20020078.pdfDATE - I I PERMITEXPIRES
/0// 7W - - - -
US
CITY OF EDMONDS "I
CONSTRUCTION PERMIT APPLICATION jo
AD
OWNER NAMEINAME OF BUSIN BE
o W
P
M
'A A
MAILING ADDRESt
�c
P
;;,-I Q,
CITY
C 'n
E
_jT111)
L ::2 R
N
NAME
A
A DRESS
G
o
CITY --------- 7T__7PHONE
C IT
N,
NAME
0 Ll I I 1�__ 7 4&Mlt) -jNe4EX_2_.
ADDRESS
A�
C
CITY
GI
STATE LICENSE NUMBER EXPIRATIONDATE
CHECKEDBY
11 EL N
PROP GTYT�y ELN C
�T
0 ; <:20
2 411,1,
V RESIDENTIAL 0 PLUMBING / MECH A
117;J1 AUDIT ON C] COMMERCIAL COMPLIANCE OR
CHANGE OF USE
C] REMODEL E] APARTMENT 0 SIGN
FENCE
REPAIR 13 1
C3 DEMOLISH TANK m OTHER
G CARAC, C] FETAHINyG WALL 0 REIEWAL
A PO4 E,
0
r
(TYPE OF USE, BUStNESSORATIVITY) EXP IN'
BE
c
I
7Z
V o
OF AL
WUMESEIR
D ILL NGF
AR'T'
EA S
NITS
NUMBER,
DESCRIBE WORK TO BE DONE
R
0, L
ONCE gLAlINZ;%
LrT SLOPE %
PLAN CHECr
111`11 DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CUA8S, SIDEWALKS, DRIVEWAYS, MAnGUEES, ETC.) WILL REQUIRE
z SEPARATE PERMISSION.
P MIT APPLICATION� 180 DAYS
ER
PERMIT LIMIT. I YEAR, PROVIDED W RK IS STARTED WITHIN 180DAYS
T
CK OF PINK PERMIT FOR MORE INFORMATION
SEEBAD
'APPLICANT, ON BEHALF 0 HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCC6SOR$
IN INTEREST. AGREES TO NDIEMNIFY. DEFEND AND HOLD HARMLESS T14E CITY 01
%OFFICIALS,
�A,TON EMPLOYEES, AND AGENTS FROM AHYAND
BGM.N ,
ALLCLA'ME F.G DAMAGES OFWHATEVER NATURE�ARISK,G C RECTLYORNOIRECTLY
FROM T E I EU N ; PERMIT SHALL NOT BE
H A CE OF OF ANY CITY ORDINANCE
GROINANG11H.111I.N'
I HEREBY ACKNOWLEDGE THAT � HAVE READ I HIS APPLICATION, THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DUty AUT.OFLKED A ENT 01
THEO NER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRuC
W
o BI E-PLO�F
T ION, AND IN DOING THE WORK AUTH RiZE. THEREBY, NO PERSONWILL
TO
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING 0
WORKMEN S COMPENSATION INSURANCE AND DOW 'F,�l
AD
DATE SIINID
LF
PERMM.ETRM2_�o
CHESS
SUITEIAPTO
LAT NAMEISUBDIVISt.N NO
L�o'
77�7,
DFEE�
UBLU A14GHT OF WAY PER OFFICIAL STREET MAP
A. _,, ..".
0
.
0
XIFTING_ PROPOSED-
0
EQUIREDDEDICATION-
FT -
_77-11-1
ITEFSIIE LINE 111E
NO.01111T
PRV REOUMED
I I
YES 0 NO
ERKS
WNEGCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAMAGE
IEVIEWIDIDATE
JE REVIEWED BY DATE
r z
VARIANCE On CU
SHORELINE OR ADS#
INSPECTION
BOND
!KE.
N
O'EE NO
SERA REV15W
SIGN AREA
HEIGHT
IMPLETE EXEMPT
ALLOWED PROPOSED
ALLOW lljl�'El
I
,
m
LO T COVER BE
REQUIRED SETBACKS (FT.I
PROPOSED SETBACKS ET)
L ED PROPOSED
FRONT SIDE REAR
FRONT OR SIDE REA�
�j
0
M 0
0
c
c
PARKM
GO
PROVIDED I LOT An PLtNNNG REVIEWED By DATE
C 41
I 4
&,rr AL)acvQ-,-) 6,S>
A
mZ
ca
0 'n
"n
Nax-n o-k �5. 1-7o 'R-towml
WV�Ir_l C—zn�Akill
�EUKEDBY
ITYPEOnTION
C
OCC` "
OC.IIRAN;l�
OUR
GROUP
21
,
m m
IECIAIL INSPECTOR JAPEA
CU
OCCUPANT
0
FOUIRED 0 YES
L.A.
�MA KS
40GRESS INSPECTIONS PER U.0 11,11/11NAL INSPECTION REQ'D
K. C 0)
9 [j)
mo
Z
74
z
-4
MAILUATION
FEE
LAN CHECK FEE
z
iUiLDING
0
UUMBING
m
AECHkNICAL
3RADINGIFILL
iNG REVIEW FEES
END INSPECTION FEE
PLAN CHECK DEPOSIT t
L
L�4115) -
NECEIPT"
TQTALAMOUNI DUr
APPLICATION APP�ROVAL
CALL
T 'ho
P. hl, �,Ijy Fd Lw1Jr,d
D, " "d
FOR INSPECTION
�V
OF�ll LSSIGNAIIIEP DATE
(425)
771-0220
,U,y, E TIE
/ Yi I I
ATTENTION v EXTT333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDIN -i OR STRUCTURE UNTIL -0221
A FINAL INSPECTION HAS 13EEN MADE AND APPROVAL OR A CERTIFI- 771
CATE OF OCCUPANCY HAS BEEN GRANTED, USC SECTION 109 FAX
E19�
TGINAL FiLY YELLOW - INI,PECTOH
PINK Cn�<ER GOLD ASSESSOR
FINAL PROJECT APPROVAL FORM
TO:—
DATE-.—
MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE —
A t w-5EY-EENGINEERING DIVISION DATE
PLANNING DIVISION DATE— I
PROJEC
SITE ADDRESS -
PERMIT # 2- - 60'7 ADB#_____--PATE INSPECTED So
DESCRIPTION OF WORK TO BE INSPECTED
I h approved plans. Final approval
A field inspection was conducted to determine final comp ian e wit ment to the release of
denotes that there are no objections from the above signed Depart
_7:RMA and the granting of
S
NC:
G T FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
U copy of CORRECTION NOTICE given to owner/contractor by inspector
I
2.
3.
RE_INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date—� Sign_
ocaprvi.doc.l:ternp.bldg:formsIO/OI
z
::-4
C M
rn 00
80
C
-j K
= M
M
10
z
Cn
0
ni
ME
rh rn
0 r-n
C Cn
co,
rn 0
Z
3:
z
-q
x
Cn
z
M
y
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
—>
Footing......................
waif..........................
Pier/Porch .................
Roaming Wall ...........
Slab Insulation
PLUMBING:
Under ground
Rough -In ..........
Commercial Final
HEATING:
Gas Test
Gas Piping ................
Equipment ...........
Cormnercial Final
EXTERIOR SHEATHING
NAILING
FRAMING ....................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
AL �ds _11Z_
OCCUPANCY ..................
z
0
m
m
0
80,
m M
10
C
m m
0
6 Fn
C 0)
9 to
M 0
z
z
9
:
,
0
m