20020277.pdf:1 "All RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
,181215-
CITY
NAME
= a I PERMIT EXPIRES
USE P "MIT
ONE &6 /
NUmBE
JOB SUITE/APT0
AD:n /0 4 �'A
PLAT NAME]SUBDIVISION NO LID NO.
-� 49" -
PUBLIC :y
AY PER OFFICIAL STREET MAP
_It j�
EXISTIN _ PROPOSED— cre—l—au—
REQUIRED DEDICATION— IT — Urs, IsecId
MET
��1_111'Et, I LINE SI N.'�I�IXTUAES PRV REQUIRED es
1 ;7 Y
ESk No C3 se
REMARKS
NERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/li
VwIttea') 105-pec-rujos: 6) fwost 0�)
CRY
- ZIP
TELE HONE 4
FIRE REVIEWED BY DATE
L2e_01V,2,�
9,900-0
_/0
STATE LICENSE Ni
EXPIRATION I
CHECK11 A
VARIANCE OR CLI
SHORELINE OR ADB#
INSPECTION
RE -D
BONE
DATE
/__ 5
A
I.P
--.YES
[3NO
.944=12�OLIZ
PROPERTY TAX ACCOUNT PARCEL NO.
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PAOP.E�o
HEIGHT
ALLOW'.
Is
!1 /9 4 1;0�4
7 e
,
I
NEW
JA RESIDENTIAL
9 PLUMBING f MECH
LOT COVEAAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Ft.) PROPOSED
FRONT A17 BEAR
SETBACKS (FT
FRONT URSIDE AFAR
0 ADDITION
0 COMMERCIAL
0 COMPLIANCE OR
CHANGE OF USE
"a Vo !A 5�6
0 REMODEL
0 APARTMENT
0 SIGN
BE, PARKING
On PROVIDED
_OT AREA
LA�NING REVIEWED BY
0 REPAIR
X G FENCE
_71 CVGS 0 ( — X Fy)
-IL ra 2—
I
u.4,7� 4,
REMARKS
0 DEMOLISH
[3 TANK
0 OTHER
GARAGE
WALL
13 ROCKERY
OAMPOW
BETAINING
E3 RENEWAL
OWE OF USE, BUSINESS OR ACTAMY) EXPLAIN:
-5.
15
CHECKED BY
TYPE 01 UCTION
COD
47 `7
OCCUPAN'T
GROUP 3
NUMBER
OF
NUMBER 11
DIVE LIN.
UNITS
"ITCAL
AREAS
NUMBKW,6_
SPECJALEINSPECTOR JAREAJ
REOU A
V�"' 16(46)
:1
OCCUPANT
LOAD
4
.$TORIES
DESCRIBE WORK TO BE DONE
0.�%?
0 YES I
rEl 1:
10
12
REMARKS
Description
F
Plan Check
i SOL, GLAZING
RE
LOT SLOPE %
AIIAT8
EBuilding
I 20
5 re
�ED
PLAN CHECK NOL:.
VESTED DATE
Plumbing
t��)
Mechanical
/210
THIS PERMIT AUTHORGEDS ONLY THE V;ORK NOTED. THIS PERMIT COVERS WORK To
a
IMIDOME ... r
ON PRIVATE PROPERTY ONLY ANY CONSTRUCTION ON THE
111111111111111111111111111[
2 DOMAIN (CURBS, SIOEWALKS, DRIVEWAYS, MARQUEES, I WILL REQUIRE
Grading
Recording Fee
Z I
t: SEPARATE PERMISSION.
_
Engr. Review
'56
city surcharge
PERMffAPPLI"Ti N: 180DAYS
PERMIT LAST I YEAR D WORK IS STARTED WITHIN
180 DAYS
S U E SAM 0; PPIJN;OKVPIDERMIT FOR MORE IN FO R MATION
Engr. Inspection
state Surcharge
'APPLICANT, 11" BEIi 01 HIS 08 HER SPOUSE, HEIRS, AIMING AND 5UcCESCes
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Traffic Mitigation
Plan Chk Deposit
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Review
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INWRECTLY
III . THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT
Fire Inspection
TotalAmountDur
OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CRYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscapeinsp.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APP
ICATION APPROVAL
GIVEN IS CORRECT. AND THAT AM THE OWNER. OR THE DULY AUI HORIZED AGENT OF
THE OWNER. I AGREE To COMP WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
This api 11111 a permit until signed by the
TION. AND IN DOING THE WORK'ALTH RIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Offichn a, hisihe, DIPIty: slid Fees am Paid, and
/, mclitu is aclumnskedged in space pro,lded.
WORKMEN'S CQM_FENSATION INSURANCE AND RCW 18,27.
—(OWNEljl/OR AGE"
DAT SIGNED
(425)
LS 116NATU1 DATE
1
"'
�TURY
771 -0220
A"
&IIA
Be ED BY DATE
ATTENTION—
EXT 1333
1" ]!
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 YELLOW - 11,16ECT04
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
z
C; M
IT
0
-10
0 C
IT
MO 4
E:
�
0 -n
M,
M ITI
0 Vi
0 E.-
0 IT
C Ee
r Cn
ITI 0
z
0
ITI
Z
PZ- 0 7- -,01-AIV 1,910 7 84!�A v�-, vl, coll-�olllllas
1-07- ;9(4 -5WIlR71,1Z4r,�
7; �e l0APC,-Z -4
ocrZIV-- egoo VvI4 *Zo,-Ae.-A
"-,..,-APPRovriD
4 WA
01- v aoq�
21a,
,A
aos
"A 1
Ac r4lAZ
12. /0
',,,PPR,0VED UIR A\ /
c.!;;4 a r /�o' /,a, � 1,40 V
4-IRAI
'Nf -,VC&-7 t
5-
5-, 2�0/m
7,19
-,Vs AXCA
ao4.4
16-
3/0 t56,9
'A
OWNERtCONTRACTOR IS RES WATER & SEWER
FOR EROSION CONTROL AND DA IV Q
SPECTIONS REM.
I
C 425-771-0220 EU. 13�t
7
IN
a,4-
kn
4
8 21;R
'A L/e.. v DEPT
CITY Copy
FINAL PROJECT APPROVAL FORM
TO.
DATE,
MEMO TO: PERMIT COORDINATOR, BURDINCT DIVISION
FROM: ME DEPARTMENT DATE —
I 1,612M ENGINHERINGDIVISIONDATE—*#
z
G DrVISION DATE---.:..—
0
PROJECT—L( —MWU-4-��
a
M
SITE ADDRESS.
0
PHnM # INSPE
A�=��ADB#
80
� r.
M
Mz
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
0 -n
n
EERFQRA�CE BONDS and the granting of
M 9
M M
0 C—/)
M
-!�-GRANT FINAL PROJECT APPROVAL
C
M 0
z
;0
'GRANT PROJECT APPROVAL VVMl CONDITIONS NOTED
z
a Copy of CONDMONS given to owner/contmetor by inspector
X
I
z
0
FARM FINAL INSPECTION - OUTSTANDING ISSUES
0
M
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Datc_ S,
ocaprvi.doc.l:t=V.bldg:foumIO/OI
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ..............
wall ...................
Plot/Porch
Retaining Well ...........
Slab Insulation ..........
PLUMBING:
Underground
Rough -In ..................
Commercial Final
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final
EXTERIOR SHEATHING
Sqp-cz
NAILING ........... I ..........
. ......
"Z
FRAMING ........................
.............. .......
FIRST FLOOR FRAMING...
INSULATION ..............
Floor Insulation
Wall Insulation
Calling Insulation
L,)2-
SHEETROCK NAILING
SPECIAL INSPECTION
T-- '37
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ...............
SIdeSewer#
Amout PWd $ 2.12� Receipt k.12 I _2112�
Date
WaterMeterSi.
Amountftl
DatePurchased
ROW #1
Amount Paid $�._Recqpt 1;
-'anolloolit
z
Qm
C
M 0
0
80
C
� C
IT! IT1
'0 �
z
0
"n
MITI
a
0
0
Q 0
z
z
-4
z
0
I'D