20020155.pdfe
A] DATE RECEIVED, PERMIT EXPIRES
PERMIT
CITY OF EDMONDS ZON NUMBER '19
CONSTRUCTION PERMIT APPUCATION JOB 1�IT7
ADORE1.
ER NAMEMAME OF BUSIN Be
rfe5D :Ct'=r PUT NAMSISUBDIVISION NO. LOT NO. LID NO.
J�'
�TEYTPE "
ING ADDS SS LID FEE 11
As —s
I If -22 !iof F/ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 13W11.1.1 ses.".
Us. P-1. Pws
Z ITILEPHONE EXISTING — PROPOSE
y� See s
_Z� 3 REQUIRED DEDICATION FT — ,s-
-pres—
E METER SIZE I LINE .11M F FI)OURES PRV REQUIRED
YES C3 No 13
RESS REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLJORAINAGE
ZIP
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NAME
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FIRE REVIEWED BY
DATE
ZIP
TELEPHONE
STATE LICENSE NUMBER EXPIRATION
VARIANCE OR CU
SHORELINE OR ADS#
INSPECTION
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OSTED
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ZI a. (STY, AMC, PARCEL No
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04+,3,4 0
$EPA REVIEW
COMPLETE EXEMPT
EXP I )�
SIGN AREA
ALLCli�OSED
HEIGHT
ALLOWED PROP0fEO
-6
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NEW
ADDITION
RESIDE
_;`nAL
COMMER CLAL
0 PLUMBING I MECH
COMPLIANCE OR
13 cHAN., OF USE
LOT COVERAGE
ALLOWED PROPOSED
b"dKI �1<:b
REQUIRED SETBACKS (Ft.)
FRONT SIDE REAR
' Qfo
PROPOSED SETBACKS (FT.)
no- . ...
I .7'.IDE
io
PARK' - 111.T
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PLANNING IEVIMID BY AT
REMODEL
0 REPAIR
APARTMEJ
NT
0 GRADING ,,
0 SIGN
0 FENCE
( — X F-0
REMARKS
0 DEMOLISH
1:1 TANK
0 OTHER
oRETAINING WALL
ROCKERY
RENEWAL
(ME OF USE. SU LAJN:
C.ECKE..Y I-PEOFr=N C?T�
0 OCUPAT
OR UP "o
NUM111 OF
DWELL NG
UNITS
IT
C�
ARE�
I JAREA
OCCU NI
LOAD
DESCRIBE WORK TO BE DONE
VALUATION
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ounaing
1
PLAN CHECK NO,
GA
T'� T
Plumbing
Plumbing
Mechanical
THIS PERMPTALITHOARZES ONLYTHE ORKNOTED, THIS PERMIT COVERSWORKTO
1: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON YHEPU.UC
B
Grading
2 OMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Engn. Review
SEPARATE PERMISSION.
PERMIT UMM. I PER ITAPPUCATION: ISODAYS
YEAR - PROVIDED WORK 16 STARTED WITHIN IN DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
—PLIOAN" ON 1EII111 OF HIS 01 HER SPOUSE, H1111. AIIIIIIII AND SUCCE1011
IN INTEREST AGREE. TO IN.E..1- AN. II.L. HARMLESS THE CITY .1
Traffic Mitigation
Fire Review
- - -_ - -_ -
-_
EDMONDS, WASHINGTON, IT$ OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE F THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE On RE UCE ANY REQUIREMENT OF ANY C TY ORDINANCE
0. NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE MY ORDINANCE PROVISION.-
Landscapoinsp.
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVE IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION, N, OING.THE WORK AUTHORIZED THEREBY, NO 1E11ON WILL 11 EMPLOYED
CALL
'. "o_ 0. OF T E _.on COM47'us STAT 01 WA�HINGJON RELATING TO
FOR INSPECTION
yvon.�N.7 C
O.'EN."T'.N IN" M. sew 18,27.
SIG US WNER OR DAT:Z2ED
(425)
f I of
771-0220
&T�NTION
EXT 1333
IT IS ONLAWFUL TO BE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
10101
Recording Fee
/0z) State Surcharge
PlanChkD.p..it
Receipt #
Total Amount Due
Receipt #
APPLICATION APPR6VA1
Thl-ppil.u.n 1—t. p—et -0.1greed by M
'."dirg Otficial or Issihe, Depety: We Fees are pold
.... p1Iks—I.dg.di..p ... pid.d,
46ALS SIGNATURE DATE
f 11VAJ- I / 10 L
ORIGINAL -FILE YELJLOW-INSPECI.R
PINK - OWNER GOLD - ASSESSOR
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APPROVED A NOTED
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4PROVED uY PLANNING'
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FINAL PROJECT APP-ROYALFORM
TO:_
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTNIENT DATE—
DATE-016S
A*). Gtu ENGINEERING DIVISION
PLANNING DIVISION DATE —
PROM
SITEADDRESS
# 900 1Z, ADD#_____ ---PATE INSPECTED 0( da
PERMIT
DESCRIPTION OF WORK TO BE INSPECTED—bC�±
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
pERFORMMCE 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 Spector
cl Copy of CORRECTION NOTICE given to owner/contractor by in
3.
RE
,-INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date_ Si . gn_
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RECORD,OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ...............
FOUNDATION:
5-30
Footing ......................
wall ...........
Pier/Porch ............
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final
HEATING:
GasTest ....................
Gas Piping .................
Equipment.................
Commercial Final
EXTERIOR SHEATHING
NAILING ..� ...................
FRAMING ..............
FIRST FLOOR FRAMING
INSULATION ............
Floor Insulation
Wall Insulation . ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
is .--,3
OCCUPANCY ..................
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