20020072.pdfDATE RECEIVED
PERMIT EXPIRES
CITY OF EDMONDS
USE PERMIT
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CONSTRUCTION PERMIT APPLICATION
JOB SUTTEIAPT#
OWNER NAIA��Z,0. SLIMNESS
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PLAT NAMEISUBDIVISION No. LOT NO. U NO,
MAILING ADDRESS
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Trom, Ael—
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CITY ZIP EPHONE
EXISTING — PROPOSED
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IEQUIPFD DEDICATION_ P,
NAME
METER SIZE I LINE SIZE NO. .1 FIXTURES PRV REQUIRED
YES C3 NO 0
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ADDRESS
REMARKS
OWNEWCONTRACTOR HESPONSIBLE FOR EROSION CONTROWDRAINAGE
CITY ZIP ITELEPHONE
ENGINEERING REVIEWED/DATE
ADDRESS
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FIR REVIEWED BY DATE
CITY ZIP
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STATE LICENSE NUMBER EXPIRATION DATE
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SHORELINE OR ADS#
INSPECTION
BOND
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PROPET" TAX AGO PAR L NO.
SERA REVIEW
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SIGN AREA
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NEW RESIDENTIAL
13 0 PLUMBING / MECH
LOT COVERAGE
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REQUIRED SETBACKS (Fr.)
'RIO T SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT US SIDE REAR
ADDITION \SnOM .... IAL g(��U a
PARNNO
REO'D
LOT
P�M ED DATE
qEMODEL APARTMENT
0 SIGN
0 REPAIR GRADING CYGE F NCE
( _ X Fr)
REMARKS
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n DEMOLISH TANK OTHER
fi2P- ND NEW 2 41F-
[3 GARAGE 0 RETAINING WALL
CARPORT ROCKERY 0 RENEWAL
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(ME OF USE BUSINESS OR ACTIVITY) EXP
CHECKED BY
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DESCRIBE WORK TO BE DONE
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REMARKS
INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
VALLIATION $
Description
FEE
Description
FEE
HEAT SOURCE LOT SLOPE %
[Plan EGheck
Building
I.CHEC:M_,, TED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZED 0 ILY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONVI. ANY CONSTRUCTION ON THE PUBLIC
2
Grading
Recor'ding Fee
DOMAIN (Curios, SIDEWALKS, DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERM;SSIOM. —
Engr. Review
City Surcharge
Pa MG`-PFUGA"O"h I--
PEII.IT 1111111 YEAR - PROVIDED WOR IS STARTED WITHIN 180 DAYS
Engr. Inspection
State Surcharge
SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS� WASHINGTON. ITS OFFICLALS� EMPLOYEES. AND AGENTS FROM ANY AND
-
Fire Review
, —=I
Receipt Ty
ALL CLAIMS FOR DA.AGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT 511ALL NOT E
Fire Inspection
Total Amount Due
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DEEMED To MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCHE
NOR LIMIT IN ANY WAY THE CITY$ ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
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Landscape Insp.
Receipt #
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN is conFIECT�, AND T14AT I AM THE OWNER, on THE DULY AUTHORIZED AGENT OF
THE OWNER. I SEE TO COMPLY WITH CITY AND STATE LAWS REGULATING C -
ONS'RUC
CALL
This application is not a permit urld signed by the
K
TION� AN13 IN DOING THE WOR AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATI`;k ' CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
B.11ding Offieltil or Mein., O.ptAy: end Fees Iv. peiid� end
I.C�ipti����n-3g.di.�p.�.p,.id.d.
WORKMEN. 1PqALTl..!N.AAI,I.E AN. RCW 1. �1.
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OlqMf DATE�
E SIGNED
AT
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(425)
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j6ATE
ATTIWTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
- A
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
ORIGINAL - FILE - YELLOW'. INSPECT R
PINK -OWNER - GOLD � ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM:
___YIRE DEPARTMENT DATE C�)
ENGINEERING DIVISION DATE-_
—PLANNING DIVISION DATE—
PROJEC
SITE ADDRESS Lf S7- z
PERMIT #?,,oe e0c) 7 2— ADB#------PATE iNspEcTED—L—L
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DESCRIPTION OF WORK TO BE INSPECTED_,-4--,i—
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 WrM CONDITIONS NOTED
copy of CONDITIONS given to owner/contractor by inspector
poGr e5:-"Vg ( 7' 19,41Z
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FAILED FINAL INSPECT10N - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
2. MICROFILM
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Datc�__ Sign_
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUND ATION:
Footing ..............
Wall..........................
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Pier/Porch .................
Retaining Wall ...........
Stab Insulation
PLUMBING:
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Underground .............
C: V,
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Rough -in .............
-40
0 C=
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Commercial Final
M
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HEATING:
0
Gas Test ....................
3:
Gas Piping .................
Equipment .................
3:9
Cornmercal Final
M ITI
0
EXTERIOR SHEATHING
0
0 r—
M
NAILING .......... ..............
03
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FRAMING .. .............
IT! 0
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FIRST FLOOR FRAMING
INSULATION ...............
Floor Insulation
Wall Insulation ..........
C0
Ceiling Insulation
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0
SHEETROCK NAILING
0
IT!
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL"APPROVAL FOR fy�
OCCUPANCY ..................
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