20000764.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMIENAMEOF IINISI
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PVt NAMSISUBDIVISION NO. LOT NO. U10 NO,
LID FEE S
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YES Q NO
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STATE LICENSE NUMBER
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SIGN AREA
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RCEL NO.
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NUMBgROF CRITICAL CTOR
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UMS YES
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VALUATION I FEE
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PLUMBING
MECHANICAL
TH,S.,ERMT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
E DONE . P."A, PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
GRADINGIFILL
STATE SURCHARGE
AMIT APPLICATION: 180 DAYS
Pa.'
ERMIT LIMIT. I YEAR � ROVIDED WOR S STARTED WITHIN 180 DAYS
P MIT PE P K I
YEA.-'
SEE BACK OF PINK PERMIT DR MORE INFORMATION
A KoE.
'APPLICANT. ON BEHALF OF H�S GRiFiER SFENUDSE HEIRoS ASSIGNS AND SUCcESORs
L
. AGREES "' EM Y. BE �N Lo 4ARMLESS THE CITY OF
EIN INTEREST. AGREES TO %
CM-...F.I.l TER OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
— ND . To. I A 'Is
I , CLAIM .F.AM I ECTLYORM ECTLY
A A-E�- P ERMIT $HALL NOT BE
IF ANY .11Y.FDINANC�
RDINANCE PROVISION.-
LANDSCAPI
INSPECTION FEE
PLAN CHECK DEPOSIT
T TALAMOUNT DUE
RECEIPT
R ClIrl 's
I - HERE ACKNOWLEDGE THAT I HAVE READ THI.AEpLREATI. T.ATI.EINFOR. l-
ay AMTHIE WNE .R I- D N ALT .. IZED AGENT ON
o R ULY
GIVEN IS CORRECT. AND THAT' WTRCITY A ' TATE A s REGULATING coNsTRuc-
THE I AGREE TO COMPLY R rE Y, N LL BE E-PL
is Ea o DYE
TION; A 'INGOIN THE WORK AUTHORIZED T ST R E o PERSON wl
IN VIOLNADT ON OF GTHE LABOR CODE OF THE AT F WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27,
SIGNA;�� DATE
S,
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APPLIGAI ION APPROVAL
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CALL RIa'ding 011I I d, hil/hal D,Pwy: and F... .. F.Id. and
recolpt is acknoledged in spaco pid.d�
FOR NSPECTION DATE
OFFICIA ION R
(425)
771-0220 RELEASED BY I LAYE
ATTENTION
EXT 333
IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
771-0221
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FROM: FIRE DEPARTNIENT DATE —
ENGINEERING DIVISION DATE—
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A field inspection was conducted to determine compliance with approved plans, Final approval denotes that,
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there are no objections from the above signed Department to the granting of
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Final approval of the described work
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performance Bonds associated with the project may be released
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—GRANT FINAL PROJECT APPROVAL
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______RE-INSpECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ......... . ..
tv,
FOUNDATION:
Footing ......................
wall.1 .....................
0:
Pler/Porch .............
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Retaining Wall ...........
Slab Insulation ..........
'PLUMBING:
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Underground .............
Rough -in ...................
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Commercial Final
ID —1
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HEATING:
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Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final
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EXTERIOR SHEATHING
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NAILING ............ .............
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FRAMING .............. ..........
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FIRST FLOOR FRAMING
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INSULATION ...................
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Floor Insulation
Wall Insulation ...........
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Ceiling Insulation
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SHEEfROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..............
ATE A E
I PERMIT EXPIRES
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CITY OF EDMOND
SE PERMIT
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CONSTRUCTION PERMIT APPLICATION
—NUMBER
ADD SUITUAPT#
'08AE..'21900
OWNER NAMENAME OF BUS NESS
PLAT NAMEISURDIVISION No. LOTN LIDNO�
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ETER SIZE LINE SIZE NO. OF FIXTURES PAV REQUIRED
NAME
YES 0 NO 0
ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY
ri
NAME nP
ENGINEERINdr'
ADDRESS
00
FIRE REVIEWED By DATE
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CITY ZIP TE EPHONE
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98/
STATE LICENSE NUMBER X11K)N D ATE BY
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exp-- ft I
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THIS.PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
A PA"A E PROPERTY ONLY AN' C B'RUCTION ON THE PUBLIC GRADINGIFILL
DONE
DOMAIN (CURES. S'.EW 'r , AYS. MARQUEES, ETC.) WILL REQUIRE
a ALI " DRIVE ,
SEPARATE PE AMISSION.
STATE SURCHARGE
MIT APPLICATION: ISO DAYS
PE OAK I
b. PERMIT LIMIt I YEARR PROVIDED W S STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ONRIFHYEER SPOUSE. HEIRS, ASSIGNSAND SUCCESORS
;APPLICANT. ON BEHALF OF HIS �
AGREES TO . DEFEND AND HOLD HARML S THE CITY OF
LANDSCAPI G
N INTEREST. :NDEI
Z E LS, EMPLOY.. NIA, EI�TTE FROM ANY AND
DMONDS. WA HINGTON, TS OFFICIAER
INSPECTIONFEE
NATURE "A'
R DAMAGES OF WHATEV AR�, LYORINDIRECTLY
ALLCLAIMSFOS IN.,
IS ISSUANCE OF THIS PERMIT SHALL NOT BE
SUANCE OF THIS PERMIT.
RECEIPT
PLAN CHECK DEPOSIT
FROM THE
DEEMIDTO MODIFY, WAIVE OR REDD ANY REQUIREMENT OF ANYCIT' ORDINANCE
ANY ORDINANCE PROVISION.
RE
T=INANY.I.ECITY'SABICLIET NFORCE
N WAY YTOE
ORLIMI
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APPLICATION A
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION PPROVAL
cx�r�
A
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE OULY UTHORIZED AGENT OF
GUL T
STATE L.Al RE A ILIG NS BY C
"S Co LED
1"0 Thil Ippli-1111- 11 ,1 , pjj ,bI llpld by IhD
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THE OWNER I AGREE TO COMPLY WITH CITY AND _
RE F T
TfONL AND IN DOING THE WORK AUTHORIZED THEREBY. , ' NW' E L .1k..Ildgod 11 'Pa-0 P,ovidod.
F
VI WA' EH'N.T.N RELATING TO
OLAT ON OF THE LABOR CODE OF THE STATE 0
INSUAANCE AND RCW 10;�
FOR INSPECTION
OF ]CIA IGN 7 E
WORKMEN'S COMPENSATION
;7/
(425)
771-0220 RELEASED By DATE
ATTENTION
EXT 333
['016
V�
TO USE 01, OCCUPY A BUILDING OR STRUCTUREUNTIL 771-0221
IT IS UNLAWFUL
HAS BEEN MADE AND APPROVAL OR A CERTIFI-
OR(GINAL�FILE - YELLOW- INSPECTOR
A FINAL INSPECTION
UBC SECTION 109
FAX PINK - OWNER GOLD � ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED.
MI.
7.� _7` -7
ATE RECEIVED
QfP�E�RMIT EXP�IRES
USE
ff� �. PERMIT
ZONE NUMBER
CITY OF E�100 46S SUITEIAPT�
CONSTRUCTION PERMIT APPLICATION AO.80RESS XS-0 �4 'r' A-Vz-- -S
_NB. -.I .1..EINIIS LAT NAME, LOT NO, LID No.
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YES 0 NO
NAME
REMARKS.
ADDRESS NTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP TELEPHONE
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NAME IISWED/DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. TH PERMIT COVERS WORK TO
ON GRADINGIFILL
rF IS UCT, ON T PUBLIC
PROPERTY ONLY. ANY CONST.
BE DONE ON PRIVAT _ WILL E
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DOMAIN (CUR9S, SIDEWALKS, DRIVEWAY% MARQUEE T.
SEPARATE PER STATE SURCHARGE
PERMIT A P�M*N;,lso EMS 91 r� ENG, REVIEW FEES
,, IS RTED WITHIN 180 DAYS
STA
'R.Vt
PERMIT LIMIT, I YEAR ,
SEE BACK Of PINK PERMIT FOR OREINFORMATION
PPLI A t N E LF FHSo,,,,ERSOUS, H,,RS,A,S, SA DS I F MAZ
ACRE s TO DENN"Y DEFEND AND . D A MLS I T E ITY LANDSCA ING
FEE
IN INTEREST.
N. :TSOFFICIALS.EMPLOYEE&AN ENTS FR ANYAN INSPECTION
ED NDS, ASHIN T HATEVER NATURE�ARISI IRE TLY FIN IRE TLY RECEIPT
BE 0
ALLC I IF A A F PE IT SHALL N T BE PLAN CHECK DEPOSIT
THEi EU NCE FT I PER IT. I I ANCI IS
ITY R INAN��
FA T F Ny
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T EDE 5 YA It
DE ED Y DINA CE R VISt
AYTHE SABILIT AMOUNT DUE
o N LI IT N TOTAL
APPROVAL
THAT THE INFORMA ON V\,, APPLICATION
,H ABBY L011 T�HAT lAVE READ THIS APPLICATION Rino AGENTOF uI,Ijj.Igd b, II, -
HAM OR THE DO LY UT T"ll ""'I,
AT: THE OWNER, Fi,h. D.,,uly: .�d F P� 'd
TING C
IS=".. NO STATE LAWS RAEGULOA ONSTRUI CALL Eull..,, 11 1
EIRN I REE T WiTHIRCITY AlHEREBY, Wi LLBEEMILOY �kNlg-
TH TED FOR INSPECTVON
DIN THE OR'PLY
NO PE N
KAUTH IZEDT "So
TI AN TATE OF WASHINGTON RELATING 0
54 CODE OF THE RE
N F THE LA ICW IS 27 OFFIC SIG
IN I ILE IS
C 'URANCE AND I
K E I C ENS I NI (425)
It use NER A TE
771-0220 EASED By
EXT 333
ENTION OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
TO USE
IT IS UNLAWFUL ROVAL OR A CERI
109
A FINAL INSPECTION HAS 13EEN MADE AND APP FAX
CATE OF OCCUPANCY HAS SEE N GRANTED, UBC SECTION