20020591.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
I 75/� 11.1-�".77
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CITY ZIP
V,?,'03
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STATE LICENSE NUM R
EXPIRATION DATE
BY
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[3 REPAIR E] GRADING CYDS ( X Fr)
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ITYPE OF USE. BUSINESS OR ACTIVITD EXPILAIN:
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NUMBER
OF
STORIES
NUMBER OF
DWELL No
UNITS
AREAS
CRITICAL A4_
NUMBER
DESCRIBE WORK TO BE DONE
US
ZORE PERMIT
NUMBER
JOB SUITEIAPT#
ADDRESS
PLAT NAME/SUSIDIVISION NO,
LOT NO.
LID NO,
LID FEE IT
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
""4"'rd
EXISTING — PROPOSED —
ten.
re_nX, - 0
a--mii
REQUIRED DEDICATION— FT
PAY REQUIRED
YES 13 NO 0
REMARKS
WNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLJDRAINAGE
i
FIRE REVIEWED BY DATE
VARIANCEORCU I 1110111LINEOIAOIN I INSPECTION BONI
HE 'D OSTED
OyEs ONO
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE
:XP EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS IFT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UPSIDE REAR
PARKING LOT AREA I PUNNING BEVIS ED BY DATE
REOD I P....E. I
CHIECKEDBY JTYP��N IC
SPECLALINSPECTIOK JA"IA
REQUIRED [] Yea
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VA LUATION
$
Description
FEE Descripti n FEE
Plan Check
State Surcharge
LOT SLOPE %
PE %
L. T
Building Permit
City Surcharge
T. AT E
PLAN CHECK �0..*. VESTED DATE
JOY
Plumbing
Mechanical
THISPERMITAUT ORIZES ONLY THE WORK NOTED. IN SPERM" COVERSWORKTO
WORK To
RE 00"111 P11 PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
sEPARTArEPERMiSSION.
Engr. Review
PERMIT APPLICATION: ISDOWS
PERMIT LIMIT I V. ED WORK IS STARTED WITHIN '.a DAYS
- PROVI '80 DAYS
Ertgn Inspection
SEE BACK 01 PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS ASSIGNS AND SUC.ESORS
- "
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOL HARMLESS THE CITY OF
D I
S EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM A=. AN.
Fire Inspection
Receipt #
� n_"" rtrun
11 ALL CLAIMS FO DAMAGES OF WHATEVER NATURE, AFUSIN "RE .. Y or TNIQUISITI,
9 FROM THE ISSUANCE OF THIS PERMIT ISSUANCE Or THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp.
Total Amt. Due
I
2 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION..
Recording Fee
I Receipt # 1,46
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; T14AT THE INFORMATION
f GIVEN IS CORRECT. AND THAT I AM THE OW ER, OR THE DUTY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE TO C MPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This roplimfl.. Is no, . per.1-14.1gred by th.
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
FOR INSPECTION
B,Ildino Official or hialhor Deputy: and Foos are paid. and
I —Ire is raromfi.dgrnd In space p—Ided.
WORKMEN'S C��SATIF.M*4&,URANCE AND RCW W.27.
OFFICIAL
SIGNATURE WRIER 0 T,
(425)
.��IDN�'TURE
7
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8 1
RELEASED BY DATE
ATTENTION
EXT 1333
------------------
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL � FILE YELLOW - INSPECTOR
PINK-OWNEA GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE
MAKING 5 COPIES GREEN - ACCOUNTING
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hNAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: P , rBUMILDING DIVISION
FROM: FIRE DEPARTMENT DATE V //4 10-,
ENGINEERING DIVISION DATE
------YLANNING DIVISION DATE
PROJECT —
SITE ADDRESS—
pERMIT#___Q2=_�:(DS�.AD]3#_____--PATE INSPECTED 811,16—
DESCRIPTION OF WORK TO BE INSPECTED... U5T-
A field inspection was conducted to determine compliance with approved plans. Final approval denotes that
there are no objections from the above signed Department to the granting of
e"" inal approval of the described work
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ..........
Wall ..........................
Pier/Porch ... ..............
Retaining Wall ...........
Slab Insulation
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final
HEATING:
Gas Test - .................
Gas Piping ..........
Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING . .........................
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION .. .................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ........... ......
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