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NUMBER
CONSTRUCTION PERMIT APPLICATION
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THIS PERMIT AUTHO IZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK T 0
BE DONE ON PRIVATE PROPER Y ONLY. ANY CONSTRUCTION ON THE PU BLIC
DOMAIN (CURBS, SIDEWALKS. DRIVE MARQUEES, ETC.) WI LL RED UIRE
WAYS�
GRADING/FILL
SEPARATE PERMISSION.
PERMIT APPLICATION: 100 DAYS
W.g�CHARGE
PERMIT LIMIT, I YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
9�. REVIEW FEES
MW INSPECTION FEE
-AP LICANTONIBEHALF F HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
HOLD HARMLESS THE CITY OF
u WINTER ST. AGREES TO INDEMNIFY, DEF NO AND
2 EDMOND ASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ia
4L
ALLCI-AIMS FOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
S.
FROM THE' '111A CE OF THIS PERMIT. ISSUANCE OF THIS PERMIT,SHALL NOT BE
PLAN CHECK DEPOSIT
A CEIPT
MODIFY. WAIVE OR REDUCE ANY REQUIREMENT 0 Y Y E
DEE.WTO FAN CT ORDINANC
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
R CEI
i
TOTAL AMOUNT DUE
7/6 71, A
I HER18Y ACKN.W EDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT AN. THAT I A. THE WNIER. OR THE OUILY AUTHIDMIE. AGENT OF
T EOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REQUITING CONSTRUC-
TI ON. AND IN DOING THE WORK AUTHORIZED THE REBY. NO PERSON WILL BE EMPLOY E D
CALL
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IN VIOLA OF T E LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
11—PI � 11-11-go— 11 P'llldld
K. OMPENSATION INSURANCEAKffpCW,18.27.
WOR E;,a
DATE
DATE SIGVO f
(425)
Lk-10141—
'fIELE41ED BY 'DATE
ATTENTION
/"Mr. 'UCTURE
EXT1333
IT IS UNLAWFUL TO USE OR Orr' MY I n' R STIR UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE YELLOW INSPE60R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER COLD ASSESSOR
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FINAL PROJECT APPROVAL FORM
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DATE: —
MEMO TO: TCO IN OR, BUILDING DIVISION
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ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE —
SITE ADDRESS- -10 0-k-, "41-.
PERMIT UZ �.ADB#________DATE INSPECT
DESCRIPTION OF WORK TO BE INSPECTED Us-�-
A field inspection was conducted to determine compliance with approved plans. Final approval denotes that
there are no objections from the above signed Department to the granting of:
Final approval of the described work
D L_
GRANT FINAL PROJECT APPROVAL DEC 0 2000
EDMONDS I PT.
-GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
FINAL INSPECTION - OUTSTANDING ISSUES
1.
2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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ENGINEERING DIVISION DATE -
DIVISION DATE�__
PROJECT_,�-�-�11-40 SC,&vC)L_
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PERMIT # B#_DATE INSPECTED_ta�LZ
DESCRIPTION OF WORK TO BE INSPECTED___/3 C- 6 r-1 1--J'r - L
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
PER RMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
cl Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
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3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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DATE:
MEMO TO: pERmrr COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE-
-ENGINEERING DIVISION DATE_5�� —
PLANNING DIVISION DATE —
PROJECT
SITE ADDRE�SS� 'D C9
PERWr #&&&_2�,d�ADB#________pATE INSPFCTE
DESCRIPTION OF WORK TO BE INSPECT
I 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
0 Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
t3 Copy of CORRECTION NOTICE given to owner/contractor by inspector
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Date— Sign_
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ENGINEERING DIVISION DATE—
LANNING DIVISION DATE —
PROJECT
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PERFORMANCE BONDS and the granting of
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: �� � e__ —FIRE DEPARTMENT DATE-/=L.21-0 —2-
ENGINEERING DIVISION DATE
PLANNING DIVISION DATE —
PROJECT
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SITE ADDRESS
PERMIT #_Cg&!Z�ADB#_______PATE 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
u Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINALINSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
2. MICROFILM
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall .................
Piet/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground
Rough -In ...................
Commercial Final
HEATING:
Gas Test ...........
Gas Piping ................. --------------
Equipment ........... ....
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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I'PERMIT EXPIRES
.. PERMIT
CITY OF EDMONDS Z.,,E t NUMBER 201
ADDRESS
_ 0 �'),
CONSTRUCTION PERMIT APPLICATION jas j EIA�T*Qj
OWNER NAM51NAM�l BUSINESS 5-C+400L, TPAC_I_ P- NAMElSlBDIvIsION NO, I LOT NO LID *NO.
ebm K)zs is LID FEE S
MAILINGADDRESS ... � I
PUBLIC RIGHT OF WAY PE A OFFICIAL STREET MAP Z., o
S11 . P.-I R.4 6 0
2_0
o q04- zi P TELEPHONE EX15TING - PROPOSED 83
CITY
6-70 f7o" REDD IRED DEDICATION __ FT
J,NAME NO. OF FIXTURES PRV RECOPIED
YES 0 NO 0
ADDRESS
jx I �L(
REMARKS ROSION CONTROUDRAINAGE
OWN8RICONTRACTOR RESPONSIBLE FOR E
CITY
ENGINIE�R_11G REVIEWEDIDATE
ADDRESS
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t
ZIP TELEPHONE
CITY I
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SHOREUNE OR ADS. INSPEITIO BOND
' POSTED
STATE LICENSE NJER X ON DATE CHECKED By
0/ OeF
OYRE
ES [-] NO
SIGN AREA HEIGHT
PFICIPEP� TAX ACCOUNT PARGEL NU.
--------- EXEMPT ALLOWED PROPOSED ALLOWED I PROPOSE
Exp I
I
0 RESIDENTIAL PLUMBING / MEG
NEW H
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT1
ALLOWED PROPOSED FRONT SIDE REAR FRONT UPSIDE FEAR
C3 ADDITION COMMERCIAL [3 C MPLIANCE OR
CHANGE OF USE
PARKING LOT AR EA PINNING REVIEWED By DATE
REMODEL APARTMENT SIGN
REO'D PROVIDED
FENCE
REPAIR 0 GRADING CYDS 0 X FT)
X
REMARKS
0 DEMOLISH 0 TANK 0
[j GARAGE 0 FEIAININY� WALL 0 RENEWAL
CARPORT o""R
r (TYPE OF USE. BLISINE S OR ACTIVITY) L
F-1 ITYPE110FCONSTRUGTION I CADE 101
NUMBER NUMBER OF cR I AL
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9"OECIALINSP CTOA
ELL"'. AR AS
OF RIES D NU
0 sTo UNITS BE
JAREA
REQUIRED 11
DESCRIB o
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REMARKS
P ROGRESS INSPECTIONS PER U.0 1.81FINAL INSPECTION REO'D
Re � w I)
VALUATION FEE
=T
PLAN CHECK FEE
HEATSOURCE GLAZING %
LOT SLOPE I
BUILDING
77LA-N CHECK NO:
VESTED DATE
PLUMBING
MECHANICAL
11-111.1111MIT A"' ONLY THE WORK NOTED. THIS PERMIT COVERS WORK To
�y
E Go E o. PRIVATE IR.PERTI..- A. CONSTRUCTION ON THE PUBLIC
UIRE
REQUIRE
GRADINGIFILL
DoMAIN (CURBS SIDEWALKS , DRIVE AYS, MARQUEES, ETC.) WILL
SERARATEWPERMLSSION.
STATESURCHARGE
PERMIT APPLICATION7 180DJWS
WITHIN 180 DAYS
FEES
PERMIT LIMIT'. I AR � PROVIDED WORK IS STARTED
YE
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
�EVIEW
I
FEE
ON BEHALFOF HIS OR HER SPOUSE, HEIRS. AFFIGNS AND SUCCESORS
TjW. INSPECTION
�APPLICANT
�j N INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
INT REST. AGREES TO YA
'rANvsCAP`HG
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2 EDmo DS,.ASHINGTDN. ITSQFFICIALS. EmPLOYEES.A�DAGENTSFFOM A�_,�D
A CLAIMSFORDAMAGE OF WHATEVEANXI__ Y
LFL NOT BE
INSp, R
....... I S_
b, 3-D
F OM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL
PLAN CHICK DEPOSIT
DEEMED FYWAIVEORREDU E ANY REQUIREMENT OF ANY CITY ORDINANCE
ol MOD'WAYTHECITY'SABIC TO ENFORCE ANY ORDINANCE PROVISION.�
RECEIP
0 N ANY LITY
NOR LIMIT
TOTAL AMOUNT DUE
a
I HEREBY ACKNOWLEDGE THATI HAVE HEAD THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN I RRECTANDTHATI AM THE OWNER.ORTHE DULY AUTHORIZED A.ENTOF
SECo
Thl. IPPI1111- 1� - `F-'g��d �' -
THE OWN R. I AD RE E To COMPLY WITH CITY NDST E LAWS REGULATING CONSTRuc
CALL
Buddima QIII-1-11 �l D y �d _ - p� d
TON; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
OF SHINGTON RELATING To
FOR INSPECTION
,ip 11-110d D._ �p_ p'-d. d
IN VIOLAT$ R CODE OF THE STATE
THE I
DATE
W.FK.EWOF
OMPENSAT�ONINSURANCE,$,KgRCVtlB.27�
SIG D /,go
(425)
M,,GAS�-,NAT,�
12nE �1.�N��
I I I-u4e-u
'R ELEASM
ATTENTION
EXT/333
IT IS UNLAWFUL TO USE OR OCCUPY A A/UiLDING OR STRUCTURE U NTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE YELLOW .;NSPE6TOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK OWNER GOLD -ASSESSOR
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