20010668.pdfDATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMENAME OF BUSINESS &/�Aj 6-1 oq,= -r
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MAILING ADDRESS AL
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CITY ZIP TELEPHONE
NAME
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USE PERMIT
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SUITEIAIT.
ADDRESS
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FLAT NAME'SUBDIVIS(ON NO, I LOT No LID N04
LID FEZ S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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REQUIRED DEDICATION— FT
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METER SIZE I L114E Sli� PRY REQUIRED
REMARKS
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0 PLUMBING I NECK
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ADDITION
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APARTMENT
CO PLIANCE OR
CHANGE OF USE
SIGN
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LOTAll
P NNING REVIEWED By DATE
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0 GRADING CGS FENCE
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0 DEMOLISH
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RE RENEWAL
[3 A TAIN
(TY PE OF USE. BUSINESS
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CCUPANT
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NUMBER
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NUMBER OF
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DESCRIBE WORK TO BE DONE
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'
VALUATION
FEE
PLAIN CHECK FEE
HEAT SOURCE GLAZING % LOT SLOPE %
lUIlDIN.
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PLAN CHECK NO: VE -TEIT . TE
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MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE P.UBUC
G.ADIN FILL
DOMAIN jCURBS, SIDEWALKS, DRIVEWAYS' MARQUEES, E RE LIFE
SEPARATE PERMISSION.
—PEAMIT
GuRcH RGE
APPLICATION: "' DAYS
PERMIT LIMIT. I YEAR PROVIDED WORK IS STARTED WITHIN 180DAYS
ENG REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-AP LICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
P
ENG, INSPECTION FEE
IN INTEREST AGREES TO INDEMNIFY. DEF ND AND HOLD HARMLESS THE CITY 01
LANDSCAPING
2 E MONDS. WASHI.GTO.. ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANYAND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIFECTLYO.q IN DIRECTLY
INSPECTION FEE
FROM THE ISSUANCE OF THIS PERMIT ISSU NCE OFlHIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
DEEMED TOMODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
I
0 NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO UPOACE ANY ORDINANCE PROVISION,'
IRECEffl LN
TOTAL AMOUNT DUE
I HEREBY ACKNOWL EDGE 'HAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
APPI*VAL
I
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
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THEOWNER I AGREE TOCoMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
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PERSO WIILBEL
CALL
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ION.ANDIN DING THE WORK AUTHORIZED THEREBY. NO
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OF THE LABOR C ODE OF THE STATE OF WASHINGTON RE ATING 0
FOR INSPECTIO N �l 10 pl—ded
A�LAIION
;W 'EN S COMFEAS595MSUA�NCE AND RCW 11 21
OF Cjll.&S�SIGNATU my
DATE SIGNED
(425)
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771-0220
D�TE
JRES By
ATTEOON
EXT 1333
IT IS UNLAWFUL 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 - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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TO:
DATE:
M[EM0 TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE__SL:�13 _-0
ENGINEERING DIVISION DATE—,
PLANNING DIVISION DATE
PROJECT__CL&,�a���6' (1-1i
srrE ADDRESS fo`�k LAZzy
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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 WIT11 CONDITIONS NOTED
o Copy ofCONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
o Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Wall
3!
Retaining ...........
Slab Insulation ..........
PLUMBING:
Underground
............ .
M,
Rough -in ...................
C:
ME
Commercial Final
00.
HEATING:
M
Gas Test ....................
Gas Piping .................
Equipment .................
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Commercial Final
M M
EXTERIOR SHEATHING
HAILING
_FRAMING ...........
rn.
oc*,
FIRST FLOOR FRAMING
INSULATION ....................
Floor insulation
Wall insulation ...........
Ceiiing Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
crr� OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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MAILINGADDRESS
CITY ZIP ITELIP"O E
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NAME
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STATE LICENSE NUMBER Ex,-- OAT, E
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VNEW
0 RESIDENTIAL
0 PLUMBING I MECH
0 ADDITION
0 COMMERCIAL
o C PLIANCEOR
CHANGE OF U!E
0 REMOOtL'
APARTMENT
0 SIGN
0 REPAIR
0 GRADING CYOS
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0 X FT)
0 DEMOLISH
0 TANK
o OTHER
"0 GARAGE
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CA P �T,
RETAININGWALL
[:] SnrKEAY
0 RENEWAL`'�
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(TYPE OFUSE. BUSINESS OR ACTIVITY) EXPLAIN:
N ER
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L,RIBE
BER OF
NUM
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OF
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STORIES
- ELLING
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AREAS
NUMBER
DESC WORK TO
BE DONE
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ADDRESS
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PLAT NAMEISUBDIVISION NO. I LOT NO, LID NO -
LID FEE S
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PUBLIC SIGHT OF WAY PER OFFICIAL STIR EET MAP W P—N A"u- a
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EXISTING — PROPOSED— I� R".kw
[REQUIRED DEDICATION— FT
1"11111ld 0
METER SIZE I LINE SIW_F_Z777j�� PRV REQUI-ED
YES 13 NO 0
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FIRE REVIEWED BY DATE
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VARIANCE OR CU SHORELINE Oil ADBI INSPECTION I PBOND
REQ-D osTED
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SEPAREVIEW SIGN AREA HEIGHT
C_0,,PLETE EXEMPT ALLOWED I PROPOSED ALLOWED , PROPOIEO
ap
LOT COVERAGE REQUIRED SETBACKS jFT) PMOPOSEO SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE FEAR
DATE
PARKING
REGO I PROVIDED I LOT AREA I PLANNING REVii*D BY
HECKED8Y
,�7fRUCTION OCCUPANT
GROUP
I ARIA JOCC.UPANT
PE C AL IN S6E 0 LGA
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REQUIA.LED 1:3 YET I
rREMARKS
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PROGRESS INSPECTIONS PER UBC loafFINAL INSPECTION REO'D
VALUATION I FEE
6) _32�
c A L
MECHANICAL
E C"
S R M T C 0 V AS W 0 R K To
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. TH S PERMIT COVERS WORK TO
U C 0 N 0 N T E P U U C
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
'A'
G RA D N L
C W LL R a U I E
DOMAIN (CURDS. SIDEWALKS, DRIVEWAYS , MARQUEES, ETC.) WILL REQUIRE
"
SEPARATE PERMISSION.
R E
C GE
` ' C
PERMIT APPLICATION: I'D DAYS
W T H' IN A
PERMITUMIT'.1YEARI;PROVIDEDW R SSTARTEOWITHIN 180DAYS
P K I
EN F E F E
ENG. REVIEW FEES
E
GS
A 'S -
0
SEEOACKO INK PERMIT FOR MORE INFORMATION
W
T Q FEE
ENG. INSPECTION FEE
E N IN P E
ASSIGNS AND U.-ES.F.
'APPLICANT. DIV ll"ALFOF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
'LD HARMLESS T. E IT, OF
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
AF IN
LANDSCAPING
LAND SC
'N. AGENTS FROM AN, AND
EDMONDS. WASHINGTON. ITSOFFICIALS. EMPLOYEES. AND AGENTS FROM ANYAND
I N F EE
INSPECTION FEE
NSP EC
—RECEIPT
N. FE-T"OR INDIRECTLY
IRECTLYO
ALLCLAIMS FOR DAMAGESOFWHATIEVER NATURE, ARISING D RINDIRECTLY
THIS PE .IT SHALL NOT BE
2 FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE 01 THIS PERMIT SHALL NOT BE
NT.F "'CITY 0 F-NAN.E
a E ANY REQUIREMENT OF ANY CITY ORDINANCE
DEEMED TO MODIFY. WAIVE OR REDUC
PIN CHECK DEPOSIT
HE DEPOSIT
PLAN C C
7
TIN ANYWAYTHE ItITY'S ABILITY TO ENFORCE ANYORDINANCE PROVISION.*
C NORLIMI P VB,
NT U
u L
TOTAL AMOUNT DUE
RIC
7—
jr
77 r
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IHEREB ACKNOWLEDGE THAT) HAVE READ THIS APPLICATION: THAT THE INFORMATION
Y
APPLICATION
A� PL' AT'
APPROVAL
T 0. ZE N
GIVEN I CDR ECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
S R
T I, ppl,Caiibl I$ Ml a Omit �Abl llg,Gd by the
T" PF't�
WS GULATNG CON STRU.
STATE LAWS REGULATING CONSTRUC'
THE OWNER. I AGREE TO COMPLY WITH CITY AND P Y
EMPLOY ED
CALL
'I dw� OXI , hl�of Q*P,ty: A,d Fees we pa�d. ,d
S.,(lU
L
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE
CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
.. eipt I, llk.mIWQed ipw pm,ded.
,�OJILLITION OF THE LABOR
EN S COMPENS_��NCE AND RCW 1 .27.
1(;IALkSIONATU&
DATE SIGNED
(425)
425
"T
&
1 0 0
771-0220
U
IE
DATE
ATTEWION
EXT 1333
ol
ITIS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL IN SPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - COLD - ASSESSOR
5mo