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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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6 1 PERMIT EXPIR=ES"
us PERMIT az�2
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19- NUMBER
JOB UITEJAPT#
ADDRESS Fe
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FLAT NAMEISUBDIVISION NO, I LOT NO. L
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LID FEE S
PUBLIC R GHT OF WAY PER OFFICIAL STREET MAP
PROPOSED — In.
REQUIRES DEDICATION-- FT
METER SIZE I LINE SITE_T_73737;�� PRV REQUIRED
YES E3 NO C3
BY
FIRE REVIEWED By DATE
CITY ZU, TELEPHONE
seefh_ 06,3 VARIANCE.RCU EK.PELJNE.R�U.iI
STATE LICENSE NUMBER EXPIRATION DATE CHICKE. BY BOND
'L BE I Is POSTED
OYE6 13NO
EPA REVIEW SIGN Al. I INSPECTION HEIGHT
;t PROPERTY CCO DEL NO. COMPLETE , EXEMPT ALLOWED , PROP081D ALLOWED , PROPOSED
EXP
Lot COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
0 NEW RESIDENTIAL PLUMBING I MECH
ALLOWED PROPOSED FRONT SIDE BEAR FRONT URSIDE BEAR
0 ADDITION COMMERCIAL COMILIA CEOR
CHANGEOPUSE 14AI
REMODEL MULTIFAMILY SIGN REOND I PROV T
IBM ST
REPAIR GRADING FENCE
CYDS E3 I X Fn REMARKS TAININ
REMARK-.
DEMOLISH Cff TANK rl OTHER
GARAGE
[3 RETAININGWALL F RE SPRINKLER
IMPORT ROOKERY FIREALARM
(TYPE OF USE ' BUSINESS OR ACYNITY) EXPLAIN:
CHECKED BY '7� 0 C PANT
rPE 1�=N IC
OiC TAlvf( GCOUP Z'
Ell NUMBER NUMBER OF I ITICAL
OF 0 a SPECIAL INSPECTION OCCUPANT
WELLIN AR AS
EOUIRED JAIIA
STORIES UNITS NUMBER A [3 YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC IOS/FINAL INSPECTION REDD
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Description
FEE Description FEE
a h I.-
Plan Check
State Surcharge
HEAT SOURCE GLAZING %
L TT_
LOT SLOPE %
Lo
Ild I
Building Permit
n
City Surcharge
TIES A E
PLAN CHECK NOL VESTED DATE
Plumbing
U in b in g
7r
.ch'"'C""Th'
Mechanical
THIS PERMIT AUTHORIZES ONLY THE ORK NOTEM THIS PERMIT COVERS WORK TO
0 R RK
- IT T
R. C V S W.
1: BE DONE IN PHI PROPERTY 11111 CONSTRICTION I" THE 1U111
i"N ON THE PU.-.
,ad,
Grading
ng
-C I WILL R---mE
DOMAIN (CURBS, SIDEWALKS, DRIVIEWAVS MARQUEES, ETC.1 WILL REQUIRE
SEPARATEPERMISSROW
Erigr REVIEW
Engr. Review
PERMIT APPUCATION: INDAYS
PERMIT LIMIT I YEAR - PROVID D WORK IS STARTED WITHIN 1.0 DAYS
I. DAYS
Eng'. 'repadt'..
Emir. Inspection
-
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
NT. N
"AIPLICA ONII-IIOFHIIOIIIEIII-UIE.IIIIRI.Al�IIINIA-DIUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
T,
Fire REVIEW,
VIEW
Plan Chk. Deposit
12 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM NY A
g A No
F
Fire Inspection
Receipt #
I B,.FTy _ IN=D
DIRECTLY OR G R CTLY
11 ALL CLAIMS FOR DAMAGES 01 WHATEVER NATURE, ARMIN IN I E Y
2 FBI. THE ISSUA.r OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscape IRBIL
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFO E ANY ORDINANCE PROVISION.-
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS COIRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC�
"ON' AND IN DOING THIrUTHOE"IED THEREBY, NO PE SON WILL BE EMPLOYED
CALL
,,,This lippskdi-fisnota Perniftuntil signed bydni
ding 0111d.1 ., Inlb., D.K.ty: and IF— s. pid, nnd
IN VIOLATION OF THE LA . C. I THE STATE OF WASHINGTON RELAI ING TO
FOR INSPECTION
—1pt Is ack—ladoed I, spac, prmided.
.0. M S C.MPENEAT N 'NEU r
K EN AND HOW U127�
OFFICIALS SIGNATURE DATE
(425)
fil
LwAlw4i
771-0220
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RELEASED BY OATE
ATTENTION
W 1333
IT IS UNIAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORICINN, . FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
PINK OWNER - GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
GREEN - ACCOUNTING
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FINAL PROJECT -APPROVAL FORM
TO:
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DATE:
NIEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: —:FM DEPART1,MNT DATE—.d— I
ENGMEWNGDMSIONDAT9—
PLANNING DIVISION DATE—
PROJECT_LL�71
SITE ADDRESS 15z�q.g_ I Ll 0, VIC b4-/
PERMIT 9-6!�'2 - QS- 3 __ADB#_________PATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED YS a-,A4,!C f= A
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 ATIH CONDITIONS NOTED
u 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— Sip,
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INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .......... ...........
Wall .................
Pier/Porch .............
4-
Retaining Wall ...........
Slab Insulation
PLUMBING:
.............
IT,Underground
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Rough -in ...................
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"66...rcial Final
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HEATING:
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Gas Test ...........
Gas Piping .................
Equipment
Commercial Final
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EXTERIOR SHEATHING
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NAILING ..........................
6
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FRAMING ...............
9 ca,
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FIRST FLOOR FRAMING
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INSULATION ...................
Floor Insulation
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Wall Insulation ...........
Ceiling Insulation
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SHEETROCK NAILING
0
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