HomeMy WebLinkAbout20020220.pdfi" DATE RECEIVED
1 _31z'& ()z
I I
PERMIT EXPIRESq4_�
CITY OF EDMONDS
ZU SO' E PERMIT , " -0Z Z(
R'c - �0'0 NUMBER ;Lb�)
CONSTRUCTION PERMIT APPLICATION
SUITE/APT#
AODBDRESS 'Tol!� 60-)'Qa;' W1
OWNER NAMEINAME OF 'U"
7-77e-sc—z
PLAT NAME(SUBDIVISION NO.
I LOT NO,
NO.
L
'�D FEE I
CUSTa',L,
MAILING ADDRESS
Fuel. RIGHT .1 WAY FER .;7FICIAL STREET MAP
EXISTING — PROPOSES—
REQUIRED DEDICATION— FT
r-.P:':'nze.' g
as- Us. '..'a
lensoorasse-se 13
..'elued 13
Indse—d
CITY ZIP
01'3
ITILE1 0111
—
Voifirs—res 13
E
/V
ETER SIZE I
P 'T:
LINE SIZE
I 'ICT
NO. OF FIXTURES
PAV REQUIRED
YES I NO
I
is
ADDRESS
REMARK
OW,�E.19&T�ATAWIP.�9�l#�O��k�(1164POPffloDMRISE
se
E
I
I
* SIDE SEWER MUST BE CAPP
"ITY I
NAME
- -- - MW& 1XVIII IR MOVED OR
HOSE 111B B 2 M
NSTA11-
ENGINEEW REVIEWED/DATE
G Dump AT APPROVED Dump Sr= ONIy
-
ADDRESS
7 0
FIRE A FFC—nON DATE
se 'CHECKLIST ON BACK OF JOB CARD
'1W E
FOR INSPECTIQN REQUIRPI
or,
t5:0Vk'3l40& q&7�_
ITELEPHONE
Y.?_�&7a,-S(P� IT
STATE LICENSE NUMBER EXPIRATI�ON
;JA
e$
VARIANCE ON CU
I ORELINE OR ADD#
�IEE&IONI
D
C3 YES E3NO
BONDS
P.STE
PROPERTY TAX ACCOUNT PARCEL NO.
00 5(' 005'-01?_-I�3
SEPA REVIEW
EXEMPT
EX,
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED , PROPOSED
0 NEW BESIDE IAI PLUMBING I MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.) PROPOSED
FRONT SIDE REAR
SETBACKS (FE
FRONT URSIDE REAR)
ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
PARKING
REDD I PROVIDED
LOT AREA
P NNING REVIEWED BY DATE
REMODEL APART MENT 0 SIGN
Ej REPAIR GRADING Byes 0 FENCE
( - X Fri
0 TANK Ej OTHER
REMARKS
GARAGE o RETAINING WALL
C C ARPORT ROOKERY E3 RENEWAL
(TYPE OF USE, BUSINESS OR AOTIV!�M
NUMBER NUMBER 01 0111A
OF WE.N. SEA$
ST.'Usa k I III I
UNITS NUMBER
CHECKED BY
ITYPE ------
I C!TE_�_
OC rUPAW.,
I G N CUP
SIE.-L HNSPE.T.11
A E.0 ED [] YES JAIIEA
I ...0
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER USC 11081FINAL INSPECTION REGID
A kE'l , --'7 1 -
'0' ", � I ,, -k /) J41/1'm �v
VALUATION $
Description
FEE
P
Plan Check
HEAT SOURCE GLAZING %
LOT SLOPE %
Building
PLAN CHECK NO:
VISTID DATE
P
Plumbing
Mechanical
THIS FEiM—tr AUTHORIZED ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
h BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
X DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Ora ding
Grading
En r Review
Engr. Review
PERMITAPPLICATION 160DAYS
PERMIT LIMM I YEAR-PROVIO 0 WORK IS STARTED WITHIN ISIDDAYS
SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION
E g, hrep
Engr. Inspection
action
rn
'APPLICANT. ON BEHALF OF His OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Traffic Mitigation
Tra"'. lvhug.fion
Fire Review
D
E MICROS, WASHINGTON, IT' OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALLCLAIMS FOR DAMAGES OFWHAME" NATURE ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERIedr, ISSUANCi OF THIS PERMIT SHALL NOT BE
DEEMED TO &I WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANC�
Fire Inspection
S
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
Landscapeinsp.
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVE IS CORRECr, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
NINNIES.
'ITION;
rINSPECTION
THE 0 I AGREE TO COMPLY WITH C17Y AND STATE LAWS REGULATING CONSTRUC.
AND IN DOING THE WORK AUTHORIZED THEREUY, NO PERSON WILL BE EMPLOYED
LA OR ODE OF THE STATE OF WASHINGTON RELATING TO
AT N INSURANCE AND ROW 10,27.
C L
CALL Es
FOR
DATE SI NED
1"Gnzzv�_
(425)
0 11
03/;;tc�
ATTENTION
771-0220
M 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
771-0221
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
Description
FEE
Recording Fee
City Surcharge
State Surcharge
Plan Chk Deposit
Receipt #
Total Amount Due
I i 75—
Receipt #
IWIN
.ICATION APPROVAL
allon Is not a Proureft until signed by the
I or histhe, Drusuor: and Fees are Paid, and
ORIGINAL,FILE YELLOW. INSPECTOR
PINK -OWNER GOLD -ASSESSOR
z
0
C 1TI
M a
0
80
C
ITI ITI
0 _1111
'n
111 1711
0
0
C
M 0
z
17)
z
9
0
M
f t
.....
. . . . . . . .
:T=wf%7
3f
'I. . IM17,
. . . . . . . . . . . . . . .
AW,
. . . . . . . . ....
14Y
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTNIENT DATI�__
147 2
ENGINEERING DIVISION DATE
11—M
z
PLANNING DIVISION DATE,__
5
rp
PROJECT
SITEADDRESS,,
M
M 0
PERMIT# ADI3# DATEINSPECTED
0
0
8C
MM
DESCRIPTION OF WORK TO BE INSPECTED _AAr)
Mz
d
A field inspection was conducted to determine f1mal compliance with approve plans. FTMal approval
I.;
denotes that there are no objections from the above signed Department to the release of
0 -n
PERFORMANCE BONDS and the granting of
n�
M M
0 V5
0
GRANT FINAL PROJECT APPROVAL
02 M,
9 Cn
M 0
Z
rq
G PROJECT APPROVAL WITH CONDITIONS NOTED
>
z
y of CONDITIONS given to owner/contractor by inspector
rcom
I- hs� At 1
CD
z
9
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
5
M
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_
ocaprv1.doc.1:tenip:b1dg:fbmis1 0/0 1
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ....................
FOUNDATION;
Footing ..............
wall............ ...........
z
01
Pier/Porch
Retaining Will
M
Slab insulation ..........
PLUMBING:
M
Underground .............
C
Rough -In ...................
M
Commercial Final
0
HEATING:
C —
>
1: d
Gas Test ....................
Gas Piping ................
0 -n
"n
Equipment .................
rn M
Commercial Final
a a
0
EXTERIOR SHEATHING
NAILING . .........................
C
C
M 0
FRAMING .................
Z r-.
74
FIRST FLOOR FRAMING...
INSULATION ...............
z
Floor Insulation
V,
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
R1
SPECIAL INSPECTION
-;)u
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...............