20010882.pdfPERMIT EXPIRES
CITY 00 ED NDS
PER.' T
sunvAPT#
31bo
CONSTRUCTION PERMIT APPLICATION
OWNE OF 8"
7D
tJ
FLAT NAMEISUDOI�SIONI N
LOT NO
No
LID FEE S
MAILIN9'ADD S
L5 C—,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET
PW
EXISTING — PROPOSED
ZIP
TELEPHONE
7 75-L 7 3
REQUIRED DEDICATION— FT —
NAME
METER SIZE
LINE 111E
10, O� FIXTU11S
PRV REQUIRED
YES 13 No 0
ADDRESS
OEMARKS
WHERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE —
CITY ZIP
ITELEPHONE
I NAME
FM
gjFROPE—TAX "
C F1 (0 0
S-r),5
NEW
PLUMBINGIMECH
0 ADDITION
COMPLIANCE OR
CHANGE OF US'
E] REMODEL
SIGN
C] REPAIR
0 GRADING CYDS
FENCE
( _ . _ FT)
DEMOLISH
TANK
OTHER
STAINING WALL
0
RENEWAL
DGARAGE
CARPORT
ROOKERY
ITY) EXPLAIN:
NUMBER
OF
UMBER OF
DWELLIN -
"
'A R
NAt
STORIES
UNIT a AIX—
BER
DESCRIBE OQK
TO E I'S
FIRE REVIEWED By
DATE
OR CU
SHORELINE OR ADS#
INSPECTION
VARIANCE
POSTE
NO
ONO
�gg]J
$EPA REVIEW
COMPLETE EXEMPT
- ' t ,
A�
�141. -D PROPOSE
HEIGHT
ALLOWT PROPOSED
EXP --4—
/ILRI lzla�
//
T)
PROPOSED SUBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE FEAR
FRONT UR SIDE REAR
IV,P 4�4a6j
A10 af4,A16-F
/;A 191
REMARKS
CHECKED By
1
Coo�_
I OCCUPANT
1 1771
R. P -5
SPECIAL INSPECTOR
OCCUPANT
REQUIRED F1 YES JAREA
LOAD —
PER
133-T D ... 1.0.1111 1 FEE Description I FEE
`5 Ll;�o P�a2_C�eclk
LOT SLOPE % EUidmn
PLAN CHECK NO: C) I DATE
IESI�l DATE
THIS P�rr AUTHORIZES ONLY THE WORK NOTED. THIS PERM9 COYERS WORK TO
BE DOME ON PRNAIPE PROPERIPY ONLX ArfY CONSTRUCmON.ON THE PUSLIC
DO"N (CURBS, SIDEWALKS, ORR�AYB 1EES,1C)WILLRE0 HRE
..EPERM;S=10NQ.
PERMITAPPLICATION: ISDIDAYS
YEAR-PRO.OSO WORK IS STARRIED W"IN HID DAYS
K OF PINK PERUM FOR MORE INFORMATION
Plumbing
Mechanical
Grading
Recording Fee
Engr. Revie.
City Surcharge
Engr. Inspection
State Surcharge
SEE
_L_BAC
M BUD'
f(affic Mitigation
"a"
Plan Chk De�posl,,,,�
Plan Chk Do osft
A AND E
HIS OR HER SPOUSE. HEIHS, ASSIUNS AND SUCCESORS
' S"'N' SUCC So'
LD ARML.. E CITY OF
M V S
IN INEEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
ONHIEGTONO
g
Flacelpt #
.C. I
FROM No
D AGENT , M — A
6
ITS OFFICIALS. EMPLOYEES. AND AGENTS FRO �ANU
WAS NATURE SING DIRECTLY OR INDIRECTLY
'IN DIRECTLY OR INDIRECTLY
CLAIMS FOR �GES OF �TEVER AR G
Fr"c
R ev
Fir. Revie.
'a
E
ROC_.S
THIS PER. �_LL NOT BE
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
. THE 1.
HT IT
OF Y._ R.,_.
DEEkjEDT=FYY,;,WOR REDUCE ANY REOUIREMENT OFANYCRY ORDINANCE
-
HIS Pa.' On
Fire Inspection
U 0
Gum'.u.
A I
Total Amou
Tot.,
ANY ORDINANCE PR I.,.
NOR LIMIT WAY THE CITYS ABtURY TO ENFORCE ANY ORDINANCE PROVISION.
Scapa SID
Land I n p
Landscapains
RSc-,P,,-
MA
I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION� THAT THE INFORMATION
a
APPLICATION
APPROVAL
Gr,EN IS CORRECT. AND THAT AM THE OMER. OR THE Duly AUTHORIZED AGENT OF
REGULATING CONSTRUC-
WS Ta
THE OM5 I AGREE To COMPLY VMH CITY AND STATE LAWS
a
L
CALL
T
P So WILL BE
IN ING ME WORK AUTHORIZED THEREBY NO PERSON WILL BE EMPLOYED
TION; AND Do STATE OF WASHINGTON RELATING TO
OF THE
FOR I ECTION
NSP
0 SP
Bu,I
...... In.pc. pn�d�.
IN VIOLATION OF THE LABOR CODE
WORIQUENS COMPENSAT12=RANCE AND RM 18 2'
OFFI�ML AT DATE
-
S��: (OYY,ER ENT,
0 E SIGNED
AT
(425)
(425
11 - -7
771-02,20
1_0
D a TE
ATTEWION
EXT 1333
FR
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 - i-SICCMR
CATE OF OCCUPANCY RAS BEEN GRANTED. USC SECT13109 FAX PINK - OWNER GOLD - ASSESSOR
late, a�mw,,_ :;�
z
9 ,
0
0 M
C: 0
IT 0
RR
M
ID
z
O"n
n
M M
0
0
0
a CO
0
X
CA
z
ITI
FINAL PROJECT APPROVAL FORM
DATE:
MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DATE -
FROM:
ENGINEERING DIVISION DATE -
PLANNING DIVISION DATF-���
q,� rMvjr,,�,
c/
SITE ADDRESS!
-7
PERMIT A DATEINSPECTED
DESCRIPTION OF WORK TO BE INSPEC1110
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
PER_FORMANCE BONDS and the granting of:
�,_GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy ofCONDITIONS given to owner/contractorby inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
c, Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date- Slgn�
ocaprvl.doc.l:tmM:bldg:formsIO/OI
z
0
i
0
C M
MO
0
-40
0 C:
-1 K
X M
M Z
JO -1
z
0 -n
n
MM
0 U5
0
C>
C: M
K co
M 0
Z
z
--i
3:
Cn
z
0
i
0
M
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall ..........................
Pier/Porch .................
zi
Retalnlng Wall
3
...........
0
M�
Slab Insulation ..........
PLUMBING:
ca
Underground .............
C
Rough -in ...................
0
Commercial Final
HEATING:
z
Gas Test ....................
Gas Piping .................
CO
0 -n
Equipment .................
-n
Commercial Final
A M
EXrERIOR SHEATHING
NAILING ..........................
FRAMING ....................
C)
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
z
SHEETROCK NAILING
A
M
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
7
�_L - 777 __ 7 7
S
OFEDMONDS
CITY OF EDMONDS
USE PERMIT
ZONE 'UMIER4,�V/-
0 p PP LICATION]
CONSTRUCTION PERMIT APPLICATION
, N
'AODBORESS L
SUPE/APT'
C_
OF U�j'
Or
NE_(�
_0
"D NO,
_ _
,
=\, " � L
FLAT NAMEISUBDIV.SION NO.
LOT NO,
US FEE S
5ERMITA
MAIIJH� as
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED-
C"
ITELEPHONE
7
REQUIRED DEDICATION— FT —
LINE ���10.
OF 7FIMAES
PRV REQUIRED
NAME
METER SIZE I
I
YES 0 NO 13
A13DREBS
EMARKS
R1.11111 RP.—SIBLE FOR EROSION CONTROL/DFUMNAGE
CRY
NAME
OAIW�
ENGINEERING
REVIEWEDIDATE
ADDRESS
CITY
ZIP
TELEPHONE
FIRE REVIEWED BY
DATE
VARIANCE OR CU
SHOR NEORADBO INSPE ON ' PBOND
ORTED
STATE LICENSE NUMBER
EXPIRARON'OATE (>VECKEDGY
.0
I
PROfERTYTZX
$EPA REVIEW
COMPLETE EXEMPT
SIGN AREA I HEIGHT
'kLLO 0 PROPOSE ALLOA15P PROPOSED
j 41EL
O(D6
EXP
NEW
RESIDENTIAL
El
0 PLUMBRIGIMECH
LOT COVERAGE
ALLOWED PROP
RED RED SETBACKS PROPOSED SETBACKS
FRPNT SIDE HEAR FRONT UP SIDE BEAR
COMPLIANCE OR
13
.
Alo elklAN6,F
0 ADDITION
0 REMODEL
A(COMMERCAL
0 APARTMENT
CHANGE OF USE
- PARKING LOT
SE11D DEC
AREA PLANNING 14EVI�-
0 REPAIR
0 OWING .,as 0 FENCE
X FT)
REMARKS
0 DEmousli
0 TANK
0 OTHER
e—
oGARAGE
CARPORT
RETAINING WALL 0
0 F OCKERY RENEWAL
ME OF USE. SUEAMESS OR EXPLAIN:
CHECKED By OF OCCUPANT
COG� GROUP
ITYPE
,R;;W?
I
NUI
I NWU:. OF
EL.NG
DU
RITICAL
AREAS
I
MLINSPECTOR
SPEC LOAD
OF
STORIES
as AIX
NUMBER
JAREA,
REQUIRED [D YES
DESCRIBE WORK TO HE DONE
H "MAMS
G FR UBC 108/FiNAL INSPECTION FIEUD
PRO REISS INSPECTIONS P
(OL,
!!Ij;
VALUATION $
FEE
iDescription
FEE
Plan Check
LOT SLOPE %
PLANCHECKNO: C VESTED DATE
Mechanical
AIW k,'24 -52
EERSWO1KTO
';Bf
PRQftFrrY ONLX TH P US
Grading
Recording Fee
EC'uC
(CURES, S�VALKS, DRIVEWAYS. MARaUEER, UC.)WLLR IRE
Enqr. Review
City Surcharge
ERM APINUCATIO INDAYS
P "
YEAB-PROVIDEDW K159TARTEDWrGUN INCA"
PEFMR`U"R" OF'
Engr. Inspection
StaleSurchargo
MATION
SEZ RACK OF MW PERNITT FOR MORE INFORMATION
Plan Chk Deposit
-APPLICANT, ON BEH� OF HIS 00 HER SPOUSE. HEIRS. ASSIGNS AND SUC ESORS
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
Trattic Mitigation
Receipt #
EDMONDS, WASHINGTON. He OFFICALS. EMPLOYEES, AND AGENTS MOM ANY AND
Fire Review
ALL ,,JMS FOR DAMAGES OF w;,UI7EVER NATURE. MUSING DIRECTLY OR INDIRECTTVY
MOM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL Nor BE
Fire Inspecction
TbtalAmountDuB
OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
:EOEME�DTO ,=PY�W CHyS ABILITN' TO ENFORCE ANY ORDINANCE PROVISION.
Receipt
I HERE AX�MWILEDGE THAT HAVE READ THIS APPILICATION; THAT THE INFO ION
By
APP OVAL
E
GIVEN 13 CORRECT AND THAT AM THE OWNER. OR THE DULY AUTHGRIZ D AGENT OF
�
THE OWN EFL I AGREE To COMPLY WIM CITY AND STATE LAWS REGULATING Cott
CALL
�Sd,g OftW 11 W31h: SepZrd F.,
TION; AND IN WNG THE We"' AUTHORIZED THEREBY. No PERSON MLL BE EMPLOYUED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
WORKMENS CCUPEN HANCEAN RCWla.27.
OF DATE
DATE SIGNED
�16V_4
(425)
�_T
771-0220
R �SED By DATE
A-FTENTION
EXr 1333
/ 1114,?I")l
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-022 1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGMLE YELLOW-INSPEAR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTI�/�
FAX PINK.OWNER GO —ASSESSOR
Z'V1IRK"
z
0
d _'
0
0 rn
m
-10
00
C
m IT
z
10-4
0 -n
n
M ITT
a U5
0
o Fn
M 0
z
z
2
0
m