20000607.pdfECEIVED
EXPIRES
PERMIT
1 US PERMIT
ZON, Z00607
NUMBER
CITY OF EDIVION
CONSTRUCTION PERMIT APPLICATION joa SUITEIAPT.
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ROPOSED SETBACKS (FT.)
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MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
ON THE PUBLIC
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION
SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
/ftw4/
DOMAIN (CURBS,
SEPARATE PERMISSION.
STATE SIJFCHAFGE
PER MIT APPLICATION: 180-AYS
PERMIT LIMIT: 1 YEAR. PROVIDED WORK IS STARTED WITHIN 180 DAYS
FNG, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENO. INSPECTION FEE
2 00
ON BEHALF OF HIS OR HER SPOUSE EIPILA.IGNEAKD EUC�F,.FS
:APPLICANT. 'INDEMNIFY, DEFEND XNU .0 D HARMLESS THE CITY OF
ST AGREES T1
6
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ED S. AE.,N.T.N ITS OFFICIALS, EMPLOYEES. AN. AGENTS FROM ANY AND
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ARI SI NO DIRECTLY OR INDIRECTLY
PERMIT SHALL NOT BE
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PLAN CHECK DEPOSIT
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)RDINANCE PROVISION,
HLCEIPT
ACK14OWLEDGE THAT I HAVE READ THIS APPLICATION� THAT THE lF R.ATION
PLICATION A PROVAL
I HEREBY
GIVEN IS CORRECT. All THAI I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
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THE OWNER I AGREE TO LYW1TIICiTYAN.STA7E A REGULA, N�G C NSTRUC
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AND IN DING THE WCOMP BY. NO 'E�R
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IN VIOLATION OF THE LABOR CODE OF T
WOFKMCNS COMPENSATIol'NSURA BZ7
OFICI IGN ATE
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(42 5)
771-0220
RELEASED By DATI
ATTENTION
EXT 333
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F-1 TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771 no9l
IT IS UNLAW
A FINAL INSPECTION AS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILE YELLOW INSPECTOR
CATE OF OCCUPANCYHHAS BEEN GRANTED. UBC SECTION 109 FAX PINK -OWNER GOLD - ASSESSOR IV
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RECEIVED
APR 0 3 2000
DEVELOPMENT SEFIVICES CTR.
CITY OF EDMONDS
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RECEIVED
MAY 16 2000
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
Project Review Checklist
P roj ec t Name*. UAA .— . — — Plan Check #: 6-D 'I (/ I
ProjectAddress: -7-� -VE CA) - Receipt Date: iz-a-,
Underground Wiring Required
ye�
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Hydraulics Permit
plat/Subdivision Requirements
—
RECEIVED
Street Dedications
APR 0 3 2000
Easements - Public/Private
Engineering Storm Drain Review Feel
A >
PUBLIC WORKS DEPT
Engineering 29-Inspection Fee
Drainage Plan (On -site)
Setback - Storm Drain Line
Open Ditch - Existing
Culvert Required
Culvert Size
Shoulder Drainage/Shale Open Runoff
Catch Basin Required
Driveway Slope & Vehicle Access
/97P
Sidewalk Required
AJIN
I/V
Curb & Gutter Required
A; /,4-
Curb Cut for Driveway Required
Street Paving Required
Right -of -Way Construction Permit Required
Bond Required for Public Improvements
FEMAMal) Check/Water Table
-T-
Side Sewer Availability
calculate Sewer Fee i"No LlD#
Water Meter Size
water Meter charge Required
Hydrant Required
Street Cut
Miscellaneous
RWPennit# 0'-/'Z3
SS Permit # 21, ')Q P, —
Fire Connection $ —
Meter Size — Paid $
Date Issued
Date Issued
Date Issued
Date
Receipt #
Rec eipt #
Receipt #
Receipt #
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERWT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE—
�ENGINEERING DIVISION DATE L
J12L
PLANNING DIVISION DATE —
PROJECT —4
SITE ADDRESS------L:..:—
PERWT # ADB#_________PATE INSPECTED
DESCRIpTION OF WORK TO BE INSPECTED —
A I 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
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
002
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Footing ......................
Wail ...................
00
Pier/Porch .............
Retaining 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
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..................
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FPERMIT EXPIRES
PERMIT
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CITY OF EDMONDS
_NUMBER
CONSTRUCTION PERMIT APPLICATION
SUITE/APTN
'A'DC,E,,S /4v q
I �;NERNAM�2�ME OF BUSIN4S
PILAT NAMEISUBDIVlSION NO. —NO. LID 40
UD�FEE S
I MAIL NO ADDRE S
E'P �..
PUBLIC RIGHT OF WAY PER OFFICIAL STREET I,IAI INV I.— A.1-d
_71
CITY
EXISTING _— PROPOSED
REOUIRFD DEDICATION--==— FT
0 E.UIA
11 'M YEPR'
M�T L ZE I NO OFFIXTURES S K NOEDO
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FOR EROSION CGNTROUDRAINAGE
ADDRESS
0 WNER/CONTRACTOR RESPONSIBLE
y"rpe_cr1"_S Z�W
jC'Y
X"Woo 7'
80 DAYS REVJ:EW`FEES
NAME �t�do �A
ENGIN FRING EvjEwED"
M A DD
FIRE REVIEWED By DATE
CITY IF TELEPHONE -2-? 8 —
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RE FRONT URSIDE REAR
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COMPLIANCEOR
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ADDITION CHANGE OF USE
PARKING LOTAREA PLANNING REVIEWED By DATE
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PROVIDED
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REPAIR GRAD NG,, CYDS X FT) 61
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VALUATION FEE
P AN CHECK FEE
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PLAN CHECK NO: ..... ....
MECHANICAL
THIS PERMIT AUTHOlIZES ONLY THE L�YK .11CYTED HIRSUPER IT.CNIT.E's WORK 11
ST CTgN E PUBLIC
ON C6�T
X141 /7
BE G.�E . P., VA PROPERTY .
DOMAIN (CURBS. SIDEWALKS. DRIVEWAYS, MARQUEE S, ETC.) WILL REQUIRE
:I SEPARATE PERMISSION -
STATE SURCHARGE
PERMIT APPLICATION: MOLY2
W I D WITHIN 1
PERMIT LIMIT. 1 YEAR. ROVIDED "FOR MORE INFORMATI-�
SEE BACK OF PINK PERMIT
N
ENG. INSPECTION FEE
200
;APPLICANT. ON BEHALF F`IS OR HER SPOUSE. HEIRS, ASSIGNS�A�E`SUCOESORS
EES T INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY —
AGREES T
LANO-Q�
-
6 -5
N INTEREST.
ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANYAN.
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INSRSQZWA�
r
OFYIHATEVER NATURE.ARISING U-11 11 — 11-- -
' PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
In
OF ANY CITY ORDINANCE
RECEIPT
ORDINANCE PROVIS10-
OTAL AMOUNT DUE
0
THAT: HAVE READ THIS APPLICATION: THAT THE N1 AMATION
APPLICATION A PROVAL
A. T.I. OWNER, OR THE DULY H
'H , = TA.G.' THAT A�UT ORIZED AGENT OF
G,�ENEAY 0 CONSTnUC
CITY AND STATE LAWS EGULATIN
CALL
Th. PP-i-.ti-- 11 �01 � 1 ��" �"
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Offi—I �l hmlh., D-1, P.d �.,l
THE OWNER. I AGREE TO COMPLY WITH
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PEAS N WILL BE EllLOYE.
TO
B01,11,Xj
ipt l� Ckl.wl.d,.d m P p—ld.
FOR INSPECTION
WASHIO
IN VIOLATION OF THE LABOR CODE OF THE STATE OF NGTON RE ATING
ATE
(425)
OFEIC' IGN E
KOWNE _R> �A�
771-0220
RELEASEDBY
EXT 333
J76 0
ATTENTION
IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
YELLOW - INSPECTOR
HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE
GOLD - ASSESSOR
A FINAL INSPECTION
HAS BEEN GRANTED. US C SECTION 109
FAX
PINK - OWNER
OF
CATE OCCUPANCY