20020634.pdfDATE RECEIVED
I
PERMIT EXPIRES
CITY OF EDMONDS
'USE PERMIT
ZONE NUMBER a3
CONSTRUCTION PERMIT APPLICATION
SUITEIAPT#
AODRESS
:L1 <_ /Z)`
'.1 z)
OWNER NAMEINAME OF BUSINESS
PLAT NAMEISUBDIVISION NO.
LOT NO,
L
L�D NO.
D FEE
PUBLIC RIGHT OF WAY PEA OFFICIAL STREET MAP
EXISTING — PROPOSED—
Isso"re.—
sw
"'We
ssi R ...... d
.try ZIP ]TELEPHONE
REQUIRED DEDICATION— FT —
U-11—d
NAME
METER SIZE
LINE Bill
NO. 01 FIXTU111
PRV REQUIRED
C
I
I yes E3 No C3
ADDRESS
'REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP
ITELIPHONE
NAME
ENGINEERING Reviews. BY DATE
ADDRESS
133r2lq
z
FIRE REVIEWED By DATE
It
CITY ZIP
ITELEPH HE
_Plep
2314-0-74 6
9
0
ST LICENSE NUMBER EXPIRATION DATE
R.... D BY
VARIANCE 1111 CU
I SHORELINE I; ADEN
INSPECTION
RE
BOND
POSTED
I
S 13NO
S
SEPA REVIEW
COMPLETE EXEMPT
SIGN All
ALLOW PROPOSED ALLLOVV
HEIGHT
D
7Pa 67-
I
��!; I I
/-14' 1 MIT'S
6
EXP
0 rh
NEW
r PLUMBING I MECH
LOT COVERAGE
_QUINRTED SFTEACKB�IFT)
READ SID A A�
I
PROPOSED SETBACKS (FT)
FRO IJA SIDE AFAR
C:
Aaj;1jq;O1EIl
z
In
0
ADDITION
COMPLIANCE OR
f CHANGE OF USE
A I
T 7
0
a
REMODEL
JX SIGN
AFOO PROVID D
LOT At-
I Pt,= DATE
r�
4 K
X M
I
IT1
REPAIR
0 GRADING C.
rl PENCE
, X — FT)
—
:10,6b No
DEMOLISH
TANK
E] 077H E_R
o GARAGE
CARPORT
RFTAININGWALL
ROCKERY
F RE SPRINKLER
FIRE ALARM
am
r,
ITYPE OF USE, BUSINESS
OR ACTIVITY) EXPLAIN:
CHECKED BY
In
JTY��ION
NUMBER
de OF
NUM Ise OF
WELLING
RITICAL
AREA,
IC
SPECIAL INSPECTION
nn III
STORIES
UNIT$
EN
NUMBI
JAREA
REQUIRED [] YES
0
DESCRIBE WORK
TO BE DONE�
0
REMA KS
C Co
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REaD
III:, jhj
Z 0
4� 1 J"
I
n
;a
z
Ca
z
0
a;F-. eszk,.4
VALUATION
$
UAL.- jELA,&f/JC heemit-
Descriptiop
FEE
Description
FEE
State Surcharge
HEAT SOURCE GLAZING Is
LOT SLOPE %
City Surcharge
d
0
1711
PLAN CHECK Ill
111T11 1E
Plumbing
AD6 A
:29
Mechanical
AMA 10
THIS PERMIT AUTHORIZES ONLY THE ORK NOTED. THIS PERMIT COVERS WORK TO
1: IEIIN""PRIIPI.PERrVO.Ll,..CO.ST�L)CTI..Otil.g�1J..0
Grading
DAMN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
t: SEPARATE PERMISSION.
Engr. Review
PERMITAPPLICATION: 160DAYS
PERMITUM I YEAR -PROVIDED WORK IS STARTED WITHIN IODDAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT ON BEHALF OF H 11 OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chit. Deposit
IN INTEREST. AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANYAND
Fire Inspecti IT
Receipt #
ALL CLAIMS FOR DAMAGES OFWHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
.. ...............
.. ........ .... ...
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT BHA NOT CE
DEEMED TO MODIFY WAIVE OR REDU IS ANY REQUIREMENT OF ANY CITY O`R`DWANUE
Landscape Insp.
Total Amt. Due
. 0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PRMISIO1,
Recording Fee
I Receipt #
N41L) J_
INSIDE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVE IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNE . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
".'.n is net. pe"'ll 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
FOR INSPECTION
a 11, n1,,,I,dFs..1.PsId..nd
WORKMENS COMPENSATIOJMNCE AND NOW 18.27.
OF
ESG
(425)
Z_
771
-0220
4EL BED BY DATE
EXT 1333
A17ENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE JELLOW.INSPE TOR
CATE OF OCCUPANCY HAS BEEN GRANTED. URIC SECTION 109
PINK - OWNE�. GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE_
ENGINEERING DIVISION DATE
--.YLANNING DIVISION DATE I
PROJECT
)DRESS
PERMIT 44=- ADB#--------PAT9 INSPECTED
oo
CTED..
DESCRIPTION OF WORK TO BE INSPE
A field inspection was conducted to determine final compliance with approved plans. Final a_
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
GRW PROJECT APPROVAL WYIH CONDITIONS NOTED
1,9��Copy of CONDITIONS given to owner/contractor by inspector
�SlAn 6,-- ���
cts V1-';16[e— -44,
FAILED FNAL INSPECTION- OUTSTANDING ISSUES
o 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:tenip:bldg:formsIO/OI
z
0 X
a rn
M 0
-q 0
00
a
--i
M z
g) —i
C
-4
Cn
0 -n
I
--i
x
M M
0
0
0 M
C ca
C ca
M
;0
-q
X
z
-q
z
0
M
FINAL OJECT APPROVAL FORM
TO:
DATE:
MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTNMNT DATE -
ENGINEERING DIVISION DATE__
z
PLANNING DIVISION D
0
0
PROJECT ed Fiw �i /
O'n
CM
Mo
SITEADDRESS
0
0
B
PERmrr# *_:��AD # DATE INSPECT
-4 r
M M
M
DESCRIPTION OF WORK TO BE INSPECTED
2
-4
a I ov
A field inspection was conducted to determine final compliance with approved plans. Fi a appr al
2;
co
denotes that there are no objections from the above signed Department to the release of
o -n
_n
PERFORMANCE BONDS and the granting of:
M M
0 vi
GRANT FINAL PROJECT APPROVAL
0 r-
0 M
C: C/)
9 CD
M 0
z
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
GRX
z
u Copy of CONDITIONS given to owner/contractor by inspector
C
co
z
AILED FINAL INSPECTION - OUTSTANDING ISSUES
F AIL
o Copy of CORRECTION NOTICE given to owner/contractor by inspector
I
2.
3.
RE -INSPECT 0 STAND,ING ISSUES - GRANT FINAL PROJECT APPROVAL
�D Sign_
vl.doc,l: mp:bId:fbnns10/01
4,,
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ..............
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
rn 0�
Rough -in . ................
0
-40
Commercial Final
M
HEATING:
a —
Gas Test ..............
Gas Piping .................
Equipment ............
Commercial Final
1711 IT
EXTERIOR SHEATHING
NAILING ..........................
0 ITI
z
FRAMING ........................
C co
0,
FIRST FLOOR FRAMING
INSULATION ...................
W
i
i
Floor Insulation
z
Wall Insulation ...........
Ceiling Insulation
z
0
SHEETROCK NAILING
-.4
0
SPECIAL INSPECTION
IT
MISCELLANEOUS � ......... .
FINAL APPROVAL FOR
OCCUPANCY ..............