20020540.pdfit" DATE RECEIVED I
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER "MEINAME OF BUSINESS
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MAILING ADDRESS
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CITY Zip
TE, EPHONE
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CITY ZIP
ITILEI"ONI
NAME
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CITY Zip
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TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE
CHECKED BY
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1
PROPERTY TAX ACCOUNT FARCIL No.
I-10 ; 2-4 0 0201 Inc> 0
NEW [4-.01DENTIAL I'LUMN. I MECH
0 ADDITION [3 COMMERCIAL o C MPLIANCE OR
CHANGE OF USE
REMODEL APARTMENT 0 SIGN
[3 F NCE
E] REPAIR GRADING
G,GG t � X _ FT)
0 DEMOLISH 0 TANK C!r15VveUL)q1T,
A-IIE EAtNING WALL
A RT ROOKERY RENEWAL
C Spo [3
(TYPEGFUSE,BUSINPORACTIVITY)EXUP N:
/1,r,
Ir
NUM ER OF
CRITICAL
as OF DWELLING AREAS
STORIES UNITS NUMBER GO =-
DESCRIBE WORK To BE DONE
DEJACgEO GAe_A66 j4 Q191PoIJ
2-117(1 51'
PLAN CHECK
VESTED DATE
THIS PERUrr AUTHORIZIES ONLY THE We K NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEFA EPERMISSION.
P131MITAPPLICATION: IN DAYS
PERMIT LIMM I YEAR -PROVIDED WORK IS STARTED WITHIN 180DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS,ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND NO 0 ;' '7A`NYANO
EDMONDS, WASHINGTON, 'Is 0111CIII.S. EMILOY111. AND ZINT AD
ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO
MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY C TY ORDINANCE
NOR LIMIT IN ANY WAY THE DING ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN V50LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RE"TING TO
0
WORKMEN'S COMPENSATILFIANCE DOW 18,27.
jND
U HER OR
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!!!� NUMBIER,��,�V,
JOB Sul
ADDRESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
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L�D
0 FEE i
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED—
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REQUIRED DEDICATION— FT
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METER SIZE LINE S17E
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REMARKS
OWNER/cONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAI
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ENGINEERING
FIRE REVIEWED BY
-?It of 01_�
DATE
13yii)kNO I——
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT A Al�
XF
LOT COVERAGE REQUIRED SETBACKS (Frj, �PROPOSEO SMACKS
IULLOWEO PR
FRO SIDE REA�;A :7 FRONT jUR SIDE REA
MI
OF
PARKING
..D PROVIDE. LOT AREA PLANI4IN%* Iff— DATE
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'NECKED BY CILIPANT
TYPE OF COARTR OC
GROUP
ip—ECIAL INSPECTOR �GPANT
REQUIRED [] YES 1AREA 3 L.
JEMARKS
IROGRESS INSPECTIONS PER DEC 108/FINAL INSPECTION REO'D
VALUATION $ 17 14,kq
Description
FEE
Description
FEE
Plan Check
Building
Plumbing
Mechanical
Grading
Recording Fee
Engr. Review
CilySurcharg a
Engr. Inspection
State Surcharge
Z/
Traffic Mitigation
Plan Chk Deposit
Fire Review
Receipt #
Fire Inspection
TotalAmountDue
4/71
Landscapainsp.
Receipt #
CALL
FOR INSPECTION
(425)
771-0220
APPLICATION APPROVAL
This application is not a permit until signed by me
Building Official a, his/her Dopofly: and Fees are paid, and
I.colptisackno,tedg,din�p..p,.id.d.
OF LS SIGNATURE DATE
DAI
ATTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL VIA4
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 771-0221 ORIGI - NAL-FILE YEtIOW.(NSP I
8
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK -OWNER GOLD-ASSESSOTO
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OMEPJCONTRACTOR IS RESPONSIBLE FOR
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APPROVED AS NOTED I p-o")
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PLUT. PLAM
'FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE._
ENGINEERING DIVISION DATE,
PLANNING DIVISION DATE —
PROJECT
SITE ADDRESS tL
PERMIT# �al-0(2V? ADB#_------.PATE INSPECTED 61�31 �00cve—
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
E3 Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractorby inspector
2.
3.
RE -INSPECTED OUTSTANDINQISSUES - GRANT FINAL PROJECT APPROVAL
Datq_ Sign
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..... . ....
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
? rd4- a?
SETBACKS ....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Hough -in ................ —
Commercial Final
HEATING:
Gas Test ...............
Gas Piping .................
Equipment ................. .
Commercial Final
EXTERIOR SHEATHING,..
NAILING ......................
\Ins
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..............