20000846 (2).pdfT>
PERMIT EXPIRES
USE PERMIT
PERMIT
Cirf OF EDMONDS ZONE NUMBER,?
r R
N U7�
T1,1APT1
CONSTRUCTION PERMIT APPLICATION JOB 'fr (�)/
ADDRESS 01'
OWNER NAMEINAME OF BU
7" t PIL4T NAMEISUDDIVISION No. LOT 00.
I LOT NO "�'D'
FEE It
MAILING ADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
-a 'a
CITY EXISTING — PROPOSED
DEDICATION— FT
REQUIRED
NAME MMn SIZE LINE I PAV REQUIRED as
Esi3 NO E3
I
/t/ 12— 5
se
-A..R... REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDMINAGE
CITY ZIP
ITELIPIONE
OZ-TAW A PE:Rwr nti R u!-�e:'-OE CLU ROW
NAME
A LA11FIZ UALA_ FI)P-- I Or-
I
EVIEWEIIDIT
/v E E.Vba lNfA
r N
se ADDRESS Z�q-j oo2_=Dj
FIRE REVIEWED BY DATI!
l�E
CITY ZIP TEL6HONE
STATE LICENSE NUMBER EXPIRATION VARIANCE OR CU SHORELINE OR ADS# INSPECTION I BOND
POSTED
A�go No
B-6 2--9(o E3
$EPA REVIEW S... a— HEIGHT
ALLOW
GEL NO COMPLETE EXEMPT ED P; ALLOWED PROPOSED
V
i
EXP J 6
...
LOT COVERAGE R. As. .... "T., PROPOSED SMACKS (FT)
As. I'.
NEW 0 RESIDENTIAL 103 LUMPING I MECH ALLOWED PROPOSED FRONT SIDE BEAR FRONT URSIDE REAR m
Z
ADDITION 11 COMMERCIAL [3 COMPLIANCE OR
CHANGE OF USE -J
PARKING IT All P a RE a DATE
LOT AS
0 REMODEL 0 APARTMENT 0 SIGN 'Eqo 1 ...... E I — 6-19—&z
REMARKS
• REPAIR 0 GRADING CYUS X Fill REMARKS A LL"A/11 (�D 1* PP4>po�� ff'� it
• DEMOLISH [3 TANK
INLOV100 (b ff EPARf�F-D 6
A
GARAGE RETAINING WALL
RENEWAL
CARPORT 13 ROCKERY
A
ITYPE Or U17 OR ACTIVITY) EXPLAIN:
CHECKED BY CCUPANT
PREMARKS
G OUP
ITyp
NUM:R BUTIC(Al. tA OCCUPANT
OF 'REAS SPECIAL INSPECTOR
JARS
As STORIE!�t JUMBER REQUIRED [:] YES LOAD
S
9
DESCRIBE WORK TO BE DONE
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REOD
P.O. ss INSPECTION.
as
z
0 In
ITT 'a
mm
z
0 -n
,n
mm
055
0 F
C: 01
C C0
In C)
Z r-
3:
>
z
VALUATION $
12L'S r9z11W lea /? Rescription
FEE
Description
FEE
co
z
Plan Check
0
I
SOURCE
LOT SLOPE % Building
0
m
PLAN CHECK NO, aTED DATE
51� Al
Mecnanical
THIS PERMIT AUTHORIZES ONLYTHE WORK NOTED. THIS PERMIT COVERS WORK 10
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC pGrading
2 0 LL
3 OMAN ICURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC4 Wl REQUIRE
1: SEPARATE PERMISSION. Engr . We
Engr. Revie.
Recording Fee
city surcharge
2___
0 K RRE
PERMIT LIMIr. I YEAPRERPMIRTOV"10pg.D.W..R.:IS'S.TA."D WITHIN led DAYS ngr. Inspection
SEE BACK OF PINK P9RMTT FOR MORE INFORMATION
State Surcharge
Plan Chk Deposit
Traffic Mitigation
-APPLIC ON BEHALF OF His OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Receipt #
A EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Revi w
AULCLAJMSFORDAMAGESOFWHATEVE NATUBEAFIISNODIRECRYORINDIREerLy
THIS
FROM THE ISSUANCE OF THIS PERMIT." ISSUANCE OF PERMIT SHALL NOT BE
Fire Inspection
TotalAmountt)ue
DEEMED TO MODI IN, WAIVE OR REDUCE ANY REQUIREMENT OF MY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION - Landscapolnsp�
Receipt #
I HERE ACKNOWLEDGE THAT � HAVE READ TH S APPLICATION: THAT THE INFORMATION
APPLICATION
APPROVAL
GIVE 19 CORRECT. AND THAT AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
N
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING COUSTRUC. CALL
i'�Jnnt -P until signed by Me
�'P-
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL HE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TAB
FOR INSPECTION
8
oppfilentlen
_tXej 'n he, "I": and Fees M paid. and
�A�smh
jpH..unPwI Budinap—In Idea.
WORKMEN$ CO�INNSA I SURANCE AND AM 18,27.
70
Ol to
a SIG UBE D
s:
DATE SIGNED (425)
0 2-
771-0220
AIE
ATTENTION Z, EXT 1333
Z
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UN
- 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
GINAL -FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX
PINK - OWNER - GOLD - ASSESSOR
IS/01 ta
FINAL PROJECT APPROVAL-FOMM
TO:-
DATE:-,
MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: -FIRE DEPARTMENT DATE -
ENGINEERING DIVISION DATE_A1Va4&1
PLANNING DIVISION DATE-
PROJEC
SITE ADDRES
PERMIT oz) 04 b.__ADB#__________DATE INSPECTED.
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine final compliance with approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
copy ofCONDITIONS given to owner/contractorby inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
o Copy of CORRECTION NOTICE given to owner/contractor by inspector.
2.
3.
RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date_ Sigu_
ocaprvi.doc.l:temp.bidg:fomsIO/OI
z
0
i
0
0 M
C:
MO
0
80
C
X M
M Z
Cn
0 -n
n
-4
M M
M
CD
M 0
z
z
--I
a:
rn
z
M
FINAL PROJECT APPROVAL FORM
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATI�—
ENGINEERING DIVISION DATI�—
Ae— PLANNING DIVISION DATE--L& --02—
PROJECT�—
SITE ADDRESS
PERMIT#eg&—X,9e4'�� —ADBk----DATE3NSPECTFD—
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine final compliance with approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
BONDS and the granting of
GRANT FINAIL PROJECT APPROVAL
GRANT PROJECT APPROVAL WTIH CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractorby inspector
1.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_
ocaprvi.doc.l;temp:bldg:fonnsIO/OI
z
:49i
M
0
0
0
M z
0
n
M M
6 CA
0 'M
C: Cl)
C u)
Q 0
Z r- I
z
z
M
Footing ......................
Wall .....................
Pier/Porch .............
0,
Retaining Wall ...........
Stab Insulation ..........
"It
PLUMBING:
6ncl�argrouncl .............
rn
C_
Rough -in .. .................
M 0
0
C
Commercial Final
M
M
HEATING:
;G.s�Tiist ................
Gas Piping ............
Equipment.......... . .....
0
M
Commercial Final
M M
EXTERIOR SHEATHING
NAILING . .........................
0 Fn
FRAMING .....................
M 0
FIRST FLOOR FRAMING
INSULATION � ..................
;01
Floor Insulate
z
Wall Insulation ...........
Ceiling Insulation
z
SHEETROCK NAILING
SPECIAL INSPECTION
ITI
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .................