20020479.pdfJIMOATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
INNER MMEINAME OF BUSINESS
ZIP
NAME
A
ADDRESS
49 9/1�3 1142
CITY
NAME
PERMIT EXPIRES
USE
PERMIT /y,
'"' es- le000
NUMBER 04
JOB
ADDR7
FLAT NAME/SUBDIVISION NO.
LOT NO,
S,0_0000 - -50
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_tPUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTIN112L!�'--H`FPROPOSED�
REQUIRED DEDICATION—
FT � VL
METER sj�E
J
LINE SIZE
NO. OF FOOD ES
4
REMARKS
OWNFAMONTA—TOR RFSPONEISLF FOR EROSION CONTROL
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733 Ame c�� -7 IVIEWE. BY DATE
CITY ZIP TELEPHONE /
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'?,9000 1405- 774 2
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VARIANCE OR CU SHORELINE OR AD9# INSPECTION .No
VARI
STATE LICENSE NUMBER RE.-D ST--
IF
13 YES 014
rAL�LOWED
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PROPERTY TAX ACCOUNT RCEL NO, COMPLETE El ALLOWED PRO111110 ALLOWED PROPOSE
0
EXP 2-5' ,
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LOT COVERAGE REQUIRED SETBACK$ (FT.) PROPOS D SETBACKS (Fr.)
:0 NEW 0 RESIDENTIAL 21 PLUMBING I MECH PROPOSED FRONT SIDE BEAR FRONT s UR SIDE REAR
0 ADDITION COMMERCIAL o COMPLIANCE OR 7-1-1 to' to' to' 124, 15/11 '22--
0 USE
CHANGE OF
AREA PLANNING REVIEWEI try DATE
PARKING I
REMODEL APARTMENT 0 SIGN REOD PROVIDED
)LET
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REPAIR CYDS 11 ( _X_FT) REMARKS
0 DEMOLISH TANK [3 OT14ER
GARAGE RETAINING WALL
[3
ow*Qx44 ROOKERY RENEWAL
0
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(TYPE OF USE, BUSINESS Oft ACTIVITD EXPLAIN:
CHECKEDBY JTYPEOP,�R)Vhl JC�7 OCCUPANT
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LEIRNG AREAS SPECIAL INSPECTOR
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STORIES _ UNITS Num ERCA S___5 REOUIREDE:] YES
DESCRIBE WORK TO BE DONE
REMARKS
INSPECTIONS PER UBC 1011/FINAL INSPECTION REaD
Or
9
Or
VALLIATION $
FIEE
Description
FEE
Description
AMTE
Plan Check
11 U SLOPE I
Building
0.4-
ZZ96
127,T11"OL-1111 _. _
4
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PLAN C.ICKg�� RED
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE ORK NOTED. THIS PERMIT COV0S W09K TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
Grading
Recording Fee
a DOMAIN (CURaS,SIOEWALKS, DRIVEWAYS E WILL REQUIRE
'S.UC
SEPARATE PERMis'sIO'N"'
Engr. Review
City Burch rge
PE MITAPPLICATION: 130DAYS
Ll YO
PERMIT UMM I YEAR - PROVIDED WORK IS STAFITED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, AND FROM ANY AND
Fire Review
Receipt #
227 Y
E.-APLOYEES. AGENTS
ALL CLAIMS FO DAMAGES OF WHATEVER NATURE, ARISING DIRECTUY OR INDIRECTLY
FROM THE I SUANCE OF Gas PERMIT ISSUANCE OF THIS PERMIT $HALL NOT BE
_0:
DEEMED TO MODIFyWA E OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINAN E
Fire Inspection
'PIT
list Arnmrd 11,
NOR tj MIT IN ANY WAY THE CITYS ABILITY 70 ENFORCE ANY EDINA�CE PROVISION�
FLandscapeins
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT 14E INFORMATION
APPLICATION APPROVAL
IVEN IS CORRECT;AND THAT I AM THE OWNER, OR THE DULY AUTHORIZE AGENT OF
E OWNER. I AGREE 10 COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This appInaflon Is net a pomft until signed
by the
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
Building Officlist Of ble/hOr Dianati: and Fees we paid. and
FOR INSPECTION recolpt is Ci,rowledged In space Wovided.
WORKMEN'S Sp"qNSATION INSURAN E AND RCW 18,27,
AA
/DiTE
SIGNATUHqt.NE0 08 AGE ATE SIGNED
(425)
g�IALS SIG
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771-0220
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ATTENTION
EXT 1333 f
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-
L�FIUE - YELLOW -INSPECT(IR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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RECEIVED
MAY 2 0 2002
BUILDING DEPT
FINAL PROJECT ALPROVAL FORM
TO:
DATE:
MMMO TO: PERIVITI7 COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE—
L6aV- _ENGINEERING DIVISION DATE
G DIVISION DATE
PROJECT (M n-Ux- t&f-J-
SITEADDRESS
PERMrr#,�00,9--6t23—ADBk--DATEINSPECTED�—
DESCRIPTION OF WORK TO BE INSPECTED Y)
A field inspection was conducted to determine final compliance with approved plansi. Final approval
denotes that there are no objections from the above signed Department to the release of
PE RFORMANCE BONDS and the granting of
L,'�GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u 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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wall ...........
Pier/Porch .. ...............
Retaining Wall ...........
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Slab Insulation
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PLUMBING:
74 =E
Underground
Sough -In ..� .............
MID
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C
HEATING:
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GasTest .....................
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Gas Piping .................
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Equipment .................
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EXTERIOR SHEATHING
11111 M
NAILING ..........................
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FRAMING ............ ; ..........
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FIRST FLOOR FRAMING
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INSULATION ..........
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Floor Insulation ......... .
Wall Insulation
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Coiling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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