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P
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MONDS
CITY OF EDMONDS
US
USE
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PERMIT
NUMBER 21)9778
CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS
SUITEIAPT,
OWNZME/F,OF BUSINESS
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SERA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
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ADDITION
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REMARKS
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TIoN ON THE PU a L
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
GRADING/FtLL
DOMA114 (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REOUIRE
JAN
WFEE
SEPARATE PERMISSION.
2TATE 1�,CIARGE
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E MIT APPLICATION: 180 DAYS
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P I N ao DAYS
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E R
P.
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K OF PI IMATIoN
SEE8AC K OF PINK PERMIT FOR MORE INFORMATION
C
:IN
END REVIEW 'E Es
_ENG
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4 PP CANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
A L LESS F
'A RM THE CITY OF
TO INDEMNIFY, DEFEND AND HOLD HARMLESS
rOR
INSPECTION FEE
I N INTEREST. AGREES 0
" I no AN
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING' DIRECTLY 08 INDIRECTLY
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ISSUANCE OF THIS PERMIT 5yHALL NOT BE
PLAN CHECK DEPOSIT
PLAN CHECK DEPOSIT
HECESI�_�
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FROM THE ISSUANCE OF THIS PERMIT.
C
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DEEMED TO MODIFY, WAIVE 0 R REDUCE ANY REQUIREMENT OF ANY C ORDINANCE
LI:MIT ANY WAY 7HE=ILITY TO ENFORCE ANY ORDINANCE PROVISION.'
N.FI__T " Y 'NAY H CII
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TOTALAMOUNTDUE
NEC EIPT a76
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMA710N
ATION PPROVAL
GIVEN IS CORRECT , ANOTHAl I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THEO NER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING COIISTRUC.
CALL
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TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
WASHINGTON RE LAT ING TO
FOR INSPECTION ..11, --lodg,d spaco p,llldld.
INVI LATION OF THE LABOR CODE OF THE STATE OF
WORKMEN S COMPENSATION lNSU RANCE AND RCW 18.27
0 ICIALS SIGNAT DATE
W R R AGENTL�Z
DATE S ED
(425)
1, 1 OD
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14 7�')' /
771-0220
DATE
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RELEASE BY
.a
ATTENTION
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE - YELLOW INSPE TOR
A
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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FIN , PROJECT AppROVAL FORM
TO:-
DATE:-
NMMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DATE
FROM:
Q�,ao���EN 1GDIVI NDATFALZSLOL
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PL =G DIVISION DATE
PROJECT
SITE ADDRESS
SPECTED
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DESCRIPTION OF WORK TO BE INSPECT
Final approval
A field inspection was conducted to determine final compliance with approved plans
denotes that there are no objections from the above signed Department to the release of
pERFoRm.ANCEBONDS and the granting of:
C GRANT FINAL PROJECT APPROVAL
77'
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
C, Copy ofCORRECTION NOTICE given to owner/contractorby inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date__� Sign ------- --
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
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wall I ...................
Pier/Poreh .................
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Retaining Wall ...........
Slab Insulation ..........
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PLUMBING:
Underground .............
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Rough -in ...................
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Commercial Final
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HEATING:
2 t 4-..
M
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Gas Test ....................
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Gas Piping ..............
Equipment .................
Commercial Final
EXTERIOR SHEATHING
M ITI
NAILING ........................ .
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FRAMING........................
1
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FIRST FLOOR FRAMING.-
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INSULATION ................
Floor Insulation
Wall Insulation ...........
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Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
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MISCELLANEOUS
FINAL APPROVAL.FOR
OCCUPANCY...... ...........
--------------
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CITY OF EDMONDS
PERMIT v
NUMBER
SU;TEIAPT#
CONSTRUCTION PERMIT APPLICATION 57'
i
o�l��A.EN�E,.l USINESS FLAT IAMEISUBDIVISION NO. LOT NO. LID NO.
f, ��/ 0 ', ._ LID FEE $
MAILING ADDRESS S'7' PUBLIC
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RICH CIAL STREET MAP
EXISTING — PROPOSED -
CITY zip TELEPHQNh
E.UIRED DEDICATION FT
METEgl,-E.
LINE SIZE NO. OF FIXTURES PRY A EQUiRED
NAME
o YES !X NO
REMARKS
RESPONSIBLE FOR EROSION CONTROL/DPAINA—
to ADDRESS oWNERICONTRACTOR
CITY
NAME rl,lll,L e-A1,4
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U DATE
CITY
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SHORELINE OR ADS. INSPECTION
VARIANCE OR CU
STATE LICENSE NUMBER :KED By OYRE POSTED
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C C 0 Al* d F 1— ARM I'T
PROPOSED ALLOWED PROPOSED
PROPERTY TAX AGCOUNTPAR COMPLETE EXEMPT ALLOWED
EL NO.
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19�2 2 -QZX ;,06
PLUMBING
NEW (.2 RESIDENTIAL m CH ALLOWED
PROPOSED SETBACKS'(Fn
LOT COVERAGE REQUIRED VTBACKS (Fr.) FRONT UP SIDE REAR
PRopos FRONT E REAR
1V 25'
COMPLIANCE OR
ST5 7, 220
Cj ADDITION 0 COMMERCIAL CHANGE OF USE
REQ-D
PARKIN L T AREA PLANING RE�.IEW DATE
PR VIC D 'PT
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
WILL REQUIRE
GFIADINGWILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS' MARQUEES. ETC.)
:i SEPARATE PERMISSION
S ESURCHARGE
PERMIT APPLICATION: 180 DAYS
P KIS TED WITHIN 180 DAYS
T PERMIT LIMIT'. I YEAR � ROVIDEDWOR STAR
E G. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE NFORMATION
;APPLICANT, ON BEHALF OF HIS OR HER S OU'E NSSIONS AND SUCCESOPS
DEF " 'SLO CITY OF
END XNDERO HARMLESS THE
ENG. INSPECTION FEE
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INDEMNIFY.
N INTEREST. AGREES TO ITS OFFICIALS. EMPLOYEES. AND AG NTS FROM ANY AND
DMO'OSjW"HNTO'
JUSPSQUON"E
2 0 MECTLlY OR INDIRECTLY
ALL CLAIM FOR GA.A.6 OF WHATEVER NATURE. ARISIN BE
OF THIS PERMIT SHALL NOT BE
F'
ECK DEPOSIT
PLAN C T
FR THE ISSUANCE OF THIS PERMIT. ISSUANCE
OM RE CITYORDINANCE
DEEMED To MODIFY, WAIVE OR REDU EANY -QUIREMENTOFANY
NOR LIMIT IN ANY WAY THE CITY9S ABILITY TO ENFORCE ANY ORDINAN CE PROVSION'
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
THE DULY AUTHORIZED AGENT OF
M 'HE OWNER OR
GIVEN "CORR"ANDTHATA T T INGCONSTRUC
C ALL
T EOWN.. A.�EET.C..PLY�,T�C�TY�ND�TATE�WSREGULA
IN . 0 ING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
TIOR AND 0
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
WORKMEN'$ COMPENSATION INSURANCE AND RCW 16.27.
DATE SI�NED
(425)
771-0220
ATTENTION
TO USE OR OCCUPY A BUILDING OR STRUCTURE UN71L
771-0221
IT IS UNLAWFUL
HAS BEEN MADE AND APPROVAL OR A CERTIFI
A FINAL INSPECTION
CArE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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