20020115.pdfDATE RECEIVED PERMIT EXPIRES
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CITY OF EDMONDS R5 8 N MI'ER
CONSTRUCTION PERMIT APPLICATION JOB SUITEJAPT#
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ADDRESS PL V
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OWN
PLAT NAMEISUBDIVISION NO. L
(7611\i t- L�D NO*
MAILING ADDRESS D FEE$
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RY,
'10 1�5 12-4 F� v 4 a T
CITY ZIP 'X PROPOSED
ITILIPHON1
REQUIRED (I.M. TION FT — U—�
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NAME LINE SIZE I NO- OF F'11UR11 PRV REQUIRED
EsI3 No 13
ADDRESS REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ZIP
ONE
ICITY
ITILE1
FIRE MARSHAL
NAME
MUSI BETRESENT FOR
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I
ENGINEERING TANK
Fitt.. REM0VM.W/GAP-
ADDRESS
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FIRE REVIEWED BY
DATE
CITY ZIP TILEPH NE
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I
STATE LICENSE NUMBER EXPIRATION DATE
VARIANCE OR CU
SHORELINE OR ADO* INSPECTI N POOND
REO'D DOTED
C3YES [3N0
CiL
PROPERTY7447
SEPA REVIEW SIGN AREA HEIG14T
COMPLETE EXEMPT ALLOWED PROPOSED P�01080
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EXP I
, I
[3 NEW 1,;q,"ESIDENTIAL 0 PLUMS NO MCCH
_ALLOWED
LOT COVERAGE REQUIRED SETBACK$ 07.1 PROPOSED SETBACK$ (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT IJRSIDE HEAR
ADDITION COMMERCIAL C MP NCE OR
0 GRAND OF USE
n REMODEL APARTMENT 0 SIGN
PARKING
REDD I PROVIDED
LOT AREA PLANNING R HEWED BY DATE
0 GRADING n FENCE
REPAIR CYD. I — X FT)
REMARKS
DEMOLISH TANK OTHER
19
o GARAGE RETAINING WALL
0 ROOKERY 0 RENEWAL
CARPORT
ITYPE OF USE, BUSINESS OR
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CHECKEOSY ITVP=
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PECIAL INSPECTOR
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CCUFANT
ST..'�. UNITS
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JAREA
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DESCRIBE WORK TO BE DONE
REMARK$
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
'7r
VALLIATION $
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Description
FEE Description FEE
V
Plan Check
HEAT SOURCE GLAZING LOT SLOPE %
PLAN CH!!!!!q�_
Plumbing
Mechanical
THIS PERMIT AUTHORMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTRON ON THE PU13UC
Grading
Recording Fee
2 0 REQUIRE
M OMAIN (CURBS, SIDEWALKS, DRIVEVVAYS� MARQUEES, ETC.t WILL
SEPARATE PERMISSION.
Engr. Review
City Surcharge
PER ITAPPLICATION: IOODAYS
PERMIT UMM. I YEAR - PROVI ED WORK IS STARTED WITHIN 'SO DAYS
Engr. Inspection
State Surcharge
SCE 13ACK OF PINK PERMIT FOR MORE INFORMATION
HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
—111CANT. ON BEHALF 0 OR '
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND ROL H RMLESS 1H. 0
No
" " ' A' ""To ITS OFFICIALS, EMPLOYEES. AND AGENTS MOM ANY AND
Fire Review
Receipt #
T'Y
ALLCLAIM�%RTAMAGNS FW..RN.U.�,A.ISI�.DI.EC.Y.�l,�.I.E.
OF THIS PERMIT SHALL NOT BE
OF THIS PERMIT BE
FROM THE ISSUANCE ISSUANCE
DEEMED TO MODI�, WAIVE OR RE UCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Total Amount Due
NOR LIMIT IN ANY WAY THE CITY$ ABILITY TO ENFORCE ANY ORDINANCE PROVISION!
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AT
NOBODY ACKNOWLEDGE TH I HAV READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
MVIE. 1. C.e.FCT AND THAT AM THE OWNER. OR THE DULY AUTHORIZE AGENT OF
THE OWNER. I AGREE To Cc PLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
T "P I, n�
2 YED
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE "BOB CODE OF THE STATE OF WASHINGTON RELATING TO
g
B.fldl'na P
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FOR INSPECTION dS.cHF d.d
WORKMEWS COMPENSAT%Xk�SURANCE A D RCV? 10,27.
SIGN uRE CATE/
DATE SIGN D
(425)
,
I]AL,
2L
771-02M
RELEASED BY I DATE
ffitENTON
1_/
M 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 YEULO INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
FAX
PINK - OWNER GOLD, ASSESSOR
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MAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: --------YIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE
_________YLANNING DIVISION DATE
PROJECT -US
srrEADDREssa2�3/o q,�' (,z-
PERMIT (9&6— ADB# DATE INSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED
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
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
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL.
Date— Si
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ...........
FOUNDATION:
FootIng ............
Wall
Pier/Porch .................
z
-04
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
M
Underground
IT!
0
Rough -in ...................
0
Commercial FInat
M
HEATING:
t,
CE
Gas Test ....................
Gas Piping ..........
Equipment .................
Commercial Final
M IT
EXTERIOR SHEATHING
0 Fn
NAILING ..........................
C: M
FRAMING
To
r
FIRST FLOOR FRAMING
INSULATION
Floor Insulation
Wall Insulation
Ceiling Insulation
z
SHEETROCK NAILING
ITI
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ............
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