20020159.pdfDATE RECEIVED PERMITFXPIRES 4�L
"_9 L
USE PERMIT
ZONE N 4)Z22
CITY OF EDMONDS UMBER
CONSTRUCTION PERMIT APPLICATION 'AODBDRESS SUITE/All-
[EA NAME
,MAME OF PSINESS
N( x V-ii, (_ Z- t"k�'a&k PLAT NAME/SUBDIVISION NO, LOT NO. LID NO.
ING ADDRESS — I LID FEE S
e>o)� PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
'" =1
anas, .. Sea.
ZP ITELEPHONE EX STING — PROPOSED— "Pser'
C-4)y/\
b4o b
REQUIRED DEDICATION_ FT �
SMs.,IkR.q.
Undonae,d
YrIns,-0.
NAME
METER SIZE
I LINE SIZE
.1 FIXTURES
PRV REQUIR D
.1 E3 No C3
so
% =
REMARKS
NER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAIN4GE
i) bnTNcT - 0 tj]� ii*�;PecTm_ FP4oa TID IMCTALLltinol
COY ZIP
IIELIPHONE
-ro 1"Lu-ru- PQeaL C-(C1HTDIG-1A;,-l--U(zr-I0h-l_
105, Pe . I—
ENGINEERIN REVIEWED/DATE
;JLUIULI� _�j 4,1
O's-
ADDRESS
FIRE REVIEWED BY DbE
TELEPHONE
CEOPA ZIP 4� s- 040
STATE LICENSE NUMBER EXPIRATION DATE
CHECKED BY
RIANCE OR CU
SHORELINE OR ADS#
INSPECTION
REO'D
I BOND
POSTED
[3YES 13NO
PROPERTY TAX ACCOUNT PA C EL NO.
SEPA REVIEW
COMPLETE EXEMPT
EXP =
SIGN AREA
A D
MO
7� '4ED
HEIGHT
ALLOWED PIOP.7
El NEW RESIDENTIAL PLUMBIN I MECH
AD ITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
LOT COVERAGE
WE orseen
ALLOV�ED P�PqSED
/p, /A
REQUIRED SMACKS (FT.)
FRONT, SIDE, REAR
�Zs I r, ;?- -,
PROPOSED SETBACKS (FT)
FRONT URSIDE REAR
I -_ 6 -1
pxt'�"
PARKING
R7717=ED
LOT AREA
I F ATE
0 EMODEL APARTMENT [3 SIGN
0 REPAIR GRADING ;X �FEa FT
CYoS
REMARKS L
[j DEMOLISH E] TANK 0 OTHER
W H-74 2- -- Foor �6 PE12--
o GARAGE o RETAINING WALL
CARPORT ROOKERY RENEWAL
F-c-Dc-
(TYPE OF USE, BUSINESS OR A�
IRS �lr
... Ell NUNN OF CRITICAL 77
A 77
OF. WELL. No SEA.
ST RISE UNIT. NUMBER
CHECKEORY
ITYPE=
I CODE
q?1O
CUPAN;VS
... UP
SPECIAL INSPECTOR JAREA
REQUIRED [] YES
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
_REMARKS
1PR2GRESS INSP!�IiONS PER UBC 108/FINAL INSPECTION REOD
C �_ I
VALUATION $
Description FEE
Plan Check
Mechanical
THIS PERMIT AUTHORIZES ONLY THEW RKNOTED, THIS PERMIT COVERS WORKTO]
t: BE DOME ON PRIVATE PROPERM ONLY. ANY CONST" CTIONONTHEPUBLIC
Grading
Recording Fee
a C)W .
OMAIN (CURBS, SIDEWALKS. DRIVEWAYS MARQU ES, ETC.) WILL REQUIRE
SEPAMTEPEFIM;SSION. E
X
7SUCCESOR
Engr. Review
City Surcharge
I
I "PUCATION' IN DAYS
—
_S_
T PERMIT UNIT. 1 YEAR - PROVIDED WOAK'S B"A 0 WITHIN IN DAYS
Engr. Inspection
State Surcharge
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
—PLIC.- ON BEHALF OF His OR HER SPOUSE, HEUIS. ASSIGNS AND B
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND H to HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fife Review
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING 0 REMY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE F THIS PERMIT SHALL NOT BE
4
DEEMECTOMOCH WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Total Amount Due
6
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
�La
Landscapelnsp.
Receipt #
PE
HEREBY ACKNOWLE GE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECr. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I ACRE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
ppl ordlonianD, a parfait usill,ignedbyth
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMP LOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RIUATING TO
FOR INSPECTION
B.Ths.
ding Olfic�at or Warner Deputy: and Posner, paid
.-lot Is ackoo�tdgad In spose pre,ided.
WORKMENS 59M"SATION INSURANCE AND RCW 18.27.
OFFICIALS SIGNATURE DATE
(425)
771-0220
DATE
ATTENtION cowmelf—
EXT 1333
UNTIL
4 &A' /F111E
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. USC SECTION 109
FAX
ORIG ELL IN ECT
PINK - -WNBS GOLD - ASS
P, NEON
10/01
z
C
R1 0
6
M RR
z
'0-4
g-
r- -4
W
0 -n
ITT ITI
0
0
0 M
M 0
Z
71
3:
(1)
z
M
C)
5m,
-
11, 1 Y, 0, MIOND s
13UILDING DEPARTMENT
WOP't fQ
A D D RS s p-- P
OWNER
APPROVED DATE: -v-
BLDG. 0 FPICIAL
co"?
RECEIVED
F-2 7 2
DEVfELOpMENT SERVICES CTR�
CITY OF EDMONDS
'FINAL PROJECT APPMOVAL FORM
TO:
DATE:
1�IEMO TO: PERIVHT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTNIENT DATE
-ENGINEERING DIVISION DATE 54 &Z
PLANNING DIVISION DATE
PROJEC
SITEADDRESS 9V
PERMIT ADD# -----------PATE INSPECTED -
DESCRIPTION OF WORK TO BE INS?ECTED___W.4(,qe_�
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 wrrH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date- Sign,
ocaprvl.doc.l:tenip:bldg:formsIO/OI
z
0
i
0
M
M 0
0
80
M
M Z
0 -q
z
0)
0 -n
M M
a Y)
0,_
OM
a a)
K co
M 0
z
z
-4
M
Cl)
z
0
0
M
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing.. ...............
wall ...........
Pier/Porch ...........
z
Retaining Wall
Slab Insulation
PLUMBING:
Un derground .............
0 M_
C 0 : 1
Rough -in
0
...................
0
Commercial Final
M�
HEATING:
M z
C Z
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final
M M
EXTERIOR SHEATHING
0
0
NAILING ..........................
05,
C
FRAMING ..................
MO
FIRST FLOOR FRAMING
z
INSULATION .............
Floor Insulation
z
Wall Insulation ...........
W
Coiling Insulation
z
SHEETROCK NAILING
0
SPECIAL INSPECTION
M