20020464.pdf' DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
LER NAMEINAME OF BUSINESS
ZIP TELEPHONE
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a0 ADDRESS e. aAi
Iy. CITY ZIP TELEPHONE
Is 151AWt 00-3 06'S��7-83V7
STATE LICENSE NUMBER EXPIRATION DATE C Y
F(L sac 16ev /a io 03 ti�
q PROPERTY TAX ACCOUNT PARCEL NO.
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❑ NEW RESIDENTIAL ❑ PLUMBING! MECH
❑�❑ ❑ CHANGE OF USE
ADDITION COMMERCIAL
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN
❑ REPAIR
❑ GRADING CYDS ❑ FENCE X—FT)
❑ DEMOLISH 54 TANK ❑ OTHER '
x ❑ CARRAGE PORT ❑ ROOKERY WALL FIR ❑ FIREALA MKLER
(TYPE OF USE, BUSINESS OR ACTNITY) EXPLAIN:
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NUMBER NUMBER OF CRITICAL `
OF y /j DWELLING AREAS
U STORIES 7 1L UNITS NUMBER
DESCRIBE WORK TO BE DONE-2
W$14LL.
1444C eN ANIvE 6y90uaD Nam' rr v6 0& )- A-
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/� PERMIT EX�Py{i-(R^/yESUSE 1
20NE%' NUM
(ER ��/l/L L ��/
,IOD LLL SUITElAPT#
ADDRESS 7�� G,nT /C Y%ra`� ��•
PLAT NAMEISUBDIVISION NO. LOT NO, LID NO
LID FEE S
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP qW Pgrmit ggqui:ea
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EXISTING PROPOSED Si o�wgewp Qutrga O
REQUIRED DEDICATION FT wlanp rep eaa Lj
METER SIZE LINE SIZE NO. OF FIXTURES PRY REQUIRED O
YES ❑ NO ❑ t
RFMARKS
OWNER(CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE i2
FIRE REVIEWED BY DATE
VARIANCEORCU SHORELINEORADB# INSPECTION BOND
pE0'0 POSTED
AYES ENO g
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
%P
LOT COVE -GE REQUIRED BETOACKS (FT.) PROPOSED SETBACKS I".
ALLOWED PROPOSEDyyAX,,''tp'ry�FRONT SIDE �Qfl, READ
GW FRONT VR SIDE flFAfl
REO'DAIKING J ESY ( 85, C)Vj ('FQs@Y DATE
SHECNED BY TYPE P
JAREA ".
SPECIAL INSPECTION AREA OCCUPANT
REQUIRED YELOAD
❑ S
4EMAflKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge / I
PLAN CHECK NO�_-- VESTED DATE
Plumbing
Mechanical
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
E eE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN(CURBS. SIDEWALKS, DRIVEWAYS , MARQUEES, ETC.) WILL REQUIRE
t SEPARATEPERMISSION.
iew
s
pW PERMIT APPLICATION: 180CAYS
PERMIT LIMm1 YEAR -PROVIDED WORK IS STARTED WITHIN HRIDAYS
ection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
u� 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
w
E
Plan Chk. Deposit
U,f IN INTEREST, .11150 TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Y EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ction
Receipt 11AUCLAIMSFORDAMAGES
OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLYFROM
THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
CITY ORDINANCEP•
ins
TOSBI Ami. DUB
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY
NOR LIMIT IN ANY WAY THE CRYSABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Fee
Receipt #
i HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
AppL(CATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
SHE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
This q Ii II i i pormit unlit siSnutl �y No
PP ca on s no e
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
Buiitling Official or hislirar Ovpuly: antl Faus era paitl. m
racglplis acNnowiotlgatl in spoco pravitletl.
IN VIOLATION OF THE LA BO CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSAT .INSU TANCE AND RCW I827,
FOR INSPECTION
OFFICIALS PIGNATURE DATE
SIGNATIW NEfl O EN GA,TlE/JgIG ED
25)
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C^ ) I 1 G Z.
.—•`.
✓�t: (•'' `y'/
771-0220
N-'
PEl SED BY DATE'
ATTENTION
FM 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI•
ORIGINAL. FILE • YELLGw INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04102 PRESS HARD -YOU ARE MAKING
5 COPIES GREEN ACCOUNTING
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FM DEPARTMENT DATE L, - - r?" d7
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ENGINEERING DIVISION DATE
PLANNING DIVISION DATE
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PROJECTySf��f cf�yA-L / TC S
SITE ADDRESS �q
PERMIT #' ),W L- O `(4Y ADB# DATE INSPECTED 0-47--63
DESCRIPTION OF WORK TO BE INSPECTED, S f Actf --
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 WrfH CONDITIONS NOTED
o Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
o Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
2,
3.
RE -INSPECTED OUTSTANDING ISSUES- GRANT FINAL PROJECT APPROVAL
Date Sign
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RECORD OF INSPECTIONS
i
. INSPECTOR .DATE APPROVED
SETBACKS ......................
FOUNDATION:
- - Footing ......................
.,
...
" .. Wall ............
" Pier/Porch .................
. Retaining Wall ........:.. ..: ,
i
O'
.. P .... Slab insulation .......... ..
O
PLUMBING:... -
f
1�
" I Underground
i Rough -in ....... .. .
Ln
O
Commercial Final ......
O C-... ,'
M
" HEATING:
Gas Test .
C 1 "
1 Gas Piping ,.
r—{
Equipment ..........
_ -C y
-Commercial Final :......
�
.n '
"
m
EXTERIOR SHEATHING
0�1
NAILING ..........................
_0 .,.
-..
.i
co
FRAMING .........................:
to
" - FIRST FLOOR FRAMING...
1
�.
INSULATION .:....... ...
. " ... ' Floor. insulation .........
Wall Insulation ..........:
!
_
Ceiling Insulation
N
- i SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
-
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IT
MISCELLANEOUS ..........
FINALAPPROVAL FOR
OCCUPANCY
. e OCCUPANCY ..................