20000957.pdfATE RECEIVED
PE MIT EXPIRES
AE PERMIT
CITY OF EDMONDS
ZONE
NUMBER ao,�2CM
CONSTRUCTION PERMIT APPLICATION
7 il
JOB �UITV0T�
ADDRESS Avj,-A -
OWNER NIMIINAME .1 BUSINESS
PLAT NAMEISUBONtSION NO.
LOT NO,
L NO.
J�Ajk -
I
L�D
0 FEE S
MAILING ADDRP�qg
54.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TE—App, u
W 1-11 ..l. - 0
0
EXISTING — PROPOSED
0
SW—k --d 13
CITY ZIP
c—J.0"m /W ITILEPHON1
REQUIRED DEDICATION— FT —
U..".-
NAME
c
METER SIZE LINE SIZE NO. OF FIXTURES
PAV REQUIRED
I YES 13 -No 0
-ADDRESS
REMARKS
F—P—IF, F FOR EROSION CONTROUDR—
CITY v ZIP
TELE ONE
ENGINEERING REVIEWEDIDATE
By DATE
FIRE REVIEWED
TELEPHONE ,A-
I I
I
VARIANCE OR CU
SHORELINE OR ADS#
INSPEC ION
BOND
—INA"
lTj7; V 04
- No
POSTED
—
SERA REVIEW
PLETE I IXEMI
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOS I ED
12
,WWa
)jyNT RAPID L No.
EX v-
450 31,6'
14,
LOT COVERAGE
REQUIRED SETBACKS (FTJ
PROPOSED SETBACKS (FT.1 I
0 PLUMBINGIMECH
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT .1 UR SIDE REAR
ADDITION ci COMPLIANCE OR
CHANGE OF USE
IVA
AtA
PARKING LOT
Al"
0 REMODEL g"SICIN
FEQ D I PROVIDED
AfA
0 GRADING CYOS 0 FENCE
0 REPAIR X FT
REMARKIS',W 4^a 6.4ft- I f
AO
0 DEMOLISH TANK 0 OTHER
ARA E 0
G G RETAINING WALL RE.—L
ZI CARPORT
IVITY) EXPLAIN:
UCTION
JOCCUPANT
ROU P
NUMBER
OF
NUM5 .....
WILLING
��CC.LPANT
LOA
STORIES
U NIT.
REQUIRED n YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
-fiDP- �FlkVpL
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE LOT SLOPE % BU LOING
�±E.TE. DATE
PLAN CHECK NO: %w�
IMECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE l.UBLIC GRADiNGIFILL
2 DOMAIN (CURB$. SIDEWALKS, DRIVEWAYS . MARQUEES, ETC.) WILL RE B, E
:I SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
Wo ENG, REVIEW FEES
PERMITLIMIT.-I AR -PROVIDED AK IS STARTED WITHIN 180 DAYS
Y,
SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION
ENO, INSPECRON FEE
'APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HERB ASSIGNS AND SUGCES SS
IN' NDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
:TSOFFICIALS.
2 MONE,):ST.AA"`EGT0TO
ED , .IN N, EMPLOYEES, �NDAGEMTSFMONI ANYAND RE IPT
ALL _,MS,.R.A.AG.SOF-HATEVER NATURE, ARISING DIRECTLYOR INDIRECT'
FRC M THE'SSUANC. OF .IS PERMIt ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT _0,
C ORDINANCE 16,
OR REDUCE ANY REQUIREMENTOF ANYCITY
DEEMIDTO MODIFYWAIVE
INANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' REC
NOR LIMIT
TOTALAMOUNT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
THEOW 0 Y E LAWS REGULATING CONSTRUC Su'l Thl, applil I'll 11 - I P11111 'I'lil S19"Od by IhO
GIVEN CORRECT. AND THAT I AM THE OWNER OR THE DULY AUTHORIZED AGENT OF IL
ISER, I AGREE TO C MPLY WITH CIT AND STAT CA dimp 0111111111 hllfhll D,puty: ,d F111 — pa d� ,d
Ti0f,L AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE LEMPLOYTED ,—PI I, Ilk—lod9ld in spaco providod.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RE AIIN. 0 FOR INS TION
WORKMEN'S COMPENSATION I RANCE AND RCW 18.27, 0 F I LS SIGNATURE DATE
SIGNATURE IOWNE 0 E ''ZTE SIGNED (425)
771-0220
RELEASED By
ATTENTION EXT/333
IT IS UNL.AWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLOW- 114PEC�OR
CATE OF OCCUPANCY HAS BEEN GRANTED� LED SECTION 109 FAX PINK - OWNER GOLD . ASSESSOR
sigo
FINAL PROJECT APPROVAL F
TO: —L�
DATE: —
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
IRE DEPARTMENT DATE —
FROM:
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE--L—
PROJECT
SITE ADDRESS -,AIL Sp
PERMIT
Z�DATE lNSPECTED---1--L<—
DESCRIPTION OF WORK TO BE INSPE
approval denotes that
A field inspection was conducted to determine compliance with approved plans. Final
signed Department to the granting of:
there are no objections from the above
described work
Final approval of the
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
ocaprvl.doc.l:temp:bldg:fornis6/98
z
0
=j
0
M
=4 9
3:
m
M 0
-q 0
0 0
3: M
M z
z
3:
O"n
mm
065
0
0
C ca
F- "
M
Z
z
ca
z
0
4
0
M
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ......................
Z�
0,
Pier/Porch
0
Retaining Wall
Slab insulation ..........
x
u,'
t;,
PLUMBING:
M
C
Underground .............
0
ITI 0
C
q
Sough -In ...................
Commercial Final
M,
1TI 2;
10
HEATING:
C
GasTest ....................
Gas Piping .................
-n
Equipment
2:
M ITI,
Commercial Final
C',
EXTERIOR SHEATHING
'NAILING .......................
K ca
M 0�
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
-4
Wall Insulation ...........
Ceiling Insulation
Z
SHEETROCK NAILING
ITI,
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ................
V001,
,E
f- -
PERMIT EXPIRES
T
CITY OF EDMONDS P1E1MM8'ER
CONSTRUCTION PERMIT APPLICATION 'A'DBRESS NUITIEJAI"T'
! 1 �3 3 - '51, �q v L A
MAIIINGADD 11S
2�C2> _5�fi 54.
1 CITY ZIP ITELEPHONE
-'r
0. it c
E LICENSE NUMBER
itnict
EATY TAX ��
"'N 'YNT PARCE N
NEW L Lj PLUMBtNG/MECH
0 ADDITION ....".IAL ci C MPLIANCE OR
CHANGE OF USE
LOI'P'�IT.�NT
0 REMODEL
9�
C] REPAIR
n GRADING CVQS 0 FENCE
I X FT)
0 DEMOUSH
0 TANK OTHER
o GARAGE
CARPORT
r-1 RETAININGWALL
ROCKER
0 RENEWAL
0
(TYPE OF USE. BUS NESS OR CTIVITY) EXPLAIN;
NUMBER
0
ad OF "!I1.
STORIES 0 _
DWELL N
J..NUM1111 0 F
UNITS
ARE S
NO BE"
DESCRIBE WORK TO BE DONE
a f-no //'
PLAT NAMEISUBDIVtSION NO� I LOT No' UO NO,
LI. I�S I
PI 1.111, RIGHT OF WAY PER OFFICIAL STREET MAP
P.1-a --d
EXIS ING - PROPOSED�
0
0
REGUIREDDE01CATtON- PT -
0
z
REMARKS
OWNEMCONTRACTOR RESPONSIBLE FOR E80SION CONTROUDRAINAGE
Lim I
ENGINEERING
0
FIR REVIEWEDBY DATE
=4 7
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
..N.
1EQ'D
ES 13 NO
P�STED
-j
m
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLE78 EXEMPT
P;tPO
ALLOWED PRO O11D
c
M
Exp — v"
I
0
80
c
-4 m
LOT ERAGE
REQUIRED SETBACKS IFT.)
PROPOSED SETBACKS (FT)
ALLOWWOV PROPOSED
FRONT SIDE REAR
FRONT URSIDE REAq
= M
JVA.
44
IVA
mz
'0
-PARKING I
LOTAREA
P NNING HE IM DeY
REGO I PROVIDED
NA
r-
0 -n
-n
KS
x0a r_1y_ A -,A 1114 g�,,j _�hhj rkAi�,,4_
kft..'A ik
rn M
CH By
'HeC'
�O N
OCCUPANT
GROUP
065
o Fn
�TYPE�ON517@bTION
, _;E, N.a A
ALI
A OCCU NT
'P.,
�EO IMED [3 YES
LOAD
9 (a
M 0
AEMA K$
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
!:IML 'fop-, E&Itf.
z
-4
z
9
VALUATION
FEE
0
IPLAN CHECK FEE m
HEAT SOURCE 0-IIN13 I LOT SLOPE I BUILDING
PLAN CHECK NO: rESTEDD.1
:,�- cl -7 1
MECHANICAL
THIS PERMIT AUTHORIZES ..L1 THE WORK NOTED. THIS PERMIT COVERS WORK TO
L BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
. DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE
3 SEPARATE PERMIS $OW
STATE SURCHARGE
PERMIT APPL
I E P ERMI T LIM IM I Y EAR - PROVID E'C AO'on NK:1 G OSOTADRATYESO W ITH I N 180 DAY
D W
ENO. REVIEW FEES
R N1
SEE 13ACK OF PINK PERMIT FO ORE INFORMATION
.4 'APPUCANM ON BEHALF OF HIS OR HER SPOUSE, HEIRS� ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
1� IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
cut
2 EO'ONDS WASHINGTON, ITSOFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
1. ALLCII"S'll'AIISOFWHATEVER NATURE. ARISING OIFIECTLYOR INDIRECTLY
ISSUANCE OF THIS PERMIT SHALL NOT BE
INSP rE
DEPOSIT
BEDE PT
0
FR M THE ISSUANCE OF HIS PERMIT.
1 E
9 DEOMED MODIFY, WAIVE 0. REDUCE ANY FIECIIJI.�MENT.l ANY CITY..DW
THECRY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
PLAN CHECK
RECE T
0 NOR LIMITT ION ANYWAY
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT t HAVE READ THIS APPLICATION; THAT THE INFORMATION
A PLICATION
APPROVAL
GIVEN , CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
S AGREE TO COMPLY WITH CITY A ONSTRUC�
THE OWN�F` ' NO STATE LAWS REGULATING C
CA LL
Th,1 ppjt �, d a pa-1 11 ,glad by thQ
OM-- -1 Douly: ld F ... ... Pad, ..d
TION; AND IN DOIN THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
G
IN VIOLATION OF THE LASOFt CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
S'ijdl�q
P-idda,
WORKMEN'S COMPENSAT(�.N.�RANCE AND f3CW 18,27.
OF�FIALS SIGNATURE
(425)
_'. /�
('U'00. I/imin
RELEASED By DATE
ATTENTION
EXT/333
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - RLE YELLOW - INSPEC/OR
A FINAL INSPECTION
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK � OWNER GOLD � ASSESSOR
g�g