20020653.pdfCITY OF EDMONDS
ONST TION
C 7 7RUCTION PERMIT APPLICA
�E. No A.E OF a
;��AMF OF BUSINESS IFIZI C_ T" Dra 7N
r VI-elI Theoplodq rL4-z,,q
M MAILING ADDRESS
Ai a -iL-
CITY zip (V'11;3NE
*,a� ca I Is 310--1210
IIt ADDRESS
CITY ZIP ITELEP"ONE
NAME 1?4i_n i*�er.Z�nolasf ri C's 7
M ADDRESS
0 1 IPV35 61jiI 4ve� -P-
CITY re ITELEPHO E
u
STATE LICE BE NUMBER ;lPtRATION DATE
,RA1miL660r -/-03
kNsW
NT
rl IIIIIIIENTIAI
rl PLUMBINGIMECH
ADDITION
E I
MMERCIAL
C MPLIANCE OR
Co GEOFUSE
RAN
[3 REMODEL
0 MULTIFAMILY
ION
REPAIR
GRADING Cy.S
FENCE
( _ X_Fn
DEMOLISH
rl TANK
m OTHER
GARAGE
RETAININGWALL
F ES RINKLER
CARPO
P_FtT__
ROCKERY
A E ALARM
FIR
(TYPE OF USE, BUSINESS OROLT,�PLA
,
AR&
NUMBER
[S
NUMBER OF
CRITICAL
OF
WE LIN
0
a I
AREAS
STORIES
UNITS
NUMBER
DESCRIBE WORK
TO BE DONE 01
1_�,
z_
PERMITEXPIRES
E PERMIT
ZONE
'UMBER
JOB w I �y SUITEIAPT#
1u,
ADDRESS f-0 &
Tim qO
PLAT NAMEISUBDIVISION NO.
LOT NO-
UD NO,
I
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
a
REQUIRED DEDICATION— FT
METER SIZE
LINE SIZE
OF FIXTURES
REQUIRED
I
YEPRV
SO No
as
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR ERO;2� CONTROUDR MADE
FIRE REVIEWED BY
DATE
VARIANCEORCU
I IHOFEUNEOPADSP
A Do -o"s-1-34
INSPECTION
E3N.
SEPA REVIEW
COMPLETE , EXEMPT
;XP
'I'll AREA
ALLOWED
I * I
HEIGHT
ALLOWED PR POSED
Lx
L�.ETDCOVERAGE REQUINRTED SETBACKS (FT.)
ALLOI / FRO SIDE REAR
N, JY7�!D I ....
FFIROPOSED SETBACKS (FT.)
ONT UR SIDE AFAR
m�__
.!!ZA
PAAKING
LOT AREA
D PROVID So I
CHECKED BY ITYPE :5t6UMON CCUPA T
GROUP
111410 M
SPECIcL INSPECTION JAREA P NT
RED LOAD
R5QU Ej YES OCCU
REMARKS
PROGRESS INSPECTIONS PER URIC 10S/FINAL INSPECTION REOD
e5i-r&ghie� an Lari#At .1 &F
$
$
kVALUATION
Description
FEE
Description
FEE
Plan Check
bc)
—
State Surcharge
HEAT SOURCE GLAQ!ING
LOT SLOPE I
Building Permit
i (4 q
City Surcharge
PLAN CHECK NO:,D, V()/ I VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
—Ag 1f)v?_%b,/Vkh6r\
h BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
0 OMAIN (CURBS. SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION
U
PE MITAPPUCATION: INDAYS
Engr. Review
Engr. Inspection
PERMIT LIMIT I YEAR. PROVIDED WORK IS STARTED WITHIN ISODAYS
SEE SACK Of PINK PERMIT FOR MORE INFORMATION
ON 111111101 HIS OR HER SPOUSE, HEIII, ASSIGNS AND S1JroES.Ps
Fire Revim
PlanChk.Deposft
IN INTEREST, AGREES To INDEMNIFY. DEFEND AND 11010 HARMLESS THE CITY OF
WASHINGTON, OFFICIALS. EMPLOYEES, AND
EOMOND% ITS AND AGENTS FROM ANY
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Receipt #
Landscapeinsp.
Total At. Due
FROM THE ISSUANCE 01 THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY' WA E OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
q NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
Rec ipt #
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICA1 )RO1141
GIVEN IS CORRECT, AND THAT I AM T14E OWNER, OR THE DULY AUTHORIZED AGENT OF
THE DIANE . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
,,aps1I,I,na1by1,
TIOW� 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 7,F1,
clat Ot hisrhe DcfadY: and Fees .,a paid, and
eVallackno odgea, In space provided,
WORKMEN'S COMPENS=RANCE AND ACW IS.2T
11
Ll SIGN A
SIGNAZ (OWNE�.Orl DATE SIGNED
(425)
1
21
ly-d 2—
771-0220
1"L
ATTENTION
Off 1333
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 YELL -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER COLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING
z
0 Fit
a
In
0
80
C
X M
rrl�
0
C
F -4
0 -n
*n
IT! lin
a
0
0
9 C4
M 0
Z F
z
V)
z
0
IT!
_1NAL PROJECT APPROVAL FORM
To��
DATE:
�amo To: PERmrr cooRDINATOR, BUILDING DIVISION
FROM: FIRE DEPAMaNT DATE -
A /I ENGINEERING DIVISION DATE -
PLANNING DIVISION DATE_.-!
PROJECT
SITEADI)7RFSSf_Z_�_������
ERMrr
__ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED,_�
A field inspection was conducted to determine final compliance with approved plans. Lai approval
denotes that there are no objections from the above signed Department to the release of,
CE BONDS and the granting of
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
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:tnV:bldg:formsIO/OI
z
0
0
OM
C
M
0
80
a
M
M Z
co
0 -n
n
M M
CO
0 r-
0 M
C Ch
C co
M 0
z
-4
M
z
-4
3:
(0
z
9
0
M
z
co
am
a
MO
0
0
m m
a
m m
a
0
M 0
%/pjgr
,001
/e%w-Mjk;pr
41P. 0 1 A