20010768.pdfPERMIT EXPIRES
DATE RECEIVED 101 to /0 1 F
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CITY OF EDMONDS US NE NEuRmm,'ERV) 6
JOB SUITEiAPT.
CONSTRUCTION PERMIT APPLICATION ADDRESS
CITY ZIP ITIELEP"OlE
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NAME
ADDRESS
CITY zip TELEPHONE
NAME
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ADDRESS
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STATE LICENSE NUMBER EXPIRATIO
R0P9RTY TAX ACUq67EL NO.
1-97 01)
C] NEW
RESIDENTIAL
col LUMBING / MECH
C] ADDITION
COMMERCIAL
C] CoMMJ
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(TYPE OF USE, BUSINESS5r
NUMBER
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UMBEROF
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CRITICAL
AREAS
NUMBER
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
C
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBU
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS. MARGUEES, ETC.), WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPUCATI N: 180 DAYS
PERMIT LIMIT. I YEAR . PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFOR ATION
;APPLICANT. ON BEHALF OF HIS OR EP SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
N INTEREST. AC9EES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
SHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANYAND
EDMONDS. WA HIS No DIRECTLYORINDIRECTO
ALL CLAIMSFOR DAMAGSSOFWHATEVER NATURE.A I T ALL NOT BE
FF M THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMI ISH
DEOEIVED TO MODIFY. WAIVE OR REDUCE ANY REOUIREMENT OF ANY C TYORDINANCE
PLAT NAMEISUBDIVISION N&
LOT 110,
LID 40,
LID FEE
PUBLIC RIGHT OF WAY PER OFFICIAL STR E ET MAP
EXISTING — PROPOSED—
REOUIREDDEDICATION� FT
P.I.
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METER SIZE
I LINE Sj��.
OF FIXTURES
PAV REQUIRED
YES 13 NO 0
REMARKS
oWNERICONTRACTOR HESPONS18LE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWEDIQATE
FIRE REVIEWED By DATE
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION I BOND
REQ�D I POSTED
E3VES E3 NO
SERA REVIEW
COMPLETE EXEMPT
FXP
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS jFT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT SIDE REAR
PARKING DATE
REQ'G I PRoVjDAGij
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1ANK MLL, REMIUVAL, UM IjAl'
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GROUP
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PECIALINSPECTOR JAREA
AEOUIAED[3YES
OCACDUPANT
Lo
REMA KS
ROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
1,5
VALUATION
FEE
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADINGIFILL
%YgrE —SURCHARGE
END REVIEW FEES
END INSPECTION FEE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
IRECEIPT
NOR LIMIT INIANYWAY THE CITY'S ABILITY TO ENFORCE ANYORDINANCE PROVISION,
TOTAL AMOUNT DUE
RECE11 T
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT HEINIOR.AT'ON
GIVEN IS CORREC7.AND TH I AM THE OWNER, 0. THE DULY AUTHORIZED AGENT OF
AT Y WITH CITY AND STATE LAWS REG
THEOWNER IAGREETOCoMPL ULAT. ING CONSTRUC
TION, AND IN D IN THE WORK AU HoPIZEO THEREBY. No PERSON WILL BE EMPLOYED
IN VIOLAT I ON oOF GTHE LABOR CODE OF THE STATE OF WASHINGTON RE LAT'NG To
WORKMENS COMPENSATION INSURANCE AND RCW 18.27
SIGNATURE (OWNER ORI)
CALL
FOR INSPECTION
(425)
771-0220
APPLICATION APPROVAL
by I"
B0, g o".m., .1.
P_ P—d.,J
OFFtCIALSS NA DATE
RELEASED By
_ATT ENT10,W
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
HAS BEEN MADE AND APPROVAL OR A CERTIFI-
771-0221
ORIGINAL FILE YELLOW - INSPECTOR
A FINAL INSPECTION
CATE OF OCCUPANCY HAS BEEN RANTED. U.0 SECTION 109
FAX
PINK - OWNER GOLD ASSESSOR
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FINAL PROJECT AP ROVAL FORM
TO: —
DATE:
COORDJNATOI;� BUILDING DIVISION
MEMO TO: PERMIT
F ROM: FIRE DEPARTMENT DATE,61i�, 0�
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE —
PROJECT
—CL �,-,rr
SrM ADDRESS
ADB#—DATE INSPECTED—Zd—��
PERMIT #,
SPEC D 7
DESCRIPTION OF WORK TO BE IN
A field inspection was conducted to determine compliance with approved plans. Final approval denotes.that
ons from the above signed Department to the gmting of:
there are no objecti
Final approval of the described work
GRANT FINAL PROJECT APPROVAL
___qRANT PROJECT APPROVAL VMH CONDITIONS NOTED
G ISSUES
FINAL INSPECTION - OUTSTANDIN
____—YAILED
2.
3.
RE-INISPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
wait ..................
Pier/Porch .................
Retaining Wall ............
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In .............
'Comm, areal Final
HEATING:
GasTest ....................
Gas Piping ..1; ..............
Equipment .................
Commercial Final
E)(TERIOR 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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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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ILIA VEPROV NO Cl
CITY ZIP IIELIP"ON' 1— P..— 0
REOUIRED DEDICATION— FT —
METER SIZE
NAME
CITY ZIP IT11.111IONE
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'STATE LICENSE NUMBER EXPIRATION UATt
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PROPERINTAXACUqUTELNO. 4L4
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[3 NEW FEIIIIINTIAL 0 PLUMBING I MECH
F C3 CHANGE OF USE
] ADDITION COMMERCIAL o C MPLIANCE OR
E3 REMODEL C3 APARTMENT C] SIGN
[3 REPAIR GRADING CYGS E] F NCE
( _x —FT)
0 DEMOLISH cl TANK Rr 20 lmx—
ARAN N 0 RENEWAL
1 0 GCARPORT�� 0: RRQTAK' EING WALL
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ITYPI OF UBE.QUSINESS5rj
NUMBER NUMBER 01 All IT.
OF DWELLING C"��-,
FIRE REVIEWED BY
DATE
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SHORELINE OR ADBN
INSPEC!ION
RE. G
, PBOND.
OSTE
OYES ONO
SERA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALL.V4EO PROPOSED
ALLOWED PROPOSED
�p I
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I
LOTCOVERAGE
REQUIRE.SETBACKEIFTI
PROPOSED SETBACKS IT
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UPSIDE REAR
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CHECKEDBY ITYPE=ION CCUPA"
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ED D AT E
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MIT CoVE-SW-RK To
TH13 PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I ON T E P.- U
.. H
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUS LIC
RA"'N.""LL
GRADINGIFILL
TAN
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS. MARQUEES. ETC.) WILL REQUIRE
—
SEPARATE PERMISSION.
IMKESSURCHARGE
PERMIT APPLICATION: 181) DAYS
PERMIT LIMIT, I YEAR _ PROVIDED WORK 15 STARTED WITHIN 181) DAYS
ENG. REVIEW FEES
SEEIIACK OF PINK PERMIT FOR MORE INFORMATION
END. I SPECTION FEE
IN
PLICANT. ON BEHALFOF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
;A TO:NDEMNIFN. DEFEND AND HOLD HARMLESS THE CITY OF
NPNTEREST, AGREES E. T Y o
I
LANDSCAPING
G 'S '.. Ny
EDMONDS. WASHINGTON TS OFFICIALS. EMPLOYEES. AND AGE NTS FROM ANY AND
INSPECTION FEE
ALLCLAIMSFORDAMAGE OFWHATEVER NATURE. ARISING D, RECTLY OR INDIRECTLY
,
�H � o
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE 01 THIS PERMIT SHALL _ N . OT BE
PLAIN CHECK DEPOSIT
DEEMED TOMODIFY. WAIVE On REDUCE ANY REQUIREMENT o C
NORLIMITIN ANYWA� THECITY�SABIUTYTO ENFORCEANY DFANY ITYORDINANCE
RDINANCEP-1.1—
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THEOWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
TION.ANDINDOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
WASHINGTON RELATING TO
FOR INSPECTR
IN VIOLATION OF THE LABOR CODE OF THE STATE OF
WORKMENS COMPENSATION INSURANCE AND RCW 18.27
SIGNATURE( NERO ENT
DATE SIGNED
(425)
) -f le
771-0220
kT--TENTlqX'
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-
OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
VALUATION I FEE
d.q c, I,—, DIP11y: a.d Fe03 — -d.
D By . — F —1
ORIGINAL -FILE - YELLOW - INSPECTOR V
PINK - OWNER - GOLD - ASSESSOR
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