20020203.pdfDATERECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
.-DA& NY
MAILING ADDRESS
CITY
NAIVE
ZIP I TELEPHONE
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PERMIT EXPIRES
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7SE, PE
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JOB SUITEIAPT#
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PLAT NAMEISUBDIVISION NO
LOT NO.
L NO�
L�D
D FE
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
T.CP A 0
YN P.- Rl 0
EXISTING - PROPOSED.
0
0
0
REQUIRED DEDICATION- FT
PRV REQUIRED
YES 0 NO 0
REMARKS
NERICONTAACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
NAME
ENGINEERING MUST
FIRE MARSHAL
BE: PHI:SI:N4vlf6WT-E
I IIDI;5
312?.?
CITY zip
TELEPHONE
1AUK
FIRE REVIEWED BY
EILI, BE�JOVAL. OR CAP
DATE
0 A !m-03
STATE LICENSE NUMBER
Aw'! "v? -SIV q 7
EXPIRATION DATE BY
VARIANCE 08 CU
SHORELINE OR ADB� IN PECTI 'OND
A DO ON
2P QT P"
E o POSTED
NO
u Fll-COC6�?� 11-110110.13
PROPERTY TAX ACCOUNT PARCEL NO. 91
2 ;�5X 0610 07 00
SERA REVIEW
COMPLETE EXEMPT
exp
ILE (-)
.
SIGN AREA HEIGHT
ALLOWED , PROPOSED ALLOWED PROPOSED
NEW
0 PLUMBING I MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT UPSIDE REAR
ADDITION
COMPLIANCE OR
CHANGE OF USE
REMODEL
SIGN
PARKING
REQD I PROVIDED LOT AREA PI-ANNING REVIEWED BY DATE
REPAIR C3 GRADING CYCS
F NCE
( _ X _FT)
A-A-B
DEMOLISH 0 TANK
CR� OTHER 7&-4Tk
GARAGE
CARPORT 0 RETAINING WALL
ACCXF9Y
[3 RENEWAL
0
r (TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
Oil LA!L1_r
R Dre/5
NUMBER 1111ERII
OF DWELLING
STORIES UNITS
;".' &i�
CRITICAL �
NA=.
CHECKED By ITYP!�
SFEC3AL.11NSP5CToR JAREA
REQUIR YES
;�' 0
GA..uu'PAX/5
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OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
fia^'O&�r� CA&V
sogal-141
PROGRESS INSPECTIONS PER UBC I08/FINAL INSPECTION REQ'I
PLAN CHECK FEE
HEAT SOURCE GLAZING
LOT SLOPE I
BUILDING
PLAN CHECK NO:
�LUMBING
AECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE 0 PRIVATE PROPERTY ONLt ANY CONSTRUCTION ON THE P B
OMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUUIURCE
GRADMWFILL
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SEPARATE PERMISSION.
PE MITAIPLICATION: 180DAYS
PERMIT LIMIT., I YEAR - PROVID D WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEC BACK OF PINK PERMIT FOR MORE INFORMATION
PLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
ENT INSPECTION FEE
�A
N INTEREST AGREES TO INDEMNIF(. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAP NG
2 EDMONDS. WASHINGTON. ITS OFFICIALS� EMPLOYEES, AND AGENTS FROM ANY AND
A L CLAIMS FOR DAMAGES OF W14ATEVER NATURE, ARISING DIRECTLY OR INDI ECTLY
INSPECTION FEE
m FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0 IINANCE
, DEEMED MODIFY. WAIVE OR REOUCEANY REQUIREMENTOF ANYCITYORC
PLAN CHECK DEPOSIT
0 IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PRoYSIC'G.
NOR LjMi;O
TOTAL AMOUNT DUE
I HER EBY ACKNOWLEDGE THAT: HAVE READ THI S APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND T AT AM THE OWNER OR THE DULY AUTHORIZED AGENT OF
T EOWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONS TRUC
CALL
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BF EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTR
WORKMEN S COMPENSATlffNCE AND 11W
o
E, D
(425)
771-0220
'MENTION
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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
VALUATION I FEE
10 111 111 �11 b, 1'..
DATE
RCIALS SIGNATURE
ORIGINAL FILE - YELLOW. INSPECTOR
PINK OWNER- GOLD ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
DEPARTMENT DATE-3--
FROM: -YIRE
ENGINEERING DIVISION DATE—
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PLANNING DIVISION DATE—
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DESCRIPTION OF WORK TO BE INSPECTED /Q"yW 'e-
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A rield inspection was conducted to determine flual compliance with approved plans. Final approval
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denotes that there are no objections from the above signed Department to the release of
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PERFORMANCE BONDS and the granting of:
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X GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
ocaprvl.doc.l:temp:bldg:formsIO/OI
.... .... ..
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
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Pier/Porch .................
Retaining Wall
Slab Insulation ..........
M
PLUMBING:
M 0
Underground
Rough -In ...............
IT!
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Commercial Final
10 _q
HEATING:
V
Gas Test ....................
0
Gas Piping
Equipment .............
M M
Commercial Final
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1— 1
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EXTERIOR SHEATHING
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NAILING ..........................
Q 0
FRAMING ...........
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FIRST FLOOR FRAMING
INSULATION . ...................
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Floor Insulation
Wall Insulation ...........
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Coiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION