20020172.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS I�W-T m. cyle-
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CITY ZIP 0 ITELEPHONE
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LPIERMITMPIRES
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JOB SUITEIAPT#
PLAT NAME/SUBDIVISION NO. NO.
L 'CE A
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TUIZA"' F
"' :Vs.
St.. "'. 11 lus.
EXISTING — PROPOSED—
fl.,t s.
REQUIRED DEDICATION� FT
METER SIZE I LINE 1111 1 NO, OF FIXTURES PRV REQUIRED
Es 0 No C3
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
FIHEMARSHAL
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EN@NEERIN—jTRK7-_EL HLMfJVAt
ADDRESS
Po. 190 3 ,,Z?�>
CITY ZIP TELEP"O 9
TILIP"O
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
FIRE REVIEWED By DATE
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
RECI
'130N.
OSTED
F1,1 lf ac 16,-? e f
PRO16RTI TAX A CO CEL NO.
YES 13 NO
E. FIEVIEW
COMPLETE EXEMPT
IIIIN AN.
ALLOWED P10101ED
HEIGHT
ALLOWED R."Oe",
lhl�
/9/� LY'53 4nO e9-1`1 Al
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LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT)
FRONT SIDE BEAR
PROPOSED SETOACKS (FT.)
FRONT URSIDE BEAR
0 New RESIDENTIAL E] PLUMBING I MECH
ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
0 EMODEL APARTMENT SIGN
A.
PARKING
D I PROVIDED
LOT ARIA
P NNING REVIEWED BY DATE
o F NCE
E] REPAIR 0 GRADING eyes I X Fri
REMARKS
[j DEMOLISH P�_TANK 0 OTHER
o GARAGE o RETAINING WALL
CARPORT ROCKIRY 0 RENEWAL
Is OF USE, BUSINES IN;
INE7, OR A75fvff"Y) EX
1�il 7AItAW
�CNECKEO
TYPE OF N
OCCUPANT
GROUP
NUMBER NUMBER OF CRITICAL
IF W.Lu.. AREAS L
STORIES UNIT. NUMBER
SPECIAL INSPECTOR
ACQUIRED [3 YES JANCA
I occu P NT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 100/FINAL INSPECTION REIVID
6ne 3,;'V gAt ?��-'VA
Ce, I' li-Alf S 4A'd
VALUATION $
Description
FEE
Description
FEE
Plan Check
HEAT SOURCE GLAZING % LOT SLOPE %
Building
Plumbing
PLAN CHECK NO: TED DATE
I
Mechanical
THIS PERMIT AUTHORIZER ONLY 1HEWORK NOTED. THIS PERMIT COVERS WORK TO
I: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU"LIC
X D U
:3 ONAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) W1 REQUIRE
SEPARATE PERMISSION.
P FIMITAPPUCATION: INDAYS
Grading
Recording Fee
Engr, Review
City Surcharge
Engr, Inspection
State Surcharge
PERMIT LIMM I VfilliR - PROVID H) WORK IS STARTED WITHIN 180 DAYS
SEC BACK OF PINK PERMIT FOR MORE INFORMATION
Traffic Mitigation
Plan Chk Deposit
'MPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, 116 OFFICIALS* EMPLOYEES, AND AGENTS FROM ANY AND
—
Fire Review
Receipt #
ALLCLAJMSFORDAMAGESOFWHATFVE NATURE. ARISING DIRECTLY ORINDlRECTLY
FROM THE IGSLANC IF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT E
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT 0 A CITY ORDINANBE
r NY C
Fire Inspection
Total Amount Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Landscapelnsp.1
Receipt #
I HERE ACKNOWLEDGE THAT I HAVE BUD THIS APPUCATION� THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THS DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNS . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
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
WO111411111 COMPIIIIAT!!IN I!P&NCE AND ACW IB.27,
D—ATE IGNED
This application Is -I , ineunit until signed by Ins
CALL SuMdug Offi-hu., his1fit., Dsputy: And F..s.l. piths, snd
FOR INSPECTIO N —.1pi 1, mRs-I.dQ.d In sp.s. p—ld.d.
OFFICIALS SIGNATURE DATE
(425) '
771-0220 &'
RELEASED BY DArE
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
771-0221 ORIGINAL - FILE - YELLOW � INSPECTOR
FAX PINK OWNER - GOLD -ASSESSOR
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FINAL PRWECT APPROVAL FORM
TO:
DATE:
MEmoTo: PERmrrcooRDiNAToRBuiLDiNGDivisioiq
FROM:
___yIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE
4
G DIVISION DATE--
PROJEC
SIT`EADDRESS !29--76(,
PERmrr#�z �1--,�ADB# DATEINSPECTED
4=
DESCRIPTION OF WORK TO BE INSPECTED-6
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
PEHE0_Rr%&NCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a. Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
c3 Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
ocaprvl.doc.l:temp:bldg:fo=10/01
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SMACKS ............
FOUNDATION:
Footing ....................
wall ..........
Pier/Porch ... ..............
Retaining Wall ...........
z
Stab Insulation
PLUMBING:
Underground ..........
am
Rough -in ...................
a
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Commercial Final
0
0
HEATING:
M
Gas Test ....................
M z
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Gas Piping .................
:,1
Equipment ............
0 _n
Commercial Final
EXTERIOR SHEATHING
m M
NAILING ..........................
0
0
FRAMING ................
0 M
FIRST FLOOR FRAMING_
a fj)
1710
INSULATION ...................
Floor Insulation
Wall Insulation
>
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Ceiling Insulation
CA
SHEETROCK NAILING
z
0
SPECIAL INSPECTION
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MISCELLANEOUS