20020150.pdf14aA76APE RECEIVED
PERMIT EXPIRES
USE
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CITY OF EDMONDS NE P URM T -
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CONSTRUCTION PERMIT APPLICATION JOB
ADDRESS
OWNER NAMEINAME OF BUSINESS T. "/",
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n PL�T NAMEISLISDIVISION NO. LOT NO. L�D NO,
MAILINU ADDRESS L D FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP �w ". aa
ZIP TELEPHONE EXISTING — pAOpOSED_ u=,Oaa_
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HEQUIRWR).�WR84�_� nc_1�0 13
NAME IRMA IFIV,11E.W.M.
S11 L BE INS' T'
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUD RAINAGE
TELEPHONE i CITI-i
4 LAI, , �I. -I AAy'6-
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ANGIAL
_NAME
REVIEW
ADOIESI
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FIRE REVIEWED BY 11117SCIANT-M LPC 605.2 DATE
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�L I'll E A WATER SERVICE SH UTOFJ;
P r QTX A. I
ETAE
�..EN VARIANCE ON BOND
ION DATE CHECKED BY flft- AS IT _
T EXPIR !H,91!EI+TF§
STATE LICENSE NUMBER I" _D1.11NIM., POSTED
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$EPA REVIEW SIGN AREA HEIGHT
iit PROPERTY TAX ACCOUNT P COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
!!J -A-1 EXP I , ,
'9(RESIDENTIAL LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.
)�NEW PLUMBING t MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
'5111PLIANCE
ADDITION COMMERCIAL OR
13
CHANGE OF USE I
PARKING L T E
REMODEL 0 APARTMENT R
0 SIGN ED
REPAIR GOADING CYOS 0 FE BE Do- V In connectors
I X FT) REMIRR!I
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jel-hitirning Mliane in
[j DEMOLISH [3 TANK o OTHER
linhiunilied spaces. UMC 815.7
CGARA`IE RETAINING WALL RENEWAL
1 ARPORT ROGUERY
OWE OF USE. BUSINESS O��LAIN:
CHECKEDBY ITYPEOFCO ON C21!aOCCUPANT
GROUP
NUMBER Ui OF
CRITICAL
OF -WELLING AREAS SPECIAL INSPECTOR OCCUPANT
JARBA
UNITS R SOURED
T.Rl..;Z NUMBE R YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESSI
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Plan Check
HEAT SOURCE Gli Is ilding
PLAN CHECK NO: VESTED OAnTE
Et
Plumbing
chanuo.,
Mechanical
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THIS PERMIT AUTHOFILZES ONLY THE W RK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON, THEPUINJO
C
:1
or I g
Grading
Recording Fee
1 our..
:I OMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
a EPERMISSION.
PERMITAPPLICATION: 180DAYS
Engr. Review
City Surcharge
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN IN DAYS
Engr, Inspection
State Surcharge
SEE BACK Of PINK PERMIT FOR MORE INFORMATION
—PLICAW. ON 81-1 OF 1113 01 HER SPOUSE. HIRIS, AISIGNI AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNII: DEFEND AND CILD HARMLESS THE CITY OF
EDMONDS ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
Receipt #
GLAJM�WAIHINGTON.
ALL FOR DAMAGES OF WHATEVER NATURE. ARISING 01RECTLY OR INDIRECTLY
FROM THEISSUANC OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAVE OR REDUCE
Fire Inspection
Total Amount Due
ANY REQUIREMENT OF MY CITY ORDINANCE
NORLIMMINANYWAYTH CITYS ABILITY TO ENFORCE MY ORDINANCE PKOVISION�
'iHEFIE
Landscapoinsp.
R ... ipt #
ACKNOWLEDGE THAT I HAVE OEM THIS APPLICATION; THAT THE RIMMAT'i
APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, On THE U1 AUTHOR ZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
TWINplisuln. Is net. renear, unflisgarld by Me
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Olficlal,r wi Deputy: and Fees are Paid. and
molptisacknoModgadl,spaceprovlded.
WORKMEN�S COMPENSATIOLA4URANCE AND RCW 18,27.
DATE
Sig (OWNER 0 SIGNED
(425)
Mgkh!A'E�/.
LE
E ASED BY
ATTENTION
EXT 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,FLE YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OW14ES GOLD . ASSESSOR
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CITY OF EDMONDS
WATER QUALITY SECTIOA
7110-210th St. SW
BackfloW Prevention Devi
ce Test Report
Ednonds, WA 98026
Computer ID # "turn No Later Than
Name of Premises
Contact Person (�FOA
Service Address
Location of Device
P,
Device i wc
Manufacturer Model Size Serial No,
ofTesd-5 lb Type of Device
Line Pressure at Time m
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Reduced Pressure Assemblies
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Breaker
Double Check Assemblies
Air Inlet
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Relief
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Remarks:
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THE ABOVE REPORT IS CER
TO TRU .............
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ed b, 12
Initial Test Perfonn CO-9-15 I I St. of
Repaired by Date
Final Test PerfortnedAJIG Z fi 2002 Cert No. Date
DEVC.tOPMENT SEFIVICES CTR.
CITY OF EDMONDS
EXCELDATAkWATER\BACKFLW
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall
Pler/Porch .................
�Retalnlng!Wall
z
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
M
C
Commercial Final
M
0 C
HEATING:
x M
M z
Ga �Teat,
-4
z
'Equipment .................
Commercial Final
On
EXTER16R SHEATHING
M M
NAILING ..........
a
0
0
FRAMING _ .....................
C:
C
FIRST FLOOR FRAMING...
Q 0
Z
INSULATION ...................
Floor Insulation
Wall Insulation ...........
z
Calling Insulation
SHEETROCK NAILING
z
SPECIAL INSPECTION
—
0
IT!
MISCELLANEOUS ..........
FINAL APPROVAL FOR
_2 (�02
OCCUPANCY ..................
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