20020602.pdfDATE RECEIVE
I .
cirf OF EDMONDS
USE
ZONE PE mT
IN UIR, `E R2LI0,
2 6202-
CONSTRUCTION PERMIT APPLIFJOB
CATiON
7
[- ;NERNAM�EINAMF
'71Z,&4-
OF BUSINESS
ADDRESS
, ;�7/ 4
A7
PLAT NAMEISUBDIVISION NO.
Lio No,
MAILING ADDRESS
'to FEE 5
P BLIC RIGHT OF WAY PER OFFICIAL STREET MAP
ateca ac"eme
0
EXISTING — proposED—
eneact.,;im, — 13
._.'s .,u". ri
REQUMEDOEDICATION_ FT
. ma.
varr.'am—
MUER SIZE LINE Bill NO. OF FIXTURES PIV REQUIRED
I I
I YES C3 No E3
Us
REMARKS
z
NERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
7-"
NAME
7-
ENGINEERING REVIEWVDJDATE
ADDRESS
IRE REVIEWED BY
DATE
ZI! TELEPHONE
fBillOtLICENSE NUMBER EXPIRATION DATE CHECKED BY
VARIANCE OR CU SHORELINE OR ADS#
DION I'OSND.
INIX�I.C� 00
IS
E3YES E3NO
PROPERTY TAX ACCOUNT PA404
SEPA REVIEW SIGN AREA
COMPLETE EXEMPT ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
,
,
EXP
NEW RESIDENTIAL
LOT COVERAGE REQUIRED SETBACKS (FT.)
PROPOS 0 ET8ACKS (FT)
E
0 LUMBIN I MBCH
ALLOWED PROPOSED FRONT SIDE REAR
FRONT USR SIDE HEAR
0 ADDITION COMMERCIAL C Mp"AN E OR
CHANGE OF USE
z
REMODEL APARTMENT SIGN
ICA I PLANNING RIVIEVIED BY DATE
0 REPAIR [3 GRADING CYDS In F NCE
( — It
FT)
REMARKS
E] DEMOLISH 171 TANK El OTHER
Ei GARAGE RETAINING WALL [3 RENEWAL
CARPORT ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY]�RUOTIONI W�D
OCCUPANX��
is
2
N IER L
'A
q4,,,r
GROUP
—
1
0 UM
F
SPECIAL INSPECTOR
06OU P�A
.1
E IT
a To., It
1111A
EQUIRED [] YES
R 30,
L.A.
DESCRIBE WORK TO BE DONE
!j
BEMA KS
ROGIRESS INSPECTIONS PER UBC 11081FINAL INSPECTION REQ'D
as
VALUATION$
Description
FEE Description
FEE
Plan Check
SO E LOT SLOPE %
Building
THIS PERMITAUTHORIZES Nor THEWORK NOTED. THIS PERM"COVER WORKTO
mechanical
t 13 DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
Grading
Recording Fee
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr, Review
City Surcharge
EAMITAPPLICATION: INDAYS
PERMIT LIMM I V PROVIDED WORK 15 STARTED WITHIN IN DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
State Surcharge
'APPUCANI, 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, WAIIIINGTON, ITS OFFICIALI, EMPLOYEES, AND AGENTS MOM ANY AND
Fire Review
Receipt III
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY 08 INDIRECTLY
FROM THE ISSUANCE OF T IS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Total Amount Due
AN "N
NOR LIMIT IN AM WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
"' " '"""
Landscape Insp.
Receipt #
I
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
to
APPLICATION APPROVAL
GIVE" 18 CORRECT. AND THAT I AM T14E OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNE . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING COLISTRUC-
'0
CALL
This application is not a permit 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
j
Staining Oil his-, Deputy: and Fees are paid, am
FOR INSPECTION '.c.ipflailsk—dedged In space p—lded.
WORKMENS COMPENSATIOlAtURANCE AND RCW 1&27�
OFFICIALS SIGNATURE
DATE
SIGN
(425)
24a"i-A,
771-0220
' RELEASE"Y I
DATI!
ATTENTION
EXT 1333
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-
ORIG'INAL-Fa� ) YELLOW
A4SPECTdR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
FAX
PINK - OWNrR - GOLD - ASSESSOR
10101
z
IT1
3:
C M
M 0
0
80
171
z
0 -n
In
ITI 171
a F
0 5
0 r-
IT1
0)
C On
ITI C)
Z
z
9
0
M
sh Total Received
C
Amount
0
M
M;
0,
--10,
M..
'M
C z
0
"n
Milli
13 ro;
0
C)
C Ca
0)
M 0,
z
.0
E"
r
lit
Water Meter Size:
Water Connection Fee
Sewer PermittRepair
Sewer Connection/LID Fee
Street Disruption Fee (111 Fund)
Storm Drainage Fee
Engineering Inspection Fee (SFR)
Engineering 2.2*/o Inspection Fee (SP, Multi. Comm)
Engineering Review Fees (SP, Multi. Comm)
ROW/Street Use/Encroachment Permit
Street Cut/ Restoration Fee (620 Fund)
Traffic Mitigation Fee/Sidewalk Contribution
Fire Inspection Fee
Fire Plan Check Fee
Building Permit Fee - Type 17�245wn::2�
Plan Check Fee
Reimbursable Consulting Fees
Critical Areas
Landscape Inspection Fee (1%)
SEPA Review Fee
Shoreline Permit Fee
Sign Installation (620 Fund)
Zoning Application Fee - Type:
Maps / Books
-�hotocoples
..... ...... . .
Recording Fee
City Surcharge
State Surcharge (622 Fund)
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: YIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE -
PLANNING DIVISION DATE-
PROJEC
z
0
=i -9
Vi -4
SITEADDRES
-7( -------PATF INSPECTED-/-�-�?.
PERMIT 6 -----ADB#
M
M 0
0
DESCRIPTION OF WORK TO BE INSPECTED
M
A field inspection was conducted to determine final compliance with approved plans. Final approval
z
2
denotes that there are no objections from the above signed Department to the release of
>
PERFORMANCE BONDS and the granting of:
0 -n
-n 31.
GRANT FINAL PROJECT APPROVAL
M M
M 0
Z r-
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
3:
>
1.
z
-4
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
z
0
=j
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
0
M
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date�-- Si
oc-aprvl.doc.l:temp:bldg:formsIO/O1
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ....................
FOUNDATION:
Footing ...........
Wall... .......................
Pier/Porch .................
Z
Retaining Wall
Slab Insulation ..........
rp
PLUMBING:
:H
Underground
Cl IT
C:
Rough -in ................
M
0
-40
Commercial Final
HEATING:
ITI M
GasTest .................
Gas Piping . .................
Equipment .................
Commercial Final
0 -n
EXTERIOR SHEATHING
NAILING ....................
0
FRAMING ........................
C
ca
FIRST FLOOR FRAMING...
M 0
INSULATION ...........
Floor Insulation
z
Wall Insulation ...........
Coiling Insulation
03
z
SHEETROCK NAILING
0
SPECIAL INSPECTION
0
IT