20020408.pdfDATE RECEIVED
I I PERMIT EXPIRES
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CITY OF EDMONDS NE.RlM.ERdYJ, - 0 C/O
CONSTRUCTION PERMIT APPLICATION JOB ITEIAPT.
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OWNER NAMEINAME OF BUSINESS ls_�
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AILINGA HESS LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP IWC
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7 ILIIA ll\\ REQUIRED DEDICATION— FT — vb'b,.�
NAME METER SIZE I LINE SIZE I N0,011NIIH11 PAV REQUIRED
YES 0 No 0
I: RADDRE.SS REMARKS
OWNEFYCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY
ZIP
TELEPHONE
NAME
ENGINEERING
REVIEWEDIDATE
ADDRESS
FIRE REVIEWED BY
DATE
CITY
ZIP TELEPHONE
STATE LICENSE NUMBER EXPIRATION
VARIANCE OR CU
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POST
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EXP
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0 RESIDENTIAL
0 PLUMBINGIMECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT URSIDS REAR
(0 AUDIT ON
'��IDMMEICIAL
0 C MPLIANDE OR
C ANGE OF USE
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0 REMODEL
0 APARTMENT
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IIA PLA, FIND REVIEWED
By DATE
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0 REPAIR
0 11311111 CYOS
0 F X FT)
0 DEMOLISH
0 TANK
0 OTHER
o GARAGE
r-1 RETAINING WALL
0 RENEWAL
CARPORT
F (TYPE OF USE, BUSINESS
A.
— MOCKERY
OR CTIVITY� EXPLA,ft
CHECKEDBY JTY0Sj7TION
OCCUPA
GROUP
NUMBER
NUMBER 0
CRITI AL
OF
STORIES f
DWELLING
I UNITS
AREAS,
NUMBS
SPECIAL INSPECTOR JARIA
REQUIRED 0 YES
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
VCAIR� `�Jww_
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HEATSOURCC GLAZING %
LOT SLOPE %
BUILDING
115
PLAN CHECK NO'
3TED DATE
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PLUMBING
m ==L�
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
-
—
BE DONE ON PRIVATE PROPERTY ON- AN CONSTRUCTION ON THE FUEL C
RIVEWAYS, MARQUEES,
DOMAIN (CURBS. SIDEWALKS, 0 ETC.) WILL REQUIRICdE
GRADINGIFILL
ESM RATE PERMISSION.
A PE MITAPPLICATION: 180DAYS
PERMIT LlMtT� I YEAR - PROVID D WORK IS STARTED WITHIN 180 DAYS
ENG, REVIEW FEES
SEE SAC K OF PINK PERMIT FOR MO E INFORMATION
'APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAP NIS
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
E
ALLCILAIMS FOR DAMAGESOPWHATEVER NATURE. ARISING DIS CTLYOR INDIRECTLY
INSPECTION FEE
7E _GE
PROM THE ISSUANCE OF T IS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
DIEMEDTO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANYCtTYOROINANCE
PLAN CHECK DEPOSIT
I
01 NOR LIMIT IN ANY WAY THE CITYB ABILITY TO ENFORCE ANY ORDINANCE FROVISION,�
TOTAL AMOUNT DUE
JIECI
I HERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
GIVEN I$ CORRECT. AND THAT I A. THE OWNER. OR THE DULY AUTHORIZED AGENT OF
T E OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTPUC�
CALL
TION, AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VlOtATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
WORKMEN S COMPENSATION INSURANCE AND RCW 16.27.
SIC, ATURE N 0 G
(425)
771-0220
A fENTION
T
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-
CATE OF OCCUPANCY HAS BEEN GRANI ED, UBC SECTION 109
FAX
5198
VALUATION I FEE
,pplo,t,, — I P11.11 lotil S1916I by thO
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ORIGINAL - nLE - YELLOW - INSPECTOR
PINK - OWNER - GOLD . ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATERI-1 aj�_
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE —
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE —
PROJECT
L/
SITE ADDRESS ---- 14
PERMIT —DATE INS ECTED
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
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u 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..........................
Pier/Porch .................
Retaining Wall ...........
Stab Insulation ..........
PLUMBING:
MISCELLANEOUS ..........
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