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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS A)VIm-rUil:
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MAILING ADDRESS
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CITY 96-4 9 005P 15 (�-1140N'l
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ADDRESS 1 50 4.3 5 61 -vinip"C, for-,
CITY
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STATE LICENSE NUMBER F.FBAJGN�aATEHE 1.
PROPEFITYTAX ACCOUNT PARCEL NO VV(0jj6f
0 RESIDENTIAL PLUMBING/MECH
C MPLIANCE OR
bj_*MMERCAL CO
/0 HANGE OF USE
REMODEL MULTIFAMILY .11
E
FINCE
REPAIR ..A.ING YDS FT)
0 DEMOLISH rl TANK 0
GA AGE c3 ACTAININGWALL 0 FIRE SPRINK ER
CAPP014T ROCKERY FIRE ALARM
(TYPE OF USE. BUSINESS
NUMBER NUMBER OF ITICAL
OF DWELLING AREAS _
PER ES
0z 10
BE PERMIT
ONE ZUMBEFlurL
00 &JVy,4?A) SUITEJAPT#
DOFIESS qkoze,
PLAT NAMEISUBDIVISION NO. LOT NO, Ll 0.
LID FEE S
TESCP
7uBLIC RIGHT OF WAY PER OFFICIA1 STREET MAP
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EXISTING — PROPOSED
REQUIRED DEDICATION—
FF
FIXTURES pRv REQUIRED
YES 13 NO 13
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tAVS—T.11 ... FSPONSIBLE FOR EROSION CONTROLIDRMNAG _
FIRE REVIEWED BY
DATE
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YES ONG S_
SEPA REVI
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APBGP�SED
COMPLETE . EXEMPT
I ALLOWED
I ALLOWED
[CHECKED By 17YF
SPECIALINS ECTIO
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EQUIRED r�j YES
REQUIRio SETRACKS IFT, I PRGF.0SED SETBACKS III
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Description
Description
NBC
FEE
Plan ChecK
3FEE
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge 15*
PLAN "IF. UA.b
Plumbing
I
Mechanical
THIS PERMIT AUT"ORIMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
Grading
DOMAIN 4CURBS. SIDEWALKS, DRIVEWAYS MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: VINDAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN I" DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
PI.nChk.Dep0SII 0
IN INTE E T AGREES T INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
WASHINGTON, ITS OFFICIALS, EMPLOYEES A D AGENTS FROM ANY AMD
Fire Inspecton
Receipt #
DMOND .
ALL CLAIMS FOR DAMAGES HATEVER NATURE, A NO DIRECTLY OR INDIRECTLY
OFW RjSIN
PRO. THE ISSUANCE OF THIS PERMIT. ISSUANCE .1 THIS 1E..H ELALL NOT BE
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ktalAmt.Due
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
Recelpt #
IHEREGY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
OWNER, I AGREE TO COMPLY WITH AND STATE LAWS REGULATING CONSTRUG.
CITY
CALL
'�. .. X -t . P.-It 11 al led by ffie
THE
TION; AND IN DOING THE WORK AUIHO RIZED THEREBY, NO PERSON WILL BE EMPLOYED
F THE STATE OF WASHINGTON RELATING TO
I, Offim I , Iii a Di,pivy; � d F .5 a,. p.1d, .�d
FOR INSPECTIO N '11 ..Ipl� kni—I.d9idinsp ... p 90d.d.
IN VIOLATION OF THE LABOR
WORKMENS COMPENS URAN AND RCW 1827�
-
0 IC LS UBE D ATE/(T
_j�:10p—NA1 UBE IO��ER f!1A AGENT, DATE SIGNED
(425)
771-0220
—R
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
OR GINAL - FILE YELLOW - INSPECTOR
A
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNEII GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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FINAL PROJECT APPROVAL FORSLMY1
TCK
DAM: ..........
MEMO TO: PERWr COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTNIENT DATE —
A A ENGINEERING DIVISION DATI�—
:PLANNING DIVISION DATE—!/
A
PROJECT zz J U
srrEADDREss
pERmrr a& 4ek- 7 ADB#______--PATE INSPECT
DESCRIPTTON OF WORK TO BE INSPECTED, 2:4 1 4i="c�'
A field Inspection was conducted to determine final compliance with approved plans. Mmal approval
denotes that there are I no objections from the above signed Department to the release, of
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL ATIH CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
FAMED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
I
2.
3.
RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date— Sign_
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ..............
FOUNDATION:
Footing ................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation
PLUM13ING:
Underground .............
OM
Rough -In ................... .
C
ITI
0
0
Commercial Final
C
HEATING:
ITI
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10
GasTest .................
17,
Gas Piping .................
co
Equipment .................
0-.
Commercial Final
IT! M
EXTER OR SHEATHING
CA
NAILING ..........................
017 n
FRAMING ..................
M 0
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
>
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Wall Insulation ...........
Calling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
IT
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OZ-
OCCUPANCY ...............