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FPERMIT
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EXPIRES
USE
CITY OF EDMONDS ZONE PERMIT
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CONSTRUCTION PERMIT APPLICATION JOB SUITEJAPT#
ADDRESS )
[ER NAMEINAME OF BUSINESS of /1)
PLAT NAMEISUSDIVISION NO, LID No.
E T7 LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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TELEPHONE EXISTING — PROPOSED— 111P.W ft9—d 13
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REQUIRED DEDICATION —
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NO. OF FIXTURES
PAV REQUIRED
�SIZE
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OWNER/CONTRA.TOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
FIRE REVIEWED BY
DATE
TATE U.S. 5EM.E�
EXPIRATION DATE -,CHECKED BY
VARIANCE OR CU
SHORELINE OR ADS#
INSPECTION BOND
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REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
FRONT SIDE BEAR FRONT JR SIDE HEAR
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ADDITION
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APARTMENT
CHANGE OF USE
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Description FEE Description FEE
r P '0 fe* Plan Check
H�f SOURCE v _i� LOT SLOPE % u I
B-AZING
Building
PDA CHECK NO: VESTED DATE Plumbing
Mechanical
THIS PERMIT AUrBIORIZES ONLY THE WORK .... I.I. PERMIT Te
e
0 DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
D6MAIN (CURDS, SIDEWALKS, DRIVEWAYS MAROU ES,ETC.) WILL REQUIRE
C
Grading
Recording Fee
SEPARATEPERMiSSION.
Engr, Revie.
City Surcharge
PERMIT APPUCATION: IN DAYS
PROVIDED WORK IS STARTED WITHIN ISODAYS
Engr. Inspection
State Surcharge
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SEC BACK OF PINK PERMIT FOR MORE INFORMATION
—LIC NT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
14 INTEREST, AGREES TO INDEMNIFX DEFEND AND HOLD HARMLESS THE CITY OF
—
EDMONDS, WASHINGTON, 'TO OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
ALI_ CLAIMS FOR DAMAGES OF WHATEVER NATURE,
Fire Review
Receipt #
ARISING DIRECTLY OR INDIRECTLY
FROM THE I SUANCE OF THIS PERMIT. ISSUANCE F THIS PERMIT SHALL NOT BE
DEEM UCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Total Amount Due
?�ORLEOTOMODIFY�YWATIVEEORAE
IMIT IN ANY W H CIWS AStUTY TO ENFORCE ANY ORDINANCE PROVISION.%
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Receipt #
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE OULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
I E OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
Thl, �Pplilm 1. — P—h 111 �Ip�d by .
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COYCkNSATION I SURANCE AND RCW 18,27.
FOR INSPECTION
IdIding Olftl.I., hWh., O.ply. d F .. P.'d, ..d
_Iipt Is ack—ledged In space p ... ided.
SIGNATURE
(425)
111p7m,
771-0220
DATE
ENTION
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-
INSPECTO11
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD ASSESSOR
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DATE:— 6,1 �7
MEMO TO. PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE —
ENGINEERING DIVISION DATE—
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DESCRIPTION OF WORK TO BE INSPECTED�--TLE:
A field inspection was conducted to determine final compliance with approved plans. Flual approval
denotes that there are no objections from the above signed Department to the release of
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RE_INSpECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date_ Sign_�
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FINAL PROJECT APPROVAL FORM
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DATE:
MEMO TO: PERMIT COORDINATOIZ, BUILDING DIVISION
FIRE DEPARTMENT DATE-
FROM:
ENGINEERING DIVISION DATE —
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PERFORMANCE BONDS and the granting of:
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Date Sign_
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1i IS Is IUD CA
co of
viAll lot Ottupan
oe PARTMENT OF BUILDINGS fell
PER UNIFORM BUILDING CODE SECTION 109
At:-- 107 e Avenue North # 103, Edmonds 98020 Building Permit #: #20 2.0284
occupancy established by this certfficato: Dwelling Units: -NW* No. Stories: I
iOnN
uct Basement: No
. V.
B Type Construction: V-N
Dad
Maximum Occupant L, =,_(Per U.B.C. '1002)
Room capacity signs, whq t6quired, remain posted at all times.
owner of Building: Jaeg [a Mayo Address: 107 e �v Noci�, Edmonds, WA 98020
COMPLYING WITH THE REQUIREMENTS OF THE L967 EDITION
THE Olives _Gourmet Inc. HAS BEEN INSPECTED AND APPROVED -AS H
OF YREUNIFORM BUILDING CODE AS ADOPTED 13Y THE CITY FOR THE GROUP AND DIVISION OF OCCUPANCY AND THE USE FOR W ICH
THE PROPOSED OCCUPANCY IS CLASSIFIED.
Issued this ....... J7tL_dayof_M8y, 2002
CHIEF BUILDING OFFICIAL
BY: —,4u..t mi a—. myha�q..f —P.ny a m.1— bOldi.9 paatnd.
b. p.(ad J 0— P.bk a-.W ah-11 --t ba -mond- mWelad � 0—ed and shall bc Mhl&ad h
Cwtfi,aa, of 0—pancy fsa� bY ft Otyd Ed—d' SAUN Offid-1-
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing...................
Wall..........................
Pier/Porch ...........
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final
HEATING:
GasTest ....................
WAS
Gas Piping .............
Equipment...............
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
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FRAMING .....................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING ...
. ....... .
SPECIAL INSPECTION
w)s
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..................
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