20020372.pdfRECEIV'E�0/
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EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE
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CONSTRUCTION PERMIT APPLICATION JOB
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OWNER NAMEINAME OF BUSINESS
FLAT NAMEISUBDIVISION NO. LOT NO, L NO,
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ADDRESS
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ADDRESS REMARKS
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0 W NERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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NAME
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VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
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STATE LICENSE NUMBER EXPIRATION DATE REO'D POSTED
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SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT CEL 110, COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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BESIDE REQUIRED SETBACK$ (Fr.) PROPOSED SETBACKS (FT.)
LOT COVERAGE SXIE
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DESCRIBE WORK TO BE DONE REMARKS
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Dis"C"a"On FEE Description FEE
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THIS PERMIT AUTHORIZES ONILYTHE ORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. AM CONSTRUCTION ON THE PUBLIC Grading Recording Fe 0
32 OONUUN (CURDS, SIDEWALKS, DRIVEWAYS INUfflQUEES, ETC.) WIU REQUIRE
t: SEPARATEPSAMiSSION. Engr. Review City Surcharge 5—
PER MAPPUCATION: ISODAYS
PERMIT LIMIT. I YFAR-PROVI ED WORK IS STARTED WITHIN 100 DAYS Engr. Inspection State Surcharge
SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION
'APPUC—, ON BEHALF OF .1. 013 HER SPOUSE, HEIR., ASSIGNS AND SUCCESORS Traffic Mitigation Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE Or Of
EDMONDS. WASHINGTON, E.MAT.LO.YSES, AND AGENTS ... ANY A14D Fire Review
ml COF.IFICIALS,
ALL CLAIMS FOR DAMAGES P ARISING DIRECTLY OR INDIREMLY
FROM THE I IIIINCE 01 TH a PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE Total Amount Due
Or BE Firemap"C"I
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Fire Inspection
0 NOR LIMIT IN ANY WAY THE C17YS AIIIUTY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscapain P.
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
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GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
This appkaflon Is ast is p.aas, srAlliihgaad by th.
THE OWNEFL I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL
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'NON; AND IN D0114G THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE E 1-YED 11 019"lal or hislid, Daphay; vad F.—le paid, .1d
IN VIOLATION OF THE MOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION 'ad.1pl Ikn.M.dQ.d1 Jaspni, p,.Idad,
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
0;;;s OFF] '�,,N�ru RE,
DAT1 17 14251
,
771-0220 BY DKTF/
RE,
ATTENTION EXr 1333 /k 2—
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFk ORIGINAL -FILE - YELL04-INSPICTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER - GOLD - ASSESSOR
10/01
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ApPROVED AS NOTS0
By ENGINEERING
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GM`ERS0OWNSPOUTS
TO CONNECT TO EXIST. SYST.
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ZONE
OWNER10ONTRACTOR IS RESPONSIBLE FOR
SETBACKS.
EROSION CONTROL AND DPAINAGE
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FRONT
SIDE.
REAf
OTHER
HEIGHT
FINAL PROJECT &PPROVAL FORM
TO:
DATE:
MEMO TO: PERTvffr COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTNIENT DATE —
ENGINEERING DIVISION DATE L
PLANNING DIVISION DATE —
PROJECT
SITE ADDRESS Alf V�
PERMIT #__ID2��J �ADB#_______DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine foal compliance with approved plans. Huai approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANLE_ BONDS and the granting of:
-�-GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
o Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
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 ......................
Wall .................
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Pier/Porch .............
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Retaining Wall ...........
Stab Insulation
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PLUMBING:
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Underground
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Rough -in ..............
Commercial Final
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HEATING:
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Gas Test ..........
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Gas Piping .................
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Equipment ............
Commercial Final
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EXTERIOR SHEATHING
NAILING .....................
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FRAMING
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24*1'
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FIRST FLOOR FRAMING
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INSULATION ..................
Floor Insulation
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Wall Insulation ...........
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Ceiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION