20020110.pdfCITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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OWNER fIkMEINAME 0 BUSIN Be
PLAT NAMEISUBDIVIStON NO.
LOT NO, LID NO.
IRAILIN. ADDRESS
LID FEE
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CITY
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FIRE REVIEWED BY
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STATE LICENSE NUMBER
EXPIRATION
DATE
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SHORELINE OR ADD#
SEPA REVIEW
SIGN AREA
HEIGHT
PROPERTY TAXX ACCO CEL NO.
COMPLETEEXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED,
EXP
,
NEW
0 RESIDENTIAL
PLUMBING I MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS I
FRONT SIDE REAR
PROPOSED SETBACKS (Fr)
FRONT U R SIDE REAR
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FEE I Deaharliallon I FEE
HEAT SOURCE GLAZING LOT SLOPE %
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PLAN CHECK NO: WIND DATE
Plumbing
Mechanical
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THIS PERMIT AUTHORIZES ONIYTHE ORKWOTED THIS PERMIT COVERS WORKTO
HE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
B, g
Recording Fee
2 LLREQUIRE
:3 DOMAIN (CURDS. SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) W1
SEPARATE PERMISSION.
Engr. ReView
City Surcharge
PERUTTAPPUCATI N: IN DAYS
PERMIT LIMIT. I YEAR - PROVI ED WORK IS STARTED WITHIN Use DAYS
Engr. Inspection
State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON SIEHAL OF HIS Oft HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Receipt #
a EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AN AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE ARISING DIRECTLY OR INDIRECTLY
Fire Review
FROM THE ISSUANCE OF THIS PERMIT. SSUANCi OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WA VE OR REDUCE ANY REOUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Total Amount Due
Non LIMIT IN ANY WAY THE CHYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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Receipt#
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN is CORRECT. AND THAT I A THE OWNER. OR THE DULY AUTHORIZED AGENT OF
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THE OWNER. I AGRE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
arid ceder, Is,ot a pjflj signed by Me
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL HE EM PLOYED
IN VIOLATION OF THE BE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
,,,This
din Offic�rfl of his/her Dejeu": -d Prid. end
re�ejret is ackll�,I,n,d 1, sp ... pre�fided,
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WORKMENS COMPEN SU NCE AND RCVV 18,27.
S/
1
IGN DATE
ON
(425)
0121d 52-
j
771-0220
'DATE
BE
ATTENTIOW'
EXT 1333
UNTIL
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI.
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
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DEPARTMENT OF SUILDXW��-
,,AR UNIFORM BUUJXNG CODE SECTIDN-"q
At: 2 Main Street #D EdmondiWA 98020
--------- ��Bullding�6smft#:— #2002-0110
Occupancy esfablished by this ceroheate., Owellim Units: —N/A-
No. Stories: 1
B Type C
ponstruction: VN Basement: No
Maximum 6ocupant Load
Room capacity sig-, at 7B.C. 1002)
in at S.
Owner of Id
_n Longstaff
131i
TE REMENTS OF THE 1997
Bui '7 Ion Services WITH THE REQUI
THE Wild.ld
EDITION OF THE UN, RM BUILDING COJ3#'EV'
al"O D BY
WHICH THE N f
R., IVISION OF OCCUPANCY AND THE USE FOR
PROPOSED OCCUPANCY IS CLAS D By
7 —7,,77
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Issued I
2002
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BY:
TW mtfimu W WOW In —0— "ic ww sms wbe �, �iawd m ob=md ow k.WbWcmfta�jw
SITT I tT, till
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION,
FROM: FIRE DEPARTMENT DATE-2:�--�— 6f 2—�
ENGINEERING DIVISION DATIE�—
PLANNING DIVISION DATE�--
PROJECT
SITE ADDRES z-, 7-
PERMIT /l/J?--44.0-..____.ADB#__________PATEINSPECTED-2.-::�-02—�,
DESCRIPTION OF WORK TO BE INSPECTED eoA�R- ZLL�'—
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 PRO3ECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector,
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u 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 ...............
Z
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
x
Q M
Underground .............
C
M
Rough -in ...................
0 C::
Commercial Final
_j r
M
M
HEATING:
z
10-4
Gas Test ....................
-4
Gas Piping .,. ...... . .....
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Equipment .............
Commercial Final
M M
0
EXTERIOR SHEATHING
0
0
NAILING ..........................
FRAMING .. . ....................
0
FIRST FLOOR FRAMING
r
INSULATION
Floor Insulation
z
Wall Insulation ...........
CA
Ceiling Insulation
z
0
SHEETROCK NAILING
d
0
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SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ............... _zl
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