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20020351.pdfGATE RECEIVEp-/ /,t j+lw� GL LULL !� PERMITEXPIRES CITY OF EDMONDS USE ZONE CONSTRUCTION PERMIT APPLICATION JOB SUITHAPTY ADDRESS T Q� '� 1O L OWNER NAM /NAME OF BUSINESS ��",�r � pis � PLAT NAMEISUBDIVISION NO. LOT NO, LID NO. MAILING ADDRESS z LID FEE $ ffXa' 3Q PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP ,CP Mprovetl a.., Repukad CITY 21P TELEPHONE (j (, EXISTING PROPOSED S.vaet tlae.-a Rp'C inepecuon aapwnd 13 Sidewalk Reaukad p M0hj_3 9�©ails S' /�Q^ �=�3I� fl[OUIREO DEDICATION P .,.a ,..— 0 NAME METER SIZE LINE SI2E NO, OF FIXTURES PRV REQUIRED I YES ❑ NO 13 ADDRESS BE Ij OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUOMINAGE CITY ZIP TELEPHONE NAME L (�`'•4�/y ENGINEERING REVIEWED/DATE dc0 ADDRESS ,/ 7 1S 2 3D,L -7 - C FIRE REVIEWED BY DATE IP t !77 TELEPHONE 06 �DLF / STATE LICENSE NUMBER EXPIIIRATION3GATE aC ECKED y VARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND V G2 Jy J /(7 2 REO'D POSTED ❑YES MNO �7 NO. / /T �17RVCCO SEPA REVIEW SIGN AREA COMPLETE EXEMPT ALLOWED PROPOSER ALLOWED HEIGHT PROPOSED ��"`1 Io ' EXP ❑ NEW ❑ RESIDENTIAL ❑ LOT COVERAGE REQUIRED SETBFRONTKS (FL) PROPOSED SETBACKS PLUMBING / MECH ALLOWED PROPOSED FRONTSIDEAC REAR FRONT AR Ufl SIDE PEAR ❑ ADDITION ❑ COMMERCIAL ❑ CHANGE OF USE ❑ REMODEL ❑ APARTMENT ❑ SIGN PARKING LOT AREA PLANNING flEWEWED BY DATE REON) PROVIDED - ❑ REPAIR ❑ GRADING CYDS ❑ ENCE `X FT) FlEMARKS ❑ DEMOLISH Me;TANK © OTHER TT --TT WAIL ❑ RENEWAL GARAGE❑ CARPORT L.! ROCKERY ITYPE OF USE, SUSINE8S OR ACiNnY) EXPLAIN; /� CHECKED BY TYPE TR 10 C00 CCUPANT w NUMBER flOUP NUMBER OF CRITICAL OF DWELLING AREAS (/}��/,(//�/^,} SPECIAL INSPECTOR AREA OCCUPANT - O STORIES UNITS NUMBER "i/` d / REQUIRED❑ YE8 LOAD DESCRIBE WORK TO BE DONE REMARKS I / PROGRESS INSPECTIONS PER UBC 1011MINAL INSPECTION REO'D 5 VALUATION nta svunuE GLAZING % LOT SLOPE % Building PLAN CHECK NO: vasTED DATE Plumbing Mechanical THIS PERMITAUTNORL'ZES ONLYTHE WORK NOTED. TNIS PERMIT COVERS WORK TO t BE GONE ON PRWATE PROPEWf•/ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN Grading Recording Fee (CURBS, SIDEWALKS, DRIVEWAYS , MARQUEES, ETC.) WILL REQUIRE SEPARATEPERMISSION. s Engr. Review City Surcharge PERNRAPPLICATION: INDAYS PERMIT UMmf YEAR• PROVIDED WORK IS STARTED WITHIN 188DAYS Engr. lnSpeC210n Slate Surcharge SEE BACK OF PINK PERMITFOP MORE INFORMATION s� 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEISS, ASSIGNS AND SUCCESOAS Traffic Mitigation Plan Chk Deposit V� IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF EOMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND _ Fire Review Receipt #- DAMAGES OF WHATEVER NATURE, A DIRECTLY OR INDIRECTLY ALL CITIES FORISSUANCE __ 333 FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE F THIS 9 DEEMEDTOMODIFY, Fire Inspection p TDtai Amount Due OFANYCITY PROIMNCE WAIVE OR REDUCE ANY ENFORCE i NOR LIMIT IN ANY WAY THE CITY'9 ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Landscape insp. Receipt # ON GIVENFS CORAEACKNOCTCANU THAT I MDGE THAT I VTHE OWNER, OP THEE DEAD THIS TDULY Al THOAIZ OT THE FAGENTIOF APPLICATION APPROVAL THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. CALL This piba2an is nor a pmmh un81 signal by Me TION; AND IN DOING THE WONK�A{�jT(lffORIZED THEREBY NO PEPS014 WILL BE EMPLOYED IN VIOLATION OF THE LABOfC"CODE' F THE STATE OF WASHINGTON RELATING TO F'OR INSPECTION BaIIdInB Ric 1 or hia/Rar Deputy: Antl Feoe eta paid, and seal is acknawta elinapaer Pr Idmr. WORKMEN'S MPENSAT MNC AND RCW 18,27. OFF 1 t IGNATUflE AT EIGMTD (O NER O ADE DATE SIG D (425) /g 771-0220 "'ByDATE��, ATTENTION EXT 1333 ��T-- IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 7a1 `Q3221 A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX oR1GINAL • FILE vEltow • INspecroR PINK - OWNER • GOLD - ASSESSOR 10101 0 rn fA = Cm m0 On C" mz. to D � r_ —I hi hi IT!m 0 1 0rn m0 i x z 1 2 Z O n m 11 FINAL PROJECT -APPROVAL FORM TO: DATE: - MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION FROM: �-- �— FIRE DEPARTMENT DATE a— &—O `- PIP.1S8510N ENGINEERING DIVISION DATE PIP.AS851C1 , PLANNING DIVISION DATE. — Z PROJECT USf da G v SITE ADDRESSm -i T co PERMIT ADB# DATE INSPECTED Ca Z-02 0 n DESCRIPTION OF WORK TO BE INSPECTED Jr ( /.i/ S lit G c rn Z A field inspection was conducted to determine fmal compliance with approved plans. Final approval Z denotes : that there are no objections from the above signed Department to the release of PERFORMANCE BONDS and the granting of : p - a GRANT FINAL, PROJECT APPROVAL mm o m 90 ##########KKKK###KK#KK#KKKKKKKKKKKKKKKKKKKKKK##KKKKKKKKKK##KKKKKK###KKKK#KK#KKKKKKKKKK#KKKK##KKKK#KK*#KK#########KKKK####?k####: ZZ0 r- GRANT PROJECT APPROVAL WITH CONDITIONS NOTED X = o Copy of CONDITIONS given to owner/contractor by inspector z x FAILED FINAL INSPECTION - OUTSTANDING ISSUES o Copy of CORRECTION NOTICE given to owner/contractor by inspector (I- r 'r(c ¢: M 9- o Z L 2. 3. RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL Date Sign ocaprvl.doc.l:temp:bldg: forms 10/01 RECORD OF INSPECTIONS I " { INSPECTOR DATE APPROVED " I . . . SETBACKS ................ - .. FOUNDATION: ...Footing ...................... .. . ' Wall .......................... _. .. _. _ .. 1 .. Pier/Porch O Retaining Wail ..........: Slab Insulation ....:::... ,� PLUMBING: W o E_ IT, -, Underground ............ R1 i .. n ., 3 Rough-tn ... .. p Commercial Final.:..... Irria". " HEATING; A '4 D Z, " ... Gas Test .................... . " Gas Piping ............. O _n Equipment ......-..... F xs. "".. Commercial Final ........ pNr EXTERIOR SHEATHING n m ". �.... NAILING ............. 0) F.:. � ,. Z 0 FRAMING :........ ..... " FIRST FLOOR FRAMING... INSULATION ............. " z Floor Insulation .......:. — Wall Insulation ........... # belling Insulation ....... p . i SHEETROCK NAILING ... - m SPECIAL INSPECTION ... "- " IMISCELLANEOUS i ..... - - FtNAL6P.PB.QYAL FOR