
loa/FINAL
VALUATION I FEE
PERMIT APPLICATION! '80 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE, EIRS. A.�IDNS AN. SUCCE BORIS
THE CITY OF
EN..,NSPECT'.N FEE
;APPLICANT
N MTE 'EST, AGREES TO �NDEMNIFY. DEFEND AND HOLD HARMLESS
AND AGENTS FRO - ANY AND
FE
ED TO j TS OFFICIALS. EMPLOYEES.
MONGS,WASHINQ N
ARISING OIRECTLYORI----- - L
INSPECTION
A I-CLAIMSFORDAMAGE OFWHATEVER NATURE.
PERMIT. ISSUANCE OF THIS PERMIT SMALL NOT BE
PLAN CHECK DEPOSIT
I FLOM THE ISSUANCE OF THIS
IVEO REDUCE ANY REQUIREMENT OF ANY CITY ORD"
DEEMED TO MODIFY WAIVE 0
PROVISION'
0 NOR LIMIT IN ANY WAY THE CITY 'S A51LITY TO ENFORCE ANY ORDINANCE
X
TOTAL AMOUNT DUE
RECEIPT
—
I HEREBY ACKNOW EDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
L
APPLICATION APPROVAL
D H
GIVEN IS CORRECT� AND THAT I A. THE OWNER, OR THE ULY AUT ORIZEO AGENT OF
AW
THE OWNER. [AGREE TO COMPLY WITH CITY AND STATE L S REGULATING CONSTRUC
CALL
011", "Put'. F... .1.1,,1.7.
TION, AND IN DOING THE WORK AUTHORIZED THEREBY. No PERS NWILLBEEMILOYED
RELATING TO
FO R INSPECTION
—co provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHIONGTON
18.27.
OALS SIGNATURE TI
WOFKMEN-S COMPENSATION INSURANCSAND RCIV
ATE SIGNED
(425)
OF
7/7-
l�TUIE rWN5 AGENT)
(.:L t ))-tir'Ji�i —
15'/,) 11 01D ___3
1 I-IUe4V
—
L RELEASErDBY DATE
-ATTENfION
EXT 333
UNLAWFUL TO USE OR OCCUPY A BUILDIN G OR STRUCTURE UNTIL
771-0221
IT IS OR A CERTIFI-
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL �
Lt,7
(i
f
ORIGINAL FILE YELLOW- INSPECTOR
PI NN-OWNER GOLD-ASSESS.R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
519B