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CITY OF EDMONDS
U S E
USE PERMIT
IONE
0 E
k1k NUMBER Z-190 471�
CONSTRUCTION PERMIT APPLICATION
L' ATION
OWNERNAME NAMEOF USINESS
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ADDRESS
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LEGAL DESCRIPTION CH-1 SUBDIVISION
LEGAL `
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AISTING __ PEOUIRED SE.ICA ON
N. P I NOR d 0
NAME
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METER SIZE
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NO OF F11TIRIS
P11 HE IIIED
ADDRESS
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YES 0 No 0
REMARK
REMARKS
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CITY
1111"I IU ER
ER
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NAME
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ENGINEERING F-. DATED REVIEWED BY
CITY TELEPH
5�C4-1i_e -76", 12-2VU,
F, 6
FIRE MEMO DATED REVIEWED BY
0
STATE LICENSE NUMBER
—0 7-
P-1Z�lZA1FP10-LL "IJIMATO—E
SIGN AREA
SEPAIREVIEW
ADB NO
Legal Description of Property - inciude all easements
_-OWED
PROPOSED
COMPLETE
I
jEXE?JPT
SHORELINE
0
P
EXP
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VARIANCE OR CU
PLANNING REVIEW BY
DATE
T
SETBACKS - FEET
70T COVERAGE
FRONT SIDE REAR
P" 01
T.NV�l .. Irl) G<CO3
Parcel No.
REMAR KS a
A
El
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NEW
RESIDENTIAL
PLUMBING ECH
PL '
El
I
COMPLIA CEO.
1
ADDITION
�rC ... ETICIAL
CHANGEOPUSE
�MNIMODEI
1:1 SIGN
FENCE
CHECKED BY CODE
OCCIPA
REPAIR f-� GGS
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= 1"n I
DEMOLISH [:] WOOOST111 E] SWIM POOL
"'ENT HOTTUS/SPA
ECIAL INSPECTOR - AREA
NEOUIRED
OCIUP41T
0 YES I
LOAD
GARAGE
E] R FIND WALL/
ARPOST RE0`GKjERY Fj RENEWAL
REMARKS
ITY�W BUSINESS OR CTIVtTY) EXPLAIN:
PROGRESS INSPECTIONS PER UBC 108
NUMBER
NU
OF
0
TO I S
DES ISE WORK TO BE DONE TATTACHPLOJ` PLAN)
FINAL INSPECTION REQUIRED
70
VALUATION
FEE
PUN CHECK FEE
HEAT SOURCE GLAZIN�
BUILDING
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IN,
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Plan Check IND. (;9- �?z
MECHANICAL
This Permit covers work to be done on private property ONLY,
GRADINGIFILL
Any construction on the public domain icurbs, sldewBlk3,
driveways, marquess, etc.) will require separate permission,
Penn Application: 180 Days
10
::
P. Limit: I Year - Provided Work 19 Started Within 180 Days
ST h,
"Applicant, on behalf of his of her Spouse, heirs, assigns and
SX, FEE
successors in interest, agrees to indemnify, dO tend and hold
harmless the City of Edmonds Washington, its of Is.
e
W
.1
employees, and agents from any and all claims for dam
agesof
whatever nature, arising directly or indirectly from the Issuance
�j/
of this permit. Issuance of this permit shall not be dee med to
modify, waive or reduce requirement of any city ordinan e
PLAN CHECK DEPO IT
Cany
nor limit in any way the Ity's ability to enforce any ordinance
-
TOTAL AMOUNT DUE
provision
I hereby acknowledge that I have read this application ; that the
in formation given is correct; and that I am the owner, or the duly
ATTENTION
APPLICATION APPROVAL
authorized agent of the owner, I agree to comply with city and
in
T.IS PERMIT
This application is not a permit until
state laws regulating construction; and doing the work authoriz.
be in
AUTHORIZES
THE
signed by the Building Official or his/her
ed thereby, no person will employed violation of the Labor
Code of the State of Wg=on relating to Workmen's Componsa.
ONLY
WORK NOTED
Deputy; and fees are paid. and receipt is
7.
INSPEC1,01
acknowledged in space provided.
-Z
DEPARTMENT
CITY OF 0
11 SIG E DATE.
EDMONDS
CALL FOR
INSPECTION
IT S UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCT RE
UN711. A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771 -0220 .1 V�11111. - File YELLOW Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. USC
SECTION 109
PINK -- O—e, GOLD - Assessor
-FlNt, PROJECT APPROVAL Ft -AM
TO._
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: —FIRE DEPARTMENT DATE 4,Z=—/(—O
ENGINEERING DIVISION DATE
z
PLANNING DIVISION DATE--
PROJECT_,S�,�A./S�S -I 12-C ly(f
SITEADDRESS
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80
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B ____----PATE INSPECTED—( 2�_—1
PERMIT AD #
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DESCRIPTION OF WORK TO BE INSPECTED k;
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A field inspection was conducted to determine final compliance with approved plans. Final approval
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denotes that there are no objections from the above signed Department to the release of
and the granting of:
M M
_PERFORMANCRBONDS
GRANT FINAL PROJECT APPROVAL
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M
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
(n
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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
ocaprvl.doc.l:tcmp:bldg:forimIO/OI
RECORD OF INSPECTIONS
INSPECTOR.
DATE APPROVED
SETBACKS... ..... ......
FOUNDATION:
Footing ..... .............
wall.
M
Pier/Porch . ...............
RetainingWall ............
M
C.
M
Slabinsulation .......
PLUMBING:
C
:C rill
Underground...
1711 z
Ro'gh'h'
z
CommercialFinal ........
—4- HEATING:
Gas Test .........
x
M
GasPlicing ................
0
Equipment., .... I ......
C
Commercial Final .........
EXTERIOR SHEATHING
NAILING ................
j
FRAMING ................
z
INSULATION:
F loorinsulation ............
Zr
Wallinsulation ...........
M
Ceiling Insulation
SHEETROCK NAILING.
SPECIAL INSPECTION ...
RADON MONITOR AT SITE.
FINAL APPRO AL
FOROCCUPAVNCY...