20010760.pdfDATE RECEIVED
USE PERMIT
CITY OF EDMONDS ZONE I�f 6— NUMBER
SUITFJAPTO
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CONSTRUCTION PERMIT APPLICATION 1f&V y
OWNER NA�MAME OF BUSINESS PI -AT NAMEISURDIVISION NO LOT NO. LI NO.
60 H(,— LIP FEE S
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AA 9 cl PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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CITY ZI EXISTING — PROPOSED— 0
REQUIRED DEDICATION— FT — a
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NAME ME TER SIZE I L111 SIZE I No, OF FIXTURES YES 13 No 0
ADDRESS R MARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDR—A—
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NAME y6-
ADDRESS 74
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DATE
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SEPA REVIEW SIGN AREA HEIGHT
COMPLETE I E T ALLOWED , PROPOSED ALLOWED PROPOSED
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SURCHARGE
—PERMIT APPLICATI N: 18D DAYS
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PERMIT LIMIT, I YEAR - ROVIDED WORK IS STARTED WITHIN 180 DAYS
END REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
P" I N8 L HISOR HER SPOUSE. HEIRS.ASSIGNS AND SUCCESORS
HE CITY OF
;A TE E T. A EE T :: DEMNIFY. DEFEND AND HOLD HARMLESS
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TOTAL AMOUNT DUE
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ACKNOWLEDGE THAT HAVE READ THIS APPLICATION, THAT THE INFORMATION
APPLICATION APPROVAL
IHEREB
GIVEN 15 CORRECT. AND THAT AM THE OWNER. H THE 11111 AUT..FIIED AGENT 01
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REGULATING CO�STRUC
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THEOWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS
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OF THE STATE OF WASHINGTON RE ATIIG 0
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DILATION OF THE LABOR CODE
SIGNATURE 0 E01
WORKMEN'SCoMPENSAT. NINSURANCEANDACW18.27
SIGNATURE (OWNER OR OF DATE SIGNED
(425)
OFFICIALS
2],� _ I I
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771-0220
R 1-w-1 I DAIE
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EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY' A BUILDING OR STRUCTURE UNTIL
771-0221
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI_
ORIGINAL - FILE YELLOW - INSPECTOR
ASSESSOR
A FINAL
HAS BEEN GRANTED. USC SECTION 109
FAX
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FINAL PICIDJECT APPROVAL FORM
TO: 61?22
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: -FIRE DEPARTMENT DATE -
ENGINEERING DIVISION DATE -
PLANNING DIVISION DATE _6h4OL
PROJECT_L4t���
SITE ADDRESS C5W /;�r
PERMIT #_CM-
Za 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
PE )RMANCE BONDS and the granting of:
_,K-GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITII CONDY11ONS NOTED
0 Copy ofCONDITIONS given to owner/contractor by inspector
FAHXD FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inspector
if
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......................
wall ..........................
Pier/Porch .................
Retaining Wall ........... . 0
M
Slab Insulation ..........
PLUMBING:
Underground .............
Ills
Rough -in ................... —40
0 C
Commercial Final
ic
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HEATING:
Gas Test .................
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Gas Piping .................
Equipment .............. ..
Commercial Final 111111
EXTERIOR SHEATHING
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NAILING .................. . ......
FRAMING........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
wall insulation ...........
Ceiling insulation Z,
0
4.
SHEETROCK NAILING
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SPECIAL INSPECTION .;' 7
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY
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RECEIVED
.. 13ATE PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITeAPTp
ADDRES� y
OWNER NAMEMAME OF BUSINESS
PLAT NAME/SUBDIVISION NO. LOT NO. I D NO.
ROU Hc,— 7+ LID FEE S
MAILING ADDRESS PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP ;WESCI �.l
n � I � = P= %.I
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CITY ZIP ITILE EXISTING — PR.P.SE.—
PHONE
ZA REQUIRED DEDICATION— I
-NAME I NO.OIFIITURIS PRV REQUIRED
YES 0 NO 0
ADDRESS R MARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY _7F TELEPHO"l
NAM'
ENGINEERING REVIEWEDfDATE
ADDRESS
J .4,
FIRE REVIEWED BY DATE
CITY ZIP
TELEPHONE
0
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VAPIAICI .1 CU
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STATE LICENSE NUMBER PIAT
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0-141 A) -'l YC (1 -7 2
SEPA R EVIEW
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PROPERTY TAX ACCOUNT PARCEL NO.
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EXP I
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Pi NEW E] PLUMBING I MECH
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THIS PERMIT AUTHORCZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU UC .
GRAMNGIFILL
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30MAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REG IRE
L SEPARATE PfRMISSI?N.
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PERMIT LIMI�. I Y R Ell
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SEE BACEKAORF' PINK PERMIT FOR!\
100-
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES To INDEM"I � DEPEND AND HOLD HARMLESS THE CITY OF
NOSCAPING
I MONDS, WA HIN ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALLCLAiMSFORDAGOES FWHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
THIS PERMIT SHALL NOT BE
FROM THE ISSUANCE OF T IS PERMIT. ISSUANCE OF
DEEMEDTO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANYCITY ORDINANCE
PLAN CHECK DEPOSIT
0 ENFORCE ANY ORDINANCE PROVISION.'
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO
TOTAL AMOUNT DUE .
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPUCATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. ANDTHAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
..111.1p.dby-
`Zd
THEOWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
d.ng "III , hi�ot DopVty. F... .. .16. .�d
ou..T
TION. AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
RELATING TO
FOR INSPECTION PI 11 llkl,,LWgod 11 Sp- P—d1d.
IN VIOI.ATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN S COMPENSATPN!NSURANCE AND RCW 1 .27.
OFF CIALS SIG�ATURG
IOWNER OR GE" I DATE SIGNED
(425)
[SIGNATURE
-�3o-o-b
ao� ' o
771-0220
w oAlrE
_;
R ' ED 10
4fTENtft
EXT 333
ITIS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE YELLOW -INSPECTOR
CCUPANCY HAS BEEN GRANTED. UBC SECTION 10
CATE OF 0 9
FAX
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