20020209.pdfPERMITEXPIRES
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
PERMIT
NUMBER",�2
JOB SUIT5JAPTJ
IER NAMErNAME dF BUSINESS
V_b.
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
ING ADDRESS
1 .11. FIGHT .1 WAY PER OFFICIAL STREET MAI
EXISTING — PROPOSED
our DEDICATION— FT
n',a" "c'e"
ZIP ITELEPHONE
LREQUIRED
METER SIZE I
LINE SIZE
I NO. OF FIXTURES
Y,PRV REQUIR
a [3 NO
REMARKS
OV4NER/CO'NTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ZIP ITELEPHONE
�� 654W,2,�
FIRE REVIEWED BY DATE
CITY
/2
STATE LICENSE NUMBER EXPIRATION DATE 1 -K
CH KED By
41
VARIANCE OR CLI
f..PLETE
SHORELINE OR ADB#
INSPECTION
REGO
r3y No
E3
BOND
POSTEE
PROPERTY TAX ACCOUNT PARCF?. NO.
Ac, I/ 41�91
-P DEPA REVIEW
..E.PT
E
SIGN Al.
ALLOWED PROPOSED
I
HEIGHT
ALLOWED , PROPOSED
NEW [:3 RESIDENTIAL PLUMBING /2�
ADDITION �k..MERCIAIL
0 REMODEL APARTMENT 0 SIGN
REPAIR GRADING Cyas 0 F NCE
( x FT)
0 DEMOLISH E] TANK 0 OTHER
o GARAGE o RETAINING WALL
CARPORT FOCKEAY [3 RENEWAL
COVERAGE
ALLOLWoED PROPOSED
REQUIRED SETS IS (FT.)
FRONT SIDEAC BEAR
PRoPoS D SETBACK.S.A(FIF.)
FRONT E Lin SIDE R
RKING
D
REQ'PA I I.-I.E. I
LOT AREA
I PLANNING IEVI EJED BY DATE
REMARKS
OWE OF U BE, BUSINESS DR ACTIVITY) EXPLAIN:
CHECKED By
CONSTRUCTION
77
oc CIPANT
GROUP
M NUMBER
OF
STORIES
NUMBER OF
DWELL NG
ITB _,Gf_
J CRITICAL
I AREAS
NUMBER
S ECIAL INSPECTOR
REQUIRED 0 YES
AREA
LOAD
OCCUPANT ( C)
DESCR18E WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REOD
Vt:r
Z-411-y-T _112 bE&X) IN-612tU014
VALUATION $
Description
FEE
Description
FEE
Plan Check
I
HEAT SOURCE GLAZING 91 LOT SLOPE I
Building
16)lbr
PLAN CHEC�'T_ STED DATE
P lumbing
Mechanical
THIS PERMIT AUTHORIZES ONLYTHE WORK NOTED. THISPERMOICOVERS WORKTO
I= S DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUDUC
Grading
Recording Fee
2 DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS
a.. PS..j IAROU". ETC�) WILL REQUIRE
SIMON, -
Engr. Review
City Surcharge
PERMIRIAPPLICATION: IN DAYS
PERMIT LIMIT. I YEAR -PROVIDED WORK IS STARTED WITHIN HIDDAYS
Engr. Inspection
State Surchar 98
SEE BACK OF PINK PERMIT FOR MORE IN RMATION
'APPLICA", ON BEHALF OF HIS OR 11111 SPOUSE. HEIRS, ASSIGNS AND EUGCE..Ra
Traffic Mitigation
Plan Chk Deposit
IN INTEREST. AGREES To INBEM1111, DEFEND AND 110111 HARM1111 THE
EDMONDS' WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
Receipt #
ILCLAI FORDAMAGESOFWHATEVE NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUA CE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Fire Inspection
Total Amount Due
DEEMED To MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Ox NOR LIMIT 94 ANY WAY THE CITYS ABIL17Y TO ENFORCE ANY ORDINANCE PROVISION.-
1.
Landscapeinsp.1
I Receipt # y5W2
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTFUC-
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL 13E EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE 0 WASHINGTON RELATING TO
FOR INSPECTION
deg Official a, Welber Depuly: and Fees an, paid, and
—.1pill—cin-10g,dansp .. noAded.
WORKMENG COMPENSATION INSURANCE AND RCW 18.27.
OF ICI I P#N DATE
SIGr 71/URE OW7 DAT ....ED
(425)
771-0220
DATE
ATTENTION"'
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
If I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
ORIGINAL - FILE - YELLOW - INSPECTOR
PINK . OWNER - GOLD - ASSESSOR
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... FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: ---YIRE DEPARTMENT DATE Q 0
ENGINEERING DIVISION DATE,
---------YLANNING DIVISION DATI�-_
PROJECT
SITEADDRESS
PERmrr # 9-00 2-- Q,�-6 _y__ADBk__DATE INSPECTED q---1 1-0 f
DESCRIPTION OF WORK TO BE INSPECTED 7-
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 WrM CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
1
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 Sign_
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DiPARTMENT OF BUILDINGS
NIFORM SUILI
)ING CODE SECTION
Bulldln�q,PA!Tlt-#: 02002-0209
At: 201 Avenue S # 4
43;'A I
Occupancy established by this cerlifficate: Dwelling Units:—NIA— No. Stories: 2
'Me
nstruction: V-1 Hour Base nt: No
J,
Maximum Occupatft Load 0" Ad ItIon Per UB.C. 1002)
RiIo,4cepachvsigo,�� III zprqain po;ftd of
Owner of Building:_ Yues Old Millto A
Milltown Pizza HAS BEEN IN REQUIREMENTS OF THE:L99_7EDMON OF
CUi'ANCY AND THE USE FOR WHICH THE
THE Old
THE UNWORM BUILDING CODE,
PROPOSED OCCUPANCY IS CLASSIF-0.
"A
IsquacI2 1 02
CHIEFS diAL.
By:
—.M.t.11 W ad ran-ed, —Whod ar�rad and b. -Irdall 10"Iblecand0an stag 0— Anyftnaeola—pancy— raqWnasa btAdngpennft and —
DOOR
r7l)
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ............
Wall ..........................
z
Pier/Porch .................
0
d ,
0
Retaining Wall ...........
Slab Insulation
PLUMBING:
m
Underground .............
C: 0
m 0
0
Rough -in ...................
C:
Commercial Final
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