20020212.pdfy
DATE R-111%/j
CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS
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OWNER NAIVII�nME_ �USINES
LIM, HACK S./LIM,HACK S. CPA PS
IIAT �AIVIISURMIISION No.
I ICITNO,
UDNO�
MAILING ADDRESS
LID FEE S
8223 212TH ST SW #405 EDMONDS 98026
PUBLIC RIGH T OF WAY PER OFFICIAL
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EDMONDS 98026
425-774-7095
REOUIREDDEDICATION.—
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NAME
SIZE
LINE 1111
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PRV REQUIRED
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WORK WILL BE DONE BY ME
��O�ETER
YES 0 No A
ADDRESS
'EMASKS
WNERICONTRACTOR RESPONSIBLE FOR EROSION CONTAOUDSAINAGE a
N / A
ADDRESS
CITY ZIP JTELEF�"OUE
STATE LICENSE NUMBER EXPIRATION
0 NEW C] RESIDENTIAL 2w P UMBIN5AECH
C] ADDITION OMMERCIAL AN.S On
C�.AN.LE
or USS
E] REMODEL [3 APARTMENT 0 SIGN
0 REPAIR E] GRADING CYDS 0 IF NCE X FT)
0 DEMOLISH 0 TANK 0 OTHER
C RZ 0 lElEWAL
0 ARAGE NING WALL
"ARPORT C3 P, ER
_
jT�PE OF USE . BUS NESS OR ACTIVITY) EXPLAIN:
CPA OMCE
NUN,5ER
NUMBER o5
C ICAL
, /
I _.LLNG
AREAS
To.,�S
UNIT.
N umBE
DESCRIBE WORK TO BE DONE,
Setting up walls for my o fice space..
room anA small kitchen
ENGINEERING REVIEWEDIDATE
PJRF� AEVIE ED BY DATE
VARIANCE OR OU
SHORELINE OR ADS�
INSPECTION -1
PBOND
0,TSD
c3YRE k
Es No
$EPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
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AU_!!!!_, PROPOSED
ALLOWED PROPOSED
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETSACKS(FTT
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
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PARKING
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AREA 1 P�NNINO REV14.
REO'D
PROVIDED
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REQUIRE C:] YES LOAD FT'
AARKS
PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION REO'Dl
VALUATION
FEE
PLAN CHECK FEE
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GLAZING % LOT SIOPE %
6?0 �i
PLAN CHECK NO:
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTEEL THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY� ANY CONSTRUCI '.11 N THE PUBLIC
lmmwili�
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS , MAAOUEES, ETC.), WILL REQUIRE
SEPARATE PERIAISSION.
STATE SURCHARGE
PE MFEAIIL=TI.N: 180DAYS
STARTED WITHIN 11IG DAYS
'v
PERMIT LIMIT. I YEAR - PROVIDED W RK IS
SeE8AC K OF PINK PERMIT FOR MORE INFORMATION
Ell�
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INSPECTION FEE
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE� HEIFIS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
WASHINGTON, ITS rSFRoM
OFFICIALS, EMPLOYEES, AND ADEN ANYAND
mlme-"�G
2 EDMONDS.
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, AMSINGDIRECT�OR INDIRECTLY
FR M THE ISSUANCE OF THIS PERMIT� ISSUANCE OF THIS PERMi r SHALL NOT BE
INS PECTION FEE _�WWW4R'hl
PLAN CHECK DEPOSIT
DEEMED TO MODIFY, WAIVE OR REDUCE ANY RCQUIRCMENT OF ANY GITI ORDINANCE
0 'OR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANYORDWANcE PROVISION.'
TOIALAmOu TDUI
I HEU..Y A�KNE)VVIE..� THAT: HAVE READ THIS APPLICATION; THAT THE INFORMATION
APP ICATION APPROVAL
GIVEN IS CORRECT, AND THAT AM THE OWNER� OR THE DULY AUTHORIZED AGENT OF
THEOWNER, IAGREETOCo-PLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
Thl$ IPP111111 11 1-11 P01"t 'Ib$ 'B"d by lb,
TION. AND IN DOING THE WORKAUTHORIZE0 THEREBY. NO PERSQN WILL BE EMPLOYEE)
Buildmo 0111.1.1 .1 hl�ll D.oO,: — r— — 1-11P Id
IN VIOLATION Or THE LABO F THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
WORKMEN'S COMP�NSA AN. F1 -U)ZI,
OIFICI LSSIGNA DATE
lIGNATUIll 10-W A EMI AT"'
(425)
. j �A 0/")
771-0220
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"`DBY
AE TUBE
ATTENTION
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-
ORIGINAL�FILE YELL
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK OWNER GOLD ASSESSOR
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FINAL -PROJECT APPROVAL FORM
TO:
DATE:
MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: C-2 —FIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE-
-PLANNING DIVISION DATE—
PROJECT___!A2!__�,
SITE ADDRESSL
pERMrr#Cg
&&-,���.ADB#_DATE INSPECTED —
DESCRIPTION OF WORK TO BE INSPECTED
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
PE�QHHANCE 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
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
I
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date— Sign_
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ............
FOUNDATION:
Footing ......................
Wail __ ....................
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Pier/Porch .................
Retaining Wail ..........
Slab insulation ..........
PLUMBING:
Underground .............
0 M
C 0
0
Rough -in ................
0
C
Commercial Final
M
in
HEATING:
Gas Test
Gas Piping .................
Equipment................
M ITI
Commercial Final
0
EXTER16R SHEATHING
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NAILING ..............
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'3 -d'--5
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FRAMING .....................
FIRST FLOOR FRAMING
X
INSULATION ...................
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Floor Insulation
Wall Insulation ...........
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Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..................