20020646.pdf13
I—I'M "" %I " u —
I L- 2 j
CITY OF EDMONDS PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
OWNER 14AMEINAME OF Bus EBB ADDRESS 'ZIJ-211 It 0 -IL' W
RU�'j Cj I A 'aS W, LA S S e_n PLAT NAMEISUBDIVISION NO. I LOT NO. L�D 0.
MAILING ADDRESS j L DF E$
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
CITY ZIP ITELEP ONE EXISTING — PHOPOSED— 1 R—u-s 13
s—un.,.". 13
Umov'35 190 Z-0 -Lo� -5-1 2-'R'A�q REQUIRED DEDICATION— FT — -.—a
'uad
NAME METER SIZE I LINE SIZE I NO. OF FIVURES PRV REQUIRED
YE.E3 No E3
ADDRESS REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED)DATE
re ADDRESS
?:, y- 7 S7:�_ FIRE REVIEWED BY DATE
CITY lip TELEPHONE
'��eP44ic 8177 7-R, 30�, --_1 06
STATE LICENSE NUMBER EXPIRATION DAT VARIANCE OR CU SHORELINE OR ADB# ""PEOC 'ON PIOND
RE 7D ETEG
E 1777) . EEPA REVIEW 11111 AREA OYES 111,31IT
ro 1,4 i_-L_ 3 lo 4 No
;t PROPERTY TAX ACC EL NO. COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
C �Xp
7EQUIRW406ft W ZOPOSED SETBACKS (FT.)
0 NEW JZI.E.I.ENTIAL 0 PLUMBING / NEON ALLGV`VTEG`OVPA0AG BEE �Ig' A SIDE AFAR
C MPLIANCE OR
0 ADDITION E3 COMMERCUU. 11 CHANGE OF USE
13 REMODEL 0 APARTMENT 13 SIGN
o F NCE
REPAIR GRADING 11D1 ( — X FT)
[3 DEMOLISH -N. 13 OTHER
ri GARAGE RETAINING WALL
CARPORT ROOKERY 0 RENEWAL
da
PARKING ''J'16T
RECO, I PROVIDED
AAL;A]T�ANNIKI"�
ALVOkED W , —16ATe
REMARKS
(TYPE OF USE. BUSINESS %�M71N:
ce
f 4 0 a
NUMBER LIM ER OF CRITICAl_(/V6&VVx4x
OF DWELL NO AREAS
ce N
U
0 NITS NUMBER Pj—lbg
CHECKED BY
JTYP�J�r
N
_
"
F17
OCCUPANT),
GROUP
SPECIAL INSPECTOR
EOUIRED JARIA
A YES
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REGO
Aispose�`l J
r'A r, I I -a A Q TT—�__
Description
Scr
FEE
Description
FEE
Plan hec
__2w.
HEAT SOURCE GLAZING I LOT SLOPE 9%L
LCheck
U,
Building
7
PLAN CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIEZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: 8 DONEONPRIVATE OPIEFITY ONLY. ANY CONSTRUCTION ON THE PUBLIC
a
Grading
Recording Fee
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
3 SEPARATE PERM;SSION.
PE ITAPPLICATION: INDAYS
Engr. Review
City Surcharge I
PERMIT LIMIc I YEAR - PRO"A" DWORKIS STARTED WITHIN ISODAYS
Engr. In!!!!!!!j
State Surcharge
SEE BACK OF PINK PERMIT MR MORE INFORMATION
%PPUCANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIF� DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
Receipt #
ALL CLAIMS 1011 DAMAGES 01 WHATEVER NATURE. AMING .'AEc. OR IND RECTLY
FROM THELSSBAN.g 0, THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
TotalAmountDue
0 NOR LIMIT IN AM WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,
.1
Landscapsinsp.1
I
—
Receipt #
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIDN; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, Oft THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC�
CALL
applicte"onle not a pennit until signed by the
I Do ."E. THE
T %;.ANT..01N NT.T.E�6 UT.H RTE�-6140 PERSON WILL BE EMPLOYED
IN , N OF E T OF THE TA , WASHINGTON RELATING TO
X RISUP,
FOR INSPECTION
LeThet
ding Official., Inalre, D.p.y: and Fees in. paid, ad
1pt Is ack—ladglul In space pnwided.
NCE AND 9CW la,27.
OFF�GIAL
SIONA7 �n on NED
DAT�7
Lu.__j
25)
1111ZA
1J'REZ
.22� It f
771-0220
RELE any
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-
ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
10101
z
0
In
-4
x
M
M 0
0
0
M
Th Z
-i
z
--I
0)
on _n
M M
y Cl)
0
0
C on
90)
M 0
z
--I
x
55
z
0
In
FINAL PROJECT APPROVAL FORM
TO:
DATE: —
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DATE—,!j�-- �2-
FROM:
ENGINEERING DIVISION DATE—
z
PLANNING DIVISION DATE—
PROJECTZ?--���)
CM
SITE ADDRESS, a c4,?=/ 1 4,6 S:� tAl
Ma
0
80
PERMIT 0 INSPECTED -d
C
g
M
�ADB# __---DATE
In Z
'0 -1
DESCRIPTION OF WORK TO BE INSPECTED—IZSZL,�Z����
A field inspection was conducted to determine final compliance with approved plans. Final approval
0 -n
denotes that there are no objections from the above signed Department to the release of
'n
PERFORMANCE BONDS and the granting of:
M M
0 V5
0 r-
GRANT FINAIL PROJECT APPROVAL
M
C Co
Z r-
>
z
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
[3 Copy of CONDITIONS given to owner/contractor by inspector
z
L.
0
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
M
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE-INSpECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date_ Sign_
ocaprvi.doc.l:temp:bldg:fonnsIO/OI
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ..............
Wall ..........................
PledPorch .................
Retaining Wall ...........
z
0
4
Slab Insulation ..........
F) f.
PLUMBING:
�)Unclerground ............
-4
Rough -in ..........
M
C:
17111
Commercial Final
0
HEATING:
ITI
M
Gas Test ....................
z
Gas Piping .................
Equipment
fj)
0 It
Commercial Final
EXTERIOR SHEATHING
M
NAILING ............. ............
FRAMING ......................
0
0
C
FIRST FLOOR FRAMING
(A
Q 0
INSULATION .. .................
z
Floor Insulation
Wall Insulation ...........
z
Calling Insulation
S-HEETROCK NAILING
z
SPECIAL INSPECTION
Tg
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ...... .......