20000754.pdfFPERMITEXPIRES
U US' PERMIT
SE
ZONE NUMBER
CITY OF EDMOND JO.
S TAiRei.. _
CONSTRUCTION PERMIT AP . PlLICATTION JOB 7 UITFJAPT.
9L( ( k-ZJ 6 k- ��
,15R NAMSINA "'0
Kb_LmiN KW
L
CN
V�
T NAMEISUBDIVISI.N NO.
NO.
D NO.
A GRESS
117 Fi r"&
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAI
I—P u
P.'=d o
0
CITY ZIP
1XII ING_ PROPOSED
col
,,,�TILEPIIII
aYg 154,1
'700
RECURRED D901CATION
FT
0-
_.EFlDtivDwo5
NAME
METERSIZE
LINE SIZE
NO, OF FIXTURES
PAY RECUR D
Yes E3 NO 0
ADDRESS
REMARKS
I CITY
ZIP
ITILEIHON
NAMIQ\"
I
ENGINEERING
REV EWEDIDATE
m ADDRESS
FIRE REVIEWED By
DATE
CITY
ZIP TELEPHONE
IE
VARIANCE OR CU
ORELINE OR ADEN
INSPECTION
BON
STATE LICENSE NUMBER
EXPIRATION GAT
Am
POSTED
Ap
'3 No
Eajjg�
EI.-
EPA -� EXEMPT
COMPLETE EXEMPT
SIGN AREA
ALLOWED
P;27SED
HEIGHT
ALLOWED PROPOSED
TA) ACCOUNT PARCEL NO�
I
I
I
9
E.
LOT COVERAGE
REQUIRED SETBACKS (PTJ
PROPOSED SETBACKS (M.
0 NEW
RESIDENTIAL
0 PLUMBING/MECH
ALL.WE. PROPOSED FRONT SIDE FEAR
FRONT LIRSIDE FEAR
0 ADDITION
COMMERCIAL
C MPUANCE OR
0 CHANGEOFUSE
PARKING
LOT AREA
I P G R WE Y
[3 REMODEL
0 APARTMENT
BIG
REO'D
I PROVIDED
E] REPAIR
G
0 GRADIN CYDS
FENCE
ED ( X FT)
REMARKS
C] DEMOLISH
0 TANK
OTHER
c3GARAGE
CARPORT
r-1 RETAINING WALL
Y
0 RENEWAL
(TYPE OF USE, BUSINESS O_'
CHECKED By
OF
CON ON
ITIPE
DOCCURAN
ROUP
NUMBER
NUMBER OF
A,,�$CAL
S
EAS
SPECIAUINS]ECTOA
OF
STORIES
DWELLIN
UNITS
;__
MSE�__
REQUIRED[] YES
JAREA
LOAD
D IBE TO
ONE
REMARKS
PRO. FIESS INSPECTIONS
PER UBC 1081FINAL INSPECTION REO'D
I.
I
w c- w
o
VALUATION
FEE
PLAN CHECK FEE
E ZT _SLOPE %
EAT R E
WLIDIN.
rIlTED DATE
E
PLAN �K N%�
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUIL.IC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC4 WILL RED
SEPARATE PERMISSION,
STATE SURCHARGE
2 PERMIT APPLICATI N: 18B DAYS
PERM' 0
P K I
PERMIT LIMIT. I YEAR ROVIDED WOR S STARTED WITHIN 180 DAYS
YEAR P
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
;LC
N INT111SWT A FEESOTO N.111.MNIFY, DEFEND AN. HOLD HARMLESS THE CITY OF
I . I E
:T.
LANDSCAPIN
W NOT N IT " CIAI-S, EMPLOYEES. AN. A ENTSFROM ANYAND
ED NGS� ASH, 0 .
M.JIGS =T N
INSPECTION EE
DIG
ALLCLAIMS FOR DAMAGESOF WHATEVER NATURE. ARISING RECTLYOR INDIRECTLY
BE
RECEIPT
' F M T. JESU N 'S ' TH' PERMIT, ISSUANCE OF THIS PERMIT $HALL NOT
Ro THE ISSUANCE OF THIS
OM To MODIFY W ANY REQUIREMENTOF ANY CITY ORDINANCE
1
DEEMEDTO MODJFY� WAIVE OR REDU E
PLAN CHECK DEPOSIT
Ito I
0 0. LIMIT IN ANY WAY THE CITY'S ABILITY TO ENE RCE ANY ORDINANCE PFOVISION,�
0 NORUMI
N
OTAL AMOUNT DUE
REC
a E THAT AVE READ THIS APPLICATION; THAT THE INFORMATION
I REFI Y AEI(N.�U RMATION
H
APPLICATION A7 AL
GIVEN S CORRECT. AND THAT AM THE OVVN51`I� OR THE DULY AUTHORIZED AGENT OF
P-'�I �rRO
THE OWNER, I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
BE EMPLOYED
CA L
6�.ldl,"I Off,,, IF, h-11 Deplly: F_
TION;ANDINDOINGTH WORK AUTHORIZED THEREBY NO PERSON WILL
THE STATE OF WASHtNGTON RELATING TO
FOR INSPECTION
IN VIOLATtO HE LABOR CODE OF
WOZKMJN' 'P SATION INSURANCE AND RCW 18.27�
OFFI IALSSiGNATURE DATE
10 U 'OWN5w0 RAG
(425)
771-0220
ELEAS Y DATE
ATTENTION
EXT 333
ITISUNLAWFULTOUSEOROC UPYABUILD1 OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL ORJA CERTIFI_
ORIGINAL -PILE YELLOW, INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. LECSECTION 09
FAX
PINK - OWNER GOLD - ASSESSOR
5198
Z
c m
m 0
0
0
C
.L M
m
z
o -n
3:
m M
a
0
C
M 0
z
z
TO.
-DATE:
MEMO TO: PERMIT COORDINATOI;� BUILDING DIVISION
FROM: DATE —
DIVISION DATE—
. ..... JLANNINGDIVISION
PROJEC
SITEADDRESS
PERMIT cDM-7 7S# ----DATE INSPECTED —
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to detennine compliance with approved plans. Final approval. denotes that
there are no objections from the above signed Department to the granting of:
—Yinal 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.
OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
ocaprvl.doc1:ftT.b1dg:fbrm96198
z
m
m
m 0
0
0
M
M z
0-4
z
0 -n
m M
0 Y)
0
0 F;
a cc
C ch
M 0
Z
z
-4
z
0
q
0
m
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
z
Pier/Porch ..........
0
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
0 IT
ITI
0
Underground .............
Rough -In ...................
M
IR
Commercial Final
10
C:
HEATING:
t,
GasTest ....................
0 -D
Gas Piping .............
CM
Equipment .................
IR
Commercial Final
0
0
EXTERIOR SHEATHING
NAILING ........................ -
ITIO,
FRAMING.......... .............
�z
FIRST FLOOR FRAMING...
INSULATION
z
Floor insulation
Wall Insulation ...........
Z
0
Ceiling Insulation
B
SHEETROCK NAILING
0,
M
SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..................
ED PERMIT EXPIRES.
PERMIT
UE
Z NE NUMBER
SUITVAPTN
CITY OF EDMONDS jos 77, �_CJ
DDRESS
ADDR
CONSTRUCTION PERMIT APPLICATIO
LOT NO. LID NO.
oWNERNAME)NAMEoF��INESS PL�ATNAME/S DWlSloNNo LID EE S
_0 V11,A+ 5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP o
IF LING ADDRESS o
T-A CA L EXISTING � ,RoPoSED� U o
zip TELEPHONE 00 FtEoUIRED DEDICAT ON FT — w 'A IT
00 F FIXTURES
ft METER SIZE I LINE SIZE No. 0 9
5E
NAME Le.t, 0 L g - NGINEERING 7
ADDRESS DATE
FIRE REVIEWED BY
zip TELEPHONE
CITY INSPECTION
SHOR LI E OR AD # P ED
0 VAPIANCE OR CU R
W4 s jL3No
ANON ATE piJECKEDBY HEIGHT
STAr LICERSEN MB LLo KIN A EA ALLOWED pRoposED
SEP REVIEW OF E
E PT ALLO
COMPL EXE
PROP AC_ CUNT PARCEL NO. Exp 'I pRopoS DEBT ACKS(FT1
LOT CoVERA E REQUIRE BE BA El FRONT URsI,.E REAR
cH ALLOWED PR P BED FRONT sl E A
C] NEW 0 RESIDENTIAL PLUMBING f ME E
0 Co PLIANCE OR EA IF NO ZEWE Y
N 0 COMMERCIAL CHANGE OF USE RKING DED LOT
0 ADDITIO REolo PRDV
0 FEM..0, 0 APART ENT S�`NC E REMARKS
G"?t G Cy6s 0 X FTI
bREPAIR 0
0 DEMOLISH ------
C] TANK o OTHER
0 RENEWAL
0 RETAINING WALL coo- --C-PA;�s
0 c T T u $ON
GAP E' B.KEDBY TYPEOICONS
, BUSINESS OR ACTIVITY) 5XPLAIW
Ir (TYPE F E, I I AREA OCCUPANT
C ITICAL LOAD
NUMB NUMBEROF �BAS� REQUIRED 0 YES
DWELLING
OF
s IES REMARKS JOB/FINAL INSPFCT'C't4
S RIBE��K TO DONE n.G.ESS INSPECTIONS PER USC
TOR
Of 0 rj
e- i vi Ck
VALUATION FEB
4 ATSOURCE GLAZING % LOT S . LOPE % BUILDING
VESTED DATE PLUMBING
A CK N112 MECHANICAL
t —1 ERSWORKTO
IT AUTHORIZES ONLY TH E WOR K N�GTF D "M�'ToCNoTVHE PUBLIC GRADiNGfFILL
Ly. A C6,TSHT",,',
THIS E RTY oNL. R ,,
E ON PRIVAT MARQUEES, ETC.) WILLREQUIRE
t. AIN (CURBS-SIDEEPWRAoLPSKEES�AIIAAITV�EWpEA�yR�SM"ISSION.. STATE SURCHARGE
a PERPTAPPLICATI : IBG,DA - YS DWITHIN VIDDAYS ENG. REVIEW FEES
VIDEO RKIS STAR
E IT
PERMIT LIMIT,, AR , P ORE
SEE a OF K PER F RM "'FoRMATIoN
HEIRS� ASEl— � ------- -
IPLICANT ON BEHALF OF HIS OR HER SPOUSE� LAN.ISCCTAol'�N
�N _CT
DEM FALDEEND Ayll�D.S L AR L F EE
;N'INTERES�, AGREES TO �N H A E T A YA RECEIPT
T5OFFICI S.E.,L. I E T Y IN I T
E Y AL T E PLAN CHECK DEPOSIT
ALL I F R A A ES FW T ISPAN 11 Y lEcjj��
E I E
FA THEISSUAN E FTHIS I RED 'RE E T F I A EP VISI
D EDT DIFY AIVEOR T ENF R Y R
N U IT INANY AYTHEClTY A I I TOTAL AMOUNT DUE APPLICATIO APPROVAL
ol ATIULNY. HAT 'HE lNFQNENT0`F T --l. �.� "Y
P.-t ... ... d, .�,i
G T B O�N D d'F..
EBY ACKNOWLEDGE THAT I R,VTIFE.AD 11�41�S. A PL'.GE c- CALL p.. P,
I'll, M E W. P I AU CONSTRU
IS CORRECT; AND THA�TplA N
Y I RIGULITING .-P
-ER WITH CITY AND STATE LAW 'L E EMPLOYED
T.EiCW BE To -o HollizEll THEREBY. NO PERSON v N RELATING T FOR INSPECT'
A, G IN ,A.I.�. T , E W.��K ALIT E OF TH STAT
Ho"bi-ATION OF THE LABOR Coo F FCW E OF WASHINGT OFF CiALS SIGNAI Lo - 00
i IN VI UP AND 18.27.
W KM SCoMpENSATiONINS ANCE (425)
U (OWNER OR AG N 1. ATE St D -0220 RELEA Y
i SIG 771
E XT 333
ATTENTION OR STRUCTURE UNTIL F YELLOW. INSPECTOR
SE PY A BUILDI 771 -Ull I oRIGINAI- -ASSESSOR
IT IS UNLAWFUL T PINK ER GOLD
,TI B E ADE AND APPROVAL OR A CERTIFI-
A FINAL INSPECTI N AS FAX
CATE OF OCCUPA Y HAS E GRANTED. UBC SECTION 109