20020667.pdff`
DATE PIECE, I I
USE PER
CITY OF EDMONDS �G" NUM 7— --6&
CONSTRUCTION PERMIT APPLICATIOJN JOB SUITE/APT#
ADDRESS 8400 130\n/r>C0>w
OWNER NANIFINAME OF BUSINESS
La
PLAT NAME/SUBDIVISION NO. I LOT NO, LID NO,
=e—sr,14 'RZe'm,--ry M , -T- . W,
El MAILING ADDRESS Abt> 7 LID FEE $
rz.-r> :�2T
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED �
Tru..PuZ11-a
- , se
6".. U.. _a, 'es,
u,".K. A
u-ned
ZIP
f15
ITEIEPHOME
;W& '310-72-1
REQUIRED DEDICATION- FT -
'Ideguu,d
METER SIZE
LINE SIZE
.0. OF FIXTURES
PRV REQUIRED
I
1
YES E3 NO E3
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ZIP ITELEPHONE
.>-Z'
�1�
t_,-L�j
FIRE REVIEWED BY DATE
zip
TELEPHONE
as
I C4 14W I L-^ `�)5 So
I
-
leock
3TATE LICENSE NUMBER EXPIRATION BAT
VARIANCE OR CU
I
1HORIEUNEORAOSs
INSPECTION
BOND
"0",
;��
j4Vj3.0Z-I3*)(;r`Q8N.
$
ROPERTY TAX ACCOUNT PAR
OCO)GIS 000 00-700
SERA REVIEW
MPLETE I X
EX P g1T
1111 All
LOWED OPOSED
AIL78$ I
1 pa-76141
HEIGHT
I ALLOWED PROPOSED
14, 1 14,
0 RESIDENTIAL PLUMBING/MECH
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT)
NEAR
ION
\ Z-N
gg_OOMMERCIAL
COMPLIANCE OR
0 CHANGE OF USE
ALWL07;E AWD
FRONT SIDE RIAR
FRONT UR SIDE
PARAING I
R-cm PR.1 DED
LOT ARFA-1
F ATE
Mo
0 RE DEL /0 MLIT'PAAR'
9 SIGN ' I
REPAIR
GRADING CyD FENCE
7�
X
X ,
DEMOLISH
TANK
`TAA. I ii (A
[3 GARAGE
RETAININGWALL "O��....PRIN�K-L.11
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE. BUSINESS OR ACTfVnYf EXPLAIN:
-r
MU'L-Tj 15jA!5iNe5;5 jFr-jAJ L_ jnA_Dr
CHECKED By
ITYPE CTION
WIU
PANT-5
OCC P
GROU
NUMBER
0,
I NU .. N OF
.WELL N.
ITICAL
A EAS
INSPECTION
OCCUPANT
STORIES
VAPECIAL
N UMBER
R
JAREA
REQUIRED YES
LOAD
t
REMA KS
P. GRESS INSPECTIONS PER UBC 108/FINAL INSPECTION FIEG-D
PP_lV_A—rr—_
$44,70
4' 70"
j tt, A, ?=:��A V�ih
FEE
Description
FEE
hDescrlption
Plan Check
State Surcharge
HEAT SOURCE BLAZING % LOT SLOPE %
.u"Q, . Permit
Buil n
It city surcharge
PLAN CHECKI�V_ Vol VESTEDDATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE ORK NOTED. THIS PERMIT COVERS WORK TO
1- 8 DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
. DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS MARQU ES, ETC.) WILL REQUIRE
:3 E
SEPARATEPERIMISSION.
PE MITAPPLICATION, ISDDAYS
Engr. Review
PERMil"LIMIMIYEAR-PROVID D WORK HISTAIRIND WITHIN 180DAYS
Engr. Inspection
13ACK OF PINK PERMIT FOR MORE INFORMATION
_SEE
'APPLICAW, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposft47_',�
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
—
Fire Inspection
Receipt fill
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARIS No DIRECTLY OR INDIRECTLY
I
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PLERMIT SHALL NOT 8'
CITY of BE
DEEMED TO MODIFY, WAIVE OR RED CE ANY REQUIREMENT OF ANY Y ORDIN4ANCE
O"T
I-Druiscapainsp.
L
Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
x
L _
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT � HAV READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT AM THE OWNER, Off THE DULY AUTHOR ZED AGENT OF
APPLICAnON A
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
This application Is dead panall-fil signed by in.
TION; AND IN DOING THE WO AUTHORIZED THEREBY. NO PERS N WILL BE EMPLOYED
IN VIOLAT ON OF THE LABO E OF THE STATE OF WASHINGTON RELATING TO
null ding Official., his/her Barely: and Fees Om paid, and
FOR INSPECTION 1.a.ipl I, a,len—luel In ap .. p—lded,
WORKMEN'S CONIPENI.��N U CE AND RCW 18.27.
DATE BIG .
S..NAT��
(425)
OZOZ�O_L
1 771-0220
DATE
A TTENTION
EXT 1333
;2_2
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
",�JRGINAL-FILE -'YELLOW' INSPECTO
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER - GOLD . ASS SSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOLNITING
4
Z
hill
ma
0
80
C:
In
Z
O"n
M M
055
0
0
a
R1 0
Z
I
;13
Z
Z
171
FINAL PROJECT APPROVAL FORM
DATE:
MEMO TO: PEI�M COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTNfENT DATE
A i ENGINEERING DIVISION DATE�-
ng x
PLANNING DIVISION DATE-
V
PROJECT
SITE ADDRESS�
PERMIT AM - 4A;� 7 ADB#
DATE INSPECTED�--
DESCRIPTION OF WORK TO BE INSPECTED
A field Inspection was conducted to determine final complin e with approved plans. Finalapproval
denotes that there are no objections from the above signed Department to the release of
PERM BONDS and the granting of
UNT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL VnM CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
1
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractorby inspector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign
ocaprvl.doc.l:temp:btdg:formsIO/OI
z
9
0
0 3:
C: M
M 0
0
0
3:2
M
M M
0
0
0
M 0
Z
z
z
0
M
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing . .....................
Wall ..........................
Z�
Pier/Porch ..........
Retaining Wall
Slab Insulation ..........
PLUMBING:
-4
Undergroum:1
M
.............
rn 0
0
-40
Rough -In . ..................
Commercial Final
M
Z
-4
HEATING:
to
C =5
Gas Test ..................
Gas Piping .................
Equipment
0 _n
Commercial Final
ITI ITI
EXTERIOR SHEATHING
0
0
NAILING . ...................
C
FRAMING ............. ; ..........
M 0,
FIRST FLOOR FRAMING
X
INSULATION ..........
Floor Insulation
z
Wall Insulation ...........
Ceiling Insulation,..,..,.
z
0
SHEETROCK NAILING
0
M
SPECIAL INSPECTION
MISCELLANEOUS
t
FINAL APPROVAL FOR
OCCUPANCY ..............