20020003.pdfD411RIC11VID /.
_2_OZ
PERMIT
ZONE NUMBER
CITY OF EDMONDS "�z
CONSTRUCTION PERMIT APPLICATION JOB �7 IUITEIAPTI
ADDRESS
OWN)y2NAME OF SUSM SS ___JT�� L
PAR7 XA1 PLAT NAME)SUBDIVISION NO ':0 NO.
MAILINGADDRtSS DFEES
PUBLIC FIGHT .1 WAY PER OFFICIAL STREET MAP
0
0— 8-31,� 5ieivcs Da 0
CITY EXISTING — PROPOSED. 0
0
REQUIRED DEDICATION— FT — um"g—w
NAME METER SIZE I LINE SIZE I NO. 01 FIXTURES YEPRV REQUIRED
S 0 NO 0
CITY I ZIP
TELEPHONE
f
NAME Fi c 'TArc
ENGINEERING REVIEWEDIDATE
ADDRESS
FIRE REVIEWED By DATE
CITY ZIP
0 7
J-6 �-&
TELEPHONE
�;V 7 '77
STATE LICENSE NUMBER EXPIRATION DATE
LoLlyLi
*Iolv?
FVAARIANCEORCU
SHORELINE OR ADBI0
INSFEC�I..
RE C
OYES ONO
PSON�..
CST
SERA REVIEW
COMPLETE EXEMPT
EXP
SIGN AREA
ALLOWED I PROPOSED
HEIGHT
ALLOWED PROPOSED
PROPERTY TAX ACC UNT PAR EL NO.
_04-1247
-;z 2 3 0 o
RESIDENTIAL Fn
n NEW I LUMBINGIMECH
C] ADDITION COMMERCIAL c3 C MPLIAN EOR
CHANGE OF USE
n REMODEL APARTMENT [3 SIGN
13 REPAIR E] GRADING C,DS C3 F NCE
( _ X FTI
C] DEMOLISH 0 TANK Oj'�H�ER
EiGARAGE M RETAINING WALL
CARPORT " ROOKERY (3 RENEWAL
LOT COVE AGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (T
FRONT UPSIDE REAR
I
[EA
I PLANNING llVIEWEO BY DATE
REMARKS FIRE MARSHAL
MUST BE PRESENT FOR
TANK FILL, REMOVAL, OR CAP
j� (TYPE OF USE. BUSINESS OR ACTIVITY) EXPUUM
P.
1. 0/1' MAIH fi2lpLl1a['lt"6;t
=SC
TYPWCTION
GACUPANT
7C OUR 93
RITICAL a�5
CNRUMBER V11,1REIDURED
A EAS Vek
BPE.IALIN.IECTOR JAREA
SOURED Y.
13 YEs
JOCCUPINT
LOAD
DESCRIBE WORK TO BE DONE -XiIS ll:��
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'l
SW YA (, &6 f d eer 7AAw-1A '14 le
I -OL- ,oA — 171n I I VALUATION I FEE I I
114/11pe-
LA" CHECK FEE
HEAT SOURCE I LOT SLOPE 14
1
BUILDING
PLAN CHECK NO:
=
PLUMBING 7_,s'
[GRAD)NGIFILL
MECHANICAL
THIS PERMIT AUTHO IZEB ONLY THE W.BiK NOTEM THIS PERMIT COVERS WORK TO
t BE DONE 0 PRIVATE PROPERTY ONLY ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC�) WILL REQUIRE
C, B'F'LL
SEPARATE PERMISSION.
RE MIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YEAR - PROVID 0 WORK IS STARTED WITHIN 1 80 DAYS
ERG. REVIEW FEES
SEE BAC K OF PI K PERMIT FOR MORE INFORMATION
�APPUCANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS '"' " " "'
LANDSCAPING
2 EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
R DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIREC
ALLCUUMSF0 TLY
INSPECTION FEE
RECEIPT
m FROM THE ISSUANCE OF THIS PERMIT. ISS ANCE OF THIS PERMIT SHALL NOT BE
,I DE�MEDTO MODIFY. WAIVE ORAEOUCE ANY REQUIREMENT OF ANYCiTY ORDINANCE
PLAN CHECK DEPOSIT
0 NOR LIMIT INANY WAYTHE CITYGABILITY TO ENFORCE ANYORDINANCE PFOVLStON,�
—
TOTAL AMOUNT U.E
I HEREBY ACKNOW EDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. A D THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER ' HIE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
LPI-I N11— El
TION, AND:N D ING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
olfi�"' DV "11— — ,�P.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Aldll�
—OPI Iodg SP P—d1d,
WORKMEN S COMPENSATION 11 SURANCEANDRCWUB,27
OFFICIAISSG TLNE
IA;7
(425)
112100..
771
��RAGE041-�
-0220
-,WLEAIEDL/ DATE
ATTERTION
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. UBC SECTION 109
FAX
PINK OWNER - GOLD � ASSESSOR
"a
z
c
M
0
80
a
3: M
M z
jo-4
103
M m
0 rn
0
0
H
M 0
Z r-
Z
0
4
0
m
f
FINAL PRWECT APPROVAL -FORM
TO:
DATE:
MEMOTO: PERM[fr COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE—SC-3 —"—o 2—
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE —
PROJECT U-Yr-, 1,6�Q4
SITE ADDRESS. 9,3
PER11ffr#2-Q-Q - ADB#— DATE INSPECTED --- SE
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
PERFORMADLC—E AQNDS 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
2.
3.
RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date_ Si
ocaprvl.doc.l:tenip:bldg:fomisIO/OI
z
9
0
M
M
C
M
0
80
C
M M
z
'D --i
C
0
M M
0
0
0 M
C 0)
9 Cn
Q
Z
z
z
2
0
M
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch ... ...........
z
Retaining Wall ...........
Stab Insulation ..........
M
PLUMBING:
Underground ...........
M
Rough -in ...................
IT 0
Commercial Final
HEATING:
-L M
Gas Test ................
C
Gas Piping
Equipment ................
Commercial Final
0 -n
-n
MERIDA SHEATHING
IT IT!
NAILING ...................
0
FRAMING ........................
cn�
FIRST FLOOR FRAMING...
M 0
z
INSULATION ...................
Floor Insulation
Wall Insulation ...........
z
Ceiling Insulation
z
SHEETROCK NAILING
SPECIAL INSPECTION
0
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...............