20010830.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ZP ITELEPHONE
NAME
CITY f ZIP ITI
NAME
= I PERMITEXPIRES
us E — PERMIT
ZONE NUMBER 2/v/—o
JOB SUITEJAPTO
ADDRESS 'Flomrwm _S�-
PLAT NAMEISUBDIVISION NO. I LOT 10, L
DEE
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP P'
EXISTING — PROPOSED --
REQUIRED DEDICATION— ET —
METER SIZE I LINE SI P REQUIRED
YES 13 NO C3
REMARKS
—BRICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
F U, 5,17N. —1) 1 K-w
FIRE REVIEWED By DATE
ATY
ITELEPHONE
9 q 7- P3 q 7
VARIANCE OR CU
SHORELINE OR AD 50 .
INSPECTI N
0YEBOD NO
ES OHEIGHT
BO
POSTED
4 DATE
J03
I CH YOKE",\
(,0)
- SERA REVIEW
COM PLEtE I EXEMPT
FXP
SIGN AREA
ALLOWED I PROPOSED
ALLOWED P ROPOSED
ROPERTY 1__�
ACCOUNT F�L NO.
t12- — 0-1) 00
NEW 14 RESIDENTIAL 0 PLUMBING / MECH
0 ADDITION OMMERCIAL 0 C MPLIANCE OR
0 C CHANGE OF USE
LOT COVERAGE
ALLOWED PROPOSED
AEOLI Mpi
fIRRESENT
lftp,-TsFt-SI-DERsEAR I
F&Rs
A KING
mpgAt-r
a K uIlw
0 REMODEL 0 APARTMENT 0 SIGN
REG PA I PROVID7
0 IlNrE
0 REPAIR 0 EI CYD. X
IEMANIE
0 DEMOLISH 5d TANK o OTHER
oGARAGE 0 RJMETAINI��YG WALL 0 RENEWAL
CARPORT F KE
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPI.AIN:
10EL kk
CHECXEDBY
ITYP B ON
C PANT
GROuuP
17.71 Oc
�N CRITICAL
A AREA
U LAID -
N=MBER
PIEVAL""n-TOR
REOUIRED 0 YES
LIPANT
AREA OCCO
Lo�
DESCRIBE WORK TO BE DONE
REWRKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REG"] 2
VALUATION
FEE
PLAN CHECK FEE
SOURCE GLAZING I LOT SLOPE %
I
I
BUILDING
—
PLAN CHECK NO: -ETEDDATE
PLUMBING
M ECHANICAL
THIS PERMIT AtORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON TH E PUB LIC
!FILL
GRADINGIF
MEWALKS. DRIVEWAYS. MARQUEES. ETC.) WILL REQUIRE
DOMAIN (CURBS, SID
M SEPARATE PERMISSION.
ST &TrgURCHARGE
PERMIT APPLICATION; VIDUAYS
PERMIT LIMIT. I YEAR -PROVIDED WORK IS STARTED WITHIN i80DAYS
ENG REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFOR ATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
ININTEIEIWT.AAGRIESOTO Dg.��l DEFEND AND HOLD HARMLESS THE LIII -
:N ANYANO
LANDSCAPING
G
.N.S IN N T. FF CIALS, EMPLOYEES. AND A ENTSFRO.
ED . B .
A F A AGE OFWHATEVEA NATURE. ARISING DIRECTLY OR INDIRECTLY
LL CLAIM 5 ORD M
INSPECTION FEE
—
T EAMIT SHALL NOT BE
R THE ISSUANCE OF THIS PEIII . ISSUANCE OF THIS
0'
PLAN CHECK DEPOSIT
JRECIIPT
F ANYCITY ORDINANC E
'T "Y I OR E ... ANY REQUIREMENT OR
D ElE .. 'A VE
, "S'ON'
N ANY E , A Y TO ENFORCE ANY ORDNANCE PR
NOR LIMIT 0 W Y T, "Ty� "LIT
TOTAL AMOUNT DUE
IR CEIPT I<Zl��gq I V/
I E.E.Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT T.E,NF RMATION
APPLIcAlriON APPROVAL
GIVEN IS CORRECT AND WSYRAUTHORIZEO AGENT OF
OR THE t
TH 0
AT I AM THE OWNED
CONSTRUC-
TI,,l b,
THEOWNER I AGREE TOCOMILY WITH CITY AN TATELA EGUILATING
S G
IYED
NO PERSON WILL BE EMPl_0,J
CALL
d�lg On. I P, h,, Dop,ly: — F ,, p.,d
TION AND IN DOING THE WORK AUTHORIZED THEFEBY�
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
,,,.pt., ,kI,dg0d I" 1P.P. P-4.d.
WORKMEN S COMPENSATION INSURANCE AND RCW 18.27.
OFF� �IA L IGN T��/ AT/
SIG E (0 E� O]��
D7;7;; /.r
(425)
If
771-0220
RELEASED BY I DffE
A17ENTION
EXT 1333
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CEFITIFI-
ORIGINAL FILE YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
z
.2.
0
a m i:�
IT! 0
m
10
o
.n
m M
M C)
z
z
IT!
FINAL PROJECT APPROVAL FORM . I
I
TO:_
DATE:
MEMO TO: P BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE -
PLANNING DIVISION DATE
PROJECT
SITE ADDRESS-
ADB# DATE INSPECTED
PERMrr#---L----L-
DESCRIPTION OF WORK TO BE INSPECTFD----0--5-'---O --- Q-
A field inspection was conducted to determine compliance with approved plans. Final approval denotes that
there are no objections from the above I signed Department to the granting Of:
2s-- Final approval ofthe described work
GRAN� FINAL PROJECT APPROVAL
____GRANT PROJECT APPROVAL wrrH CONDITIONS NOTED
____YAILED FINAL INSPECTION - OUTSTANDING ISSUES
2.
3.
RE_INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
ocaprvi.doc.l:temp*.bldg:fOrMS6/98
z
9
0
M
q9
65 �
0 M
ca
rn 0
80
C
--i r.
x M
m
ID
z
-4
0 -n
- n
M rn
a
0
0 M
C M
r. 0)
rn 0
z
M
z
0
z
2
0
M
I
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
.............
IT!
In
m
HEATING:
GasTest ....................
Gas Piping .................
Equipment................
Ccrnmercial Final
U
EXTERIOR SHEATHING
NAILING..........................
FRAMING � ......................
F!RST FLOOR FRAMING
INSULATION . ...................
Floor Insulation
Wall Insulation ...........
Cn
z
Ceiling Insulation
SHEETROCK NAILING
M
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR.
OCCUPANCY ..................
Cr
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
CITY ZIP
r))Apf� -0 IZ 92/12
5 ol PERMIT EXPIRES
USE PERMIT
ZONE
'MIER
'05 IIITIAPT*
ADDRESS I�
PI -AT NAME/SUBDIVISION NO. I LOT NO, LID NO,
LID FEE S
WAY PER OFFICIAL STR E ET MAP d 0
f R' = P.=`R`� . 8
EXISTING — PROPOSED — t� R 0
S S
AEOUIRED DEDICATION— FT —
W11
_1_7
YEPRV REGUIRED 0
8 E3 No C3 d
ENGINEERING REVIEWEDOATE
AlpFIRE
REVIEWED BY DATE
CITY zip
TEL PHONE
7 r_/ If FTMIf3
Q,4,1-6117-R3l17
VARIANCE OR CU
SHORELINE OR AGE.
INSPECTION
RE.-D
E3NO
.T
I PBONEDC
STATE LICENSE NUMBER EXPIRAMON DATE
Fll_,"ES
_0C lo,?V)pq 16,110 Z0.3
77)
SERA REVIEW
COMPLETE I EXEMPT
EXP
SIGN AREA
ALLO WED , PROPOSED
HEIGHT
ALLOWED PROPOSED
AICIUNTPA--.L--. 0 -
PROPERTY —
cW - " �5- Oo
0 NEW RESIDENTIAL 0 PLUMBING / MECH
0
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
F NT
Ro SIDE
PROPOSED SETBACKS (Fr.)
FRONT URSIDE REAR
0 AUDITION C] ONIMERCIAL o c PLIANCEOR
CHANGE OF USE
RE WRS��L J_
PARKING
PkjlplftAtjKMM4`l
I DATE
A SIGN
AEQ*D
PR (
TAN IFILL.
R$MOVAL, R CAP
REPAIR 0 GRADING CYDS 0 'FENCE x
_MANK5
DEMOLISH _-NK Ei OTHER
RETAINING WALL 0 RENEWAL
0 GARA'.'�'T
CARP
(TYPE OF USt. BUSINESS OR ACTIVITY)
1)it rAIV k
CHECKEDBY
JTNP N
G
'ROU
JC7,71 OCCURANT,��
Q
1.
OF
G
R
cNu "'CAL
AR EA.
ME R -17
SPECIAL INSPE
EGUIREDOCYTEoSR JAREA
t:.E.E.U.".....
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
r TI.N� PER U.0 1081FINAL INSPECTION REG'
c
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE LOT SLOPE %
BUILDING
PLAN CHECK NO: IVISTEDDATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
2 U
M DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS. MARQUEES, ETC.) WILL RED IRE
SEPARATE PERMISSION.
7__
STPEIEURCHARGE
PE MiTAPPLICATKIN: 11111DAYS
PERMIT LIMIT, I YEAR -PROVIDED WORK IS STARTED WITHIN 100 OAVS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMA3`10N
-APPLICANT.ONBEHALF FHISORHER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
ENG, INSPECTION FEE
IN INTEREST AGREES TO NDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
!TS
LANDSCAPING
.1 EDMONDS, %�ASHINGTON, OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALLCLAIMS FOR DAMAGES OFWMTEVER NATURE. ARISING DIRECTLYOA INDIRECTLY
INSPECTION FEE
CEIP
ex FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT, SHALL NOT BE
MEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY C TY ORDINANCE
PROVISION. -
PLAN CHECK DEPOSIT
IR
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE MY ORDI NANCE
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE TH I HAVE READ THIS APPLICATION: THAT THE INFORMATIOh
APPLICATION APPROVAL
GIVEN IS COARECT.ANDTHATI AMTHE OWNER R HEDULY T, 012D AOENTIOF
"dlFlll
C. STRUC.
THEOWNER. IAGREETOCO PLY WITH CITY AND SoTA7TE LAWS RAE I NO N
NN.
CALL
B�.Ig Offi-I .1 h1a., D.P't'y:i Im PlId. Ild
I
TION; AND IN DOING THE WORK AU HORIZED THEREBY, NO PERSO WILL BE EMPLOYED
IN VIOLATION OF THE BOR BE OF THE STATE OF WASHING ON RELATING TO
LA COT
FOR INSPECTION
..,pl I. ...-tcodg.d iI, p.. prd.d.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18,27.
OFFICI LQRE A7
SIGP&E (OtER 0 PNED
(425)
kL
7l'1Z716r
771!-022Cf
RELEASEDBY I DATE
ATTENTION
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. USC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
/
"a
- ,-. -
. I
0
om
c
c
m
'0
0 -n
m M
OF;
o
Z
9
0
M