20020117.pdfDATE RECEIVED 21—
USE
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PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB 1UffE/APT#
ADDRESS
7 717 73e'xA e
PLAT NAMFJSUBDIVISION NO��� LID NO,
ING ADORE S LID FEE S
PUBLIC RIGHT OF PER OFFICIAL STREET MAP
2Z2 R31" PZ 5-4y
ZIP TELEPHONE EXISTING — PROPOSED j
REQUIRED DEDICATION FT
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E METER SIZE I LINE 1111 1 110.01FIXTIJIES� PRV REOU11 0
REMARKS
ESO NO C3
BESS 14f114 1 11
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE I i
CITY
ZIP
ITILEPHO111
FIRE MARSHAI
NAME
6-41rll—e
IMUST BE PRESENT FDR
ENGINEERINOIANK FILL, REMOVAL.,"URT119P
ADDRESS
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FIRE REVIEWED By DATE
CITY ZIP
TELEPHONE
STATE LICENSE NUMBER
15�/L-7�7
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EXPIRATION DATE CMY
VARIANCE OR CU
SHORELINE OR ADS#
INSPECTIO
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r3yES E3NO
BOND
POSTED
SEPA REVIEW
COMPLETE EXEMPT
EXP
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED P,OPO"—O
PROPERTY TAX ACCOUNT PARCEL NO.
65?7:?5 OCO
NEW
ADDITION
0 REMODEL
El REPAIR
0 DEMOLISH
o GARAGE
CARPORT
CA RESIDENTIAL 0 PLUMBING MECH
0 COMMERCIAL CONIPL NCE OR
0 CHANGE OF USE
Ij APARTMENT 0 SIGN
F NCE
GRADING OYDS X FT)
EL TANK E] OTHER
Ei RETAINING WALL
DOCKERY RENEWAL
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT URSIDE REAR
R ING
PA KPTIOV,
REO.0 I QED
LOT AREA
PLANNING REVIEWED BY DATE
REMARKS
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CHECKED By
UCTION
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0 CUPANT
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JTY� A�CONST
GROUP
NUMBER
OF
Hum ER OF I�IEITAIIAL '
DWELLING A S
SPECIAL INSPECTOR
OCCUPANT
STORIES
U NITS If NUMBER
IV
RE IDLURE. 0 YES
JAREA
LOAD
DESCRIBE WORK TO BE DONE
EMARKS
ROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
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VALUATION $
Description I
FEE
Description
FEE
Plan Check
HEAT SOURCE GLAZING LOT SLOPE %
B u I I d I A It Tkj k)k
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZED ONLY THE WORK NOT THIS PERMIT COVERS WORK TO
h BE DONE ON PARIATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
a -
Grading
Recording Fee
DOMAIN (CURBS, SIDEWALKS. DFINEWAYS, MARQUEES, ETC3 WILL REQUIRE
t: SEPARATE PERMISSION.
Entp. Review
CltyftrOarge
Pa"MRIAPPLICATION: 'BODAYS
PERMIT LIMM. 1 YEAR � FROVIDEDWCQKISSTA DWITHIN INDAYS
Engr. Inspection
State S�charge
SEE SACK OF PINK PERMIT FOR MOREINFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chl; Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND Hot. HARMLESS THE CITY OF
ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Review
Receipt
EDMONDS, WASHINGTON,
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
SHALL NOT BE
I
FROM THE ISSUANCE OF THIS PERMfr. ISSUANCE OF THIS PERMIT
DEEMED TO MODIFY, WA E OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Total Am GuntDue
NOR LIMITIN ANYWAYTHE CITYSABIUTYTO ENFORCE A ORDINANCE PROVISIOW
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Receipt*
I HERE13Y ACKNOWLEDGE THAT � HAVE READ THIS APPLICATION: THAT THE [INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMP WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
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TION; AND IN DOING THE RK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
ding Officill. is her Deputy: d F .. — Paid. nd
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WORKMEN's COMPENSATID U�AN E No R W 18,27.
OFFICIALS SIGNATURE DATE
E a NE.
(425)
—RE/LEA'S/ED
771-0220
BY DATE'
ATTENTION
M 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK. OWNER� GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
5' TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM:
FIRE DEPARTMENTDATE-1--
ENGINEERING DIVISION DATI�—
DIVISIONDATE�--
PROJECT--L2111/—,LL��..
SITE ADDRESS T71-7 2o 3 S- Pi— S,��
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DESCRIPTION OF WO RKTOBEINSPECTED L)6'f-
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 WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
ci 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
Retalning Wall
Slab Insulation ..........
PLUMBING:
Underground .............
0 M
C:
Rough -in .............
0
0
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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Commercial Final
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EXTERIOR SHEATHING
NAILING . .......... ..............
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FRAMING ..........
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90
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FIRST FLOOR FRAMING...
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INSULATION ...............
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Floor Insulation
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Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
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MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..............