20020066.pdfDATE RECEIVED//
zo ERMIT
USE
CITY OF EDMONDS N, NUMBER
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CONSTRUCTION PERMIT APPLICATION 'AODRESS
MAILING ADDRESS
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CITY ITELEPHO
ADDRESS
CITY
NAME
ADDRESS V
56 0 0 1/ A). W,
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PLAT NAME/SUBDWISION NO. I LOT NO,
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED—
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0 NEW RESIDENTIAL 0 PLUMBING t MECH
0 ADDITION COMMERCIAL o C MPLIANCE OR
0 CHANGE OF USE
LOAPARTMIENT
0 REMODEL 0 SIGN
0 REPAIR 0 11ING CYGS 0 (FENCE X Fn
0 DEMOLISH TANK 0 OTHER
oGARAGE 0 RETAINING WALL
CARPORT ROCKERY 0 RENEWAL
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"1 OF USE. SUIANISS CTNnY1 EXPLAIN:
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NUM ER OF
DWELL
CRITICAL
OF
STORIES /
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UNITS
AREAS
NUMBER
DESCRIBE WORK TO BE DONE
REMOVAL,
FIRE REVIEWED BY DATE
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VARIANCE OR CU SHORELINE OR ADS# INSPECTIO 13OND
GO POST D
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$EPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT Ar7;0 I IR017 ALLOWED D
EXP x _L ;D "/A I Z.Gx,
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS ow)
AL�OV�EO PROP9SED FRONT SIDE REAR FRONT URSIDE ft.
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PARKING I LOT AREA ATE
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CHECKEDBY JTY��CTION PANT
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SPECIAL INSPECTOR OCCUPANT
REQUIRED 0 YES JAREA LOAD
VALUATION $
Description
FEE
Description
FEE
Plan Check
HEAT SOURCE GLAZING % LOT SLOPE %
Building
PLAN CHECM STED DATE
Plumbing
P
Mechanical
THIS PERMITAUTHORIZESONRYTHE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE: DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
2
Grading
Recording Fee
ETC.) W1
3 DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, U. REQUIRE
SEPARATE PERMISSION.
Engr. Review
City Surcharge
PE MnAIPUCATION: I..
PERMIT Leem I YEAA-PROVID D WORK IS STARTED WITHIN ISBDAYS
Engr. Inspection
State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT ON BIHAI OF HIS OR HER SPOUSE, HEIRS, ASSIG14S AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN [MEREST, AGREES TO INDEMNI�, DEFEND AND HOLD HARMLESS T E CITY OF
EDMONDS. WASHINGTOR ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Review
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
F F ROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WANE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Total Amount Du
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENTORCE ANY ORDINANCE PROVISION. -
Landscapoinsp.
Receipt #
I HEREBY ACKNOWLE GE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CO RECT. AND 11MT I AM THE OWNER. OR TH DULY AUTHORIZED AGENT OF i
APPLICATION APPROVAL
THE OWNER I AGRE TO COMPLY WITH CITY AND STATE LAWS REGULATING CON -
CALL
I� �W. p-11 ..III �Ig,u,d by M.
ISLTOYE'
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EM 0
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON REILATING TO
FOR INSPECTION
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WORKMEN'S COMPENSAI IONL!!S.UAA CE AND ACW 18,27.
1 7;,, SH'IN4AI Ral DATE
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(425)
77
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R'I EASED DATE'
�FENTION
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
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FINAL PROJECTAPPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM:
DEPARTMENT DATE
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE-
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PROJECT
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PERMIT #2:go -2- - 0 0 6 (, ADB#_-------PATEINSPECTED---:2L---5' --C-2-
DESCRIPTION OF WORK TO BE INSPECTED—CL:,�!�
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 wrrH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
I
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
I
2. MICROFILM
3.
RE -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date�-- Sign_
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ...........
FOUNDATION:
Footing ..............
Wall
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Pier/Porch .................
Retaining Wall ...........
0
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Slab Insulation ..........
PLUMBING:
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Underground .............
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Commercial Final
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HEATING:
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Gas Test ...................
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Gas Piping
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Equipment ...............
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EXTERIOR SHEATHING
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NAILING .........................
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FRAMING ........................
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FIRST FLOOR FRAMING
INSULATION
Floor Insulation
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Wall Insulation
Coiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .............
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