20010808.pdf- 'I DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ll�AIIIA"!�511111
)Willer
AND ADDRESS
d,
ZIP
? ao W 3
AE -.69-
[PERMIT
0
1-7
EXPIRES
USEE
ZON RM - 9—
PERMIT 2)
NUMBER ,
ADDRESS -6,31 q-f,- f hu-, Is SU'T4 I
FLAT NAMEISUBDIVISI.N NO
I III N1,
I NO,
, �El
PUBLIC RIGHT OF WAY PEA OFFICIAL STREET MAP
EXISTING — PROPOSED—
'�D
.
x P,
REOUIRED DEDICATION—
FT —
YEPREQUIRED
O NO C3
CITY
P'u ja�&
NAME
e ir
ENGINEERING REV EWEDIDATE
ADDRESS
FIRE REVIEWED By DATE
CITY
8
VARIANCE OR CU SHORELINE OR ADEW INSPECTION BOND
REO'�' POSTED
STATE LICENSE NUMBER
ALS-20-1-1-57 YES NO
TA x
SEPA REVIEW SIGN AREA HEIGHT
C MPLETG EXEMPT 4r�zi) pj�QSEO ALLOW�D , PROPOSED
ItROPERTY
.1, 270,7;,��(,,Io,
EX x /A
I
SETBACKS (FT.)
LOT CO ERAGE REOUIRED SETBACKS (' T') PROPOSED
REA FRONT RSIGE REAR
0 NEW
A SIDENTIAL
13
0 PLUMBING I MECH
T SIDE
ALLOWED PROPOSED FRON _ .1
-11 Itsl lol lirs, tslimG.
0 AUDITION
COMMERCIAL
0
o COMPLIANCE OR
CHANGE OF USE
Sri ml%
RA X LOT AREA P N GRE E DATE
(3 REMODEL
APARTMENT
�9
0 SIGN
REO D PROVIDED
0 REPAIR
C] GRADING CYOS
(FENCE
X FT)
C DEMOLISH
0 TANK
C] OTHER
Cl0 PAGE
CARPORT
0 RETAINING WALL
0 RENEWAL
r (TYPE OF USE. BUSINESS
OR A IV PLAIN:
CHI CK"' By
UCTION
0 STAU'
IT'py'p
Za
'C
C*7 1 1. Ac-u-plm
NUMBER
NUMBER OF
CRITICAL
SpEGIAl ZIE
IOCCU
OF
DWELLING
AREAS
REQUIRED 3 YES
LOAD
STORIES
UNIT-
NUM89 A
R
4
DESCRIBE WORK TO BE DON
INSPECTION REQ
;EMAARGIRS
R ESS INSPECTIONS PER UBC 1ONFINAL
oal"
h
llkmn
VALUATION FEE
PLAN CHECK FEE
HEAT SOURCE GLAZN LOT SLOPE I
D ILDING
PLAN CHECK NO: rlSTEO DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED TH IS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTR UCTION ON THE PUBLIC
REQUIRE
GRADINGIFILL
DOMAIN (CURBS. SIDEWALKS. DRIVEWAYS. MAROUEE S, ETC�) WILL
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATIONI: 18D DAYS
PERMIT LIMIT' I YEAR - PROVIDED WORK IS STARTED WITHIN IBQ DAYS
END. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V` -APPLICANT, ON BEHALF OF HIS oR""YER 'poUSE HEI.R&AS�IAGNS AN. S CCESORS
E. GE EN N . RMLESS THE CITY OF
ENG. INSPECTION FEE
-b..Bo�
IN INTEREST. AGREES TO �ND ,
EDMONDS. WASHINGTON, TSo,,,CE,,ALS.EpoyEE, NIAIENTSFAO. ANY AND
INSPECTION IE
2 IN..I E
FOR DAMAGES OF WHAT E.NATUgE'AA�SA A CTLYOR INDIRECTLY
SHALL NOT BE
ALLCLAIMSISSU
DEPOSIT
FROM THE ANCE OF TH ISSUANCE OF THIS PERMIT
S PERMIT
DEEMED TOMODIFY. WAIVE 'A REDUCE ANY REQUIREMENT OF ANY ITYORDI ANCE
PROVISION,'
I CHICK
PLA____
AEC
NOR LIMIT IN ANY WAYTHE cITY'S ABILITY TO ENFORCE ANY oRDINACCE
�L AMOUNT
TOT, E
THAT HE INFO
APPLI'C�ATIULNY
APPLI ATION APPROVAL
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS ARMATION
IS CORRECT, AND THAT I AM THE OWNER, OR TH D AUTHORIZE. GNT OF
Th-1 ppj_,o ,l 1,,ld by
GIVEN �_'D �T E LA E LA Fly
THE OWNEII I AGREE PLYWITHCITY N ATNoWS A GU TG C o'ST . UE%
CALL
Doull. ��d F ;,. I,
HEoWo THEREBY F ON W, E E-PL
TION. AND IN DOING T OAK AUTHORIZED ER
'N.T.N RELATING TO
FOR I NSPECTION
d
IN VIOLATION OF THE LABOR ODE OF TH E STATE OF WAS
SIGNAT U& DIE
WORKME=SATION INSURANCE AND RCW 18.27,
IALS
G�
SIGNATUtE (owNE5fOR AGENT) DATE SIGNED
(425)
�lu '�
I -ur_r_w
RELEASED By D TE
EXT 1333
ATTENTION
UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A
IT IS
INS ECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINA ILE YELLOW -IN PECT
- ASSESSOR
A FINAL
BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD
CATE OF OCPUPANCY HAS
"s
z
0
T
0 m
c
0
of
m M
0
cl M
c
M 0
X
Q)
z
9
0
m
�—r' V,
..........
-NOTICE
NO-hdk: IF tkt- ENT IN THIS RAW IS LESS CLEAR Ti" THifS
IT IS DUE 707HE QUALITY OF THE DOCUMENT
ts t3
20
tr
lu a
z
A.
2
0' a ami
ca
0 z
0
ky ej. 1 LTg
cc . . ......
i2
SIP.
41�
0
to
ge
—47 —a- A
7-
ci 3
I c-
13
t,7
> IPZ
-3,AlS:njl. ho
Lo
go-loo mvjv i 4-41
iv;x` Afaooylv
T APPROVED AS NOTED
2
....... . . ....
lko.
CITY COPY
BUILDING DEPAFffiVIENT
WORK
IR F-C V= rl, ADDRES", ;:5i2bu-r-
OWNER-
APPROVED DATE
OITY OF ZOM. L;8 BLDG. OFFIC
PERMIT NUMBER
FINAL PROJECTAPPROVAL FORM
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE-
ENGINEERING DIVISION DATE -
IS
PLANNING DI)M1ION DATE_J��__'00�-
CT_
PROJE
SrI`E ADDRESS
PERMIT A,&AL-",:29�ADB#_______DATE 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
a Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign,
ocaprvl.doc.l:tcmp:bldg:formsIO/OI
z
0
4
0
P
=i 9n
C: M
M 0
-10
00
2
M
M Z
ID __4
z
-4
o -n
n
M M
0
0
0 M
a (/)
9 Cl)
M 0
Z
z
Cl)
z
0 1
F)
M
RECORD OF INSPECTIONS
p
INSPECTOR
DATE APPROVED
.... ..
SETBACKS .....................
FOUNDATION:
Fooling......................
Wall ..........................
Pier/Porch .................
Wall
Retaining ...........
0M
Slab InsuliVon* .........
PLUMBING:
0 C.-
F
Underground .............
Rough -In ...................
Cormneriial Final
10
HIEATING:
GasTest
....................
M
Gas Piping .................
Equipment ..; ..............
fri
C
7.
Commercial Final
M
EXTERIOR SHEATHING
C)
NAILING..........................
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...................
z
Floor Insulation
Wall Insulation ...........
0
11711
Calling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
&A /0
OCCUPANCY ..............
ATE Rc "'ID
07RECEIVED 10 1 �
01
JQ_ f PERMIT EXPI2!j±=
S
CITY OF EDMONDS
PERMIT 2 _mo
NOMBER _u
LICATIO NJ'
CONSTRUCTION PERMIT APPLICATION
ADDRESS t1ji, ml't SUIT.4r
OWN NAMENAMEOF-BUSINESS
PI -AT NAMEISUBDIVISION No.
LOT 10*
U NO,
LID FEE S
S
c tMAIL7ING A;D�;DAESS
0 3
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TING — PROPOSED—
T .. 1 0.
aIUa.PR., 0
9
ZIP
ITY TELEPHONE
64, 614L f6,2o �/W- 6`73 - ?,Y91�)
EGUIREDDEDIC ION
SIZE LINE SIZE NO.OFFIXTURES
u"' "
n, =nad
PAV REQUIRED
NAME� _(��
METER
YES 0 No C3 .9
ADDRESS
REMARKS
—N—ONTRACTOR RESPONSIBLE FOR GROSION CONTPOUDRAINAGE
I fl,
ADIIIIE65
ciTy ZIP TELEPHONE
EXPIRATION DATE41
STATE LICENSE NUMBER CHEUKkU 11
FIRE REVIEWED By
VA= OR CU I SHORELINE OR AD N
SIG AREA
Co.pg
TE . EXEMPT t A,LqWED , PR0PqSE
l_IV IAA
X
1�90
EXP
0 NEW 0 RESIDENTIAL
0 PLUMBING / MECH
E
LOT Co A.
El
P
ALLOWED PROF.
0 C MPLANCE OR
PARKING
PRO
R=D =r
0 ADDITION i 0 COMMERCIAL
0 REMODEL alAPTME.T
CoHANGE OF USE
0 SIG
K
GRADING
0 REPAIR 0 cyos
'A/ x 'S; FT,
_ X FT)
[:] DEMOLISH Cl TANK
C] OTHER .'
oGARAGE 0. RETAINING WALL C] RENEWAL
CARPORT
(TYPE OF USE. BUSINESS OR Ivil XPLAIN:
NUMBER
Num EROF
RITICA e#_0k13
SPECIAL INSPECTOF
IN OF
STORIES
D SLUNG
UNITS
'EAs
UMBEF, 11JILdi
REQUIRED E3 YES
DESCRIBE WORK TO BE DONE 4 f
REMARKS
PROGRESS INS
mme Ito
f4e hu
AAIFMI
r9Frrt--
(p ffaic'
KS (FT.)
FEAR
W
Usc
VALUATION
LaDATE
0"0
�11�
�El
GMT
lRO'-`]E.
I
.S AC"S (_I
SIDE REAR
um
ATE
PLAN CHECK FEE
HEAT SO!:�
LOT SLOPE I
BUILDING
FLUIA.M.
PLAN CHECK NO:/
�E.ITEE
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I.lol.IAO'�E'01"'N�RIVATI PROPERTY ..Ll. AMY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
QtPEE%ETC.)WlLLR QUIRE
C . SIDEWALKS. DRIVEWAYS R To I LL REQUIRE
STATE SURCHARGE
SEPARATE PERWIMA
SIMON.
PERMIT APPLICATI W 160 DAYS
PERMIT LIMIT'. I YEAR , PROVIDED WORK IS STARTED WITHIN 180 DAYS
R I '"IT ' YEAR
ENG. REVIEW FE
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
SEE BACK o
FNPER
a OF HI�S OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESOnS
- BEHALF OF
CITY OF
NUCAN1�0N.SEN4LF
;APl
'EFES . A R E. .IN. MNIFY, DEFEND AND HOLD HARMLESS THE
EN NIEFE. T AGR E. To
I
PLOYEES. AND AGENT. 1130. ANYA14.
AS. CtAES.E
D No. 'N.To
ED. %" ARISING DIRECTLY OR INDIRECTLY
IPT
R-.'�=-TC�ES0N--_ATEv R NAMTURE,
CLAIMS . E
ALL.,. F.
__ - ISSU No OF THIS PERMIT SHALL NOT BE
F" THE ISSUANCE F T, PERMIT
THEISS IFYWAIVEoR IREMENTOFANYCITYORDINANCE
ROM U IF A ANY REoUE
F ANCE OF THIS EDUCE.
ME. To Mo Y W 'VE
MEDToMo
DEE D
TOTAL AMOUNT DUE
c
L
11 79
APPLI ATION
APPROVAL
I IT
N RUMITINAN A H Y� Y TO ENFORCE ANY ORDINANCE PROVISION.
YW YTHECIT SABL
. U IT, Y W Y T E ,
o
IIAVT��RE.A D THIS APPLICATION; THAT THE INFORMATION
I HEREBY ACKNOWLEDGE THAT �
GIVEN IS RAECT An"'HAT A. E WNER. oRATHE oU�LyAUTHORIN1.1DA.ENTO'
TI,'. .1pl—n— .
, t unid ap.d IV In -
I ST TE LAW FE.U' C.NS
ECFo 'TRUC6
THEOWN AGRiE TO COMPLY WITH CITY AND "MPLOYE
CALL
O"'InIl G —
',hk'no,aIodqad,n
D,P,ty: and F .. g,.,d. and
TION. AND DING THE WORK AUTHORIZED THEREBY, NO PERSON WILL B E
IN VIOLATIIN 0 E LATtNG To
ON OF THE LABOR C DE OF THE STATE OF WASHINGTON RE
FOR INSPECTION
,,
III,— plo,nded.
z
0
m
'0
0 Cc:
A m
z
0
m M
a
0
0 Fn
z
IT!
WORKVIEN)X,QK�SATION INSURANCE AND RCW 16.27. _IALS SIGNATURE
511T) 0 E SIGNED
(425) 2.
JA_ ()-8- 01 771-0220 RELEASED By
ATTENTION EXT 1333
OR STRUCTURE UNTIL
IT IS ONLAWFUL TO USE OR OCCUPY A BUILDING 771-0221
PECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL/ ILE YEL IN -IN PECT R
A FINAL INS
CATE O� OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK.MNER GO -ASSESSOR
5`98