20020056.pdfLL I I PERMIT EXPIRES
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CITY OF EDMONDS NUM
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS 71�0
OWNER NA EINAME OF BUSINESS '�Q V / -2- -rT—
I /4W /710 PLAT NAMEISUBDIVISlON NO, LOT 110, LID NO,
MAILING ADDRESS LID FEE 3
PUBLIC RIGHT .1 WAY IS. OFFICIAL STREET MAP T�,T"p.pu:,"��,`aad
E)(ISTN.— IROPOSED— TIM—nPan
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_S_t/�_3_T_Zy _REOU:RrD DEDICATION— FT — wt=Z'. 13
NAME METER SIZE I LINE PRY REQUIRED
YEs[3 NO 13
ADDRMSS REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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, -
FIRE REVIEWED BY
DATE
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STATE LICE BE NUMBER
EXPIRATION TE�
VARIANCE OR CU
SHORELINE OR ADB#
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PARCEL
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COM SERA REVIEW
PL.E EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLO WED PROPOSED
,Fg�;FOUNT
EXP ,
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NEW
RESIDE TIAL
PLUMBING MECH
LOT COVERAGE REQ RED SETBACKS BT)
ALLOWED PROPOSED FRONT SIDE BEAR
PROPOSED S BACKS (Fr.)
FRONT URESTIDE REAR
ADDITION
COMMERCIAL
COMPLIA E OR
CHANGE OF USE
n REMODEL
APARTMENT
SIGN
PARKING I
REGO I PROVIDED
LOT AREA
I PLANNING REVIBNED By DATE
REPAIR
GRADING .S F NICE
I X Fr)
REMARKS
DEMOLISH
TANK E] OTHER
[:I GARAGE
RETAINING WALL
CARPORT
o ROOKERY RENEWAL
OWE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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CHECKED BY
ITYPE OF CONSTRUCT17N
OCCUPAN;�
122�
.. Up
NUMBER
OF
NUMBER OF
WELLN"
CRITICAL
I�N
�ABEA
occu Nr
STORIES
NITS
LOAD
DESCRIBE WORK TO BE
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REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG`0
'Plan Check
LOT SLOPE %
Building
PLAN CHECK NO: VISTED OATE
plumbing
'Mechanical
Ra
THIS PERMIT AUTHORIZE-6 ONLY WE ORK NOTEM THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. AM CONSTRUCTION ON THE PUSUC
Grading
Recording Fee
IN C) WILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATEPERMISSION.
Engr. Review
City Surcharge
PER RAPPLICATION: IWDAYS
PERUffUM I YEAR -PROVIDED WORK IS STARTED WITHIN I.DAYS
Engr. Inspection
State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
%FPLICANT ON SEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation I
Flan Chk Do
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND A13INTS FROM ANY AND
Fire Review
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCi OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF MY CITY ORDINANCE
Fire Inspection
Total Amount Duo
NOR LIMIT IN ANY WAY THE C S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscaponsp.
Receipt #
M/1/
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR WE DULY AUTHORIZED AGENT OF
APPLICATION
This is not a isail sinned by In
THE OWNE . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
THE THEREBY, NO PERSON WILL BE IMILOYED
CALL
appli-Ion "I'di
B"ding odc"I Botany: and Fles IT, Paid, and
TION; AND IN DOING WORK AUTHORIZED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO IFOR
INSPECTION
.Ipt Is TkaITTd9.d in'p ... pa.id.d.
WORKMENS COMPENSARO"SURANCE AND RCW 18,27.
SIGNATURE (OWNE 777 SKINE.
(425)
�fT6
I �--
771
-0220 _§EUI�ASED
BY DATY
ATTENTON
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�OVVTNER - GOLD-ASSSSSOA
10/01
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERWr COORDINATOR, BUILDING DIVISION
FROM: —FIRE DEPARTNIENT DATE
—ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE—
PROJECT_4)_��I_
srrEADDREss -Mr \J(J/MZ C6U(QZ
PERMIT# ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED 0 1 &L11,L &AlArC CAR
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:
0 6( 4-
V- GRANT FINAL PROJECT APPROVAL IL10 UAf-;4,r
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy ofCONDMONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy ofCORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE_INSpECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date— Sigo_
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ..................
FOUNDATION:
Footing ..............
wall .......................
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Pier/Porch
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Retaining Wall ...........
Stab Insulation ..........
PLUMBING.
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Underground .............
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C:
Rough -in ...............
pill !711
Commercial Final
HEATING:
ID
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Gas Test ...................
Gas Piping .. ..........
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Equipment .................
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Commercial Final
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EXTERIOR SHEATHING
NAILING .......................
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FRAMING ..............
74
FIRST FLOOR FRAMING
INSULATION ...................
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Floor Insulation
-4
Wall Insulation ...........
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Ceiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY