20020697.pdfPERMIT EXPIRES 1:5
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USE PERMIT
CITY OF EDMONDS ZONE
NUMIBER3�Laa��-�
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPI#
ADDRESS
OWNER RAM E 0 BUSIN Ss
Ct e 0 PLAT NAMEISUBDIVISION NO. LOT NO, LID NO,
�kr, C It I
MAILING A'DRFSS LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED— 1qW-d 13
ITILIP111E 0
5E&�-O "f"-S 67-2_-21�la REQUIRED DEDICATION— FT — 13.
NAME METER SIZE
LINE 1111
NO. 01 FIXTURES
PIV REQUIRED
I
1
ES C3 NO 0
ADD Ss REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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CITY A/O A07-171111 tVC7q%L,1
lzip ITELIPHONE 32_1_
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NAME
11 C) Tca 3 i In Corpo-ochcn
nac6A ENGINEERING REVIEWEDICATE
ADDRESS
0
St FIRE REVIEWED BY DATE
ZIP TELEPHONE,
W Do
A* VARIANCE OR CLI SHORELINE OR ADS# IN "C BOND
STATE LICENSE NUMBER EXPIRATION DATE S.El"DoN POSTED
'�J(YES aNO I
E. IIEVIEW SIGN AREA HEIGHT
;I PROPERTY TAX No. COMPLETE 111111T
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NEW RESIDENTIAL PLUMBING I MECH LOT COVERAGE REQUIRED SETBACK$ (FT) PROPOSED SETBACK$ (FT.)
0 ARVIED PRO ED FRONT SIDE REAR FRONT URSIDE HEAR
0j(A..ffI.N CM COMMERCIAL COMPLIANCE OR 1`4
CHANGE OF USE
PAAKING IT ARIA ATE
0 REMODEL [3 APARTMENT El SIGN
0 REPAIR GRADING C,CS 0 FENCE
I _ X FF) REMARKS
DEMOLISH E] TANK 0 OTHER
[3 GARAGE ED RETAINING WALL
CARPORT ROOKERY, RENEWAL
_
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UP
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CHECKED BY IWT!] FFONIT CTION !n GO PA.TJ4
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NUMBER ER OF CRITICAL
"WELL
GUM
1
OF No 1-7 AREAS E.0 . JARIA
10 IVIA P.CIALE..N�180T.a
A
1, 1
STORIES UNITS NUMBER j 0 YES
DESCRIBE WORK TO BE DONE
REMARKS
I
PROGRESS INSPECTIONS PER DEC 11081FINAL INSPECTION REIWO,
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VALUATION $
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FEE
Description
FEE
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Plan Check
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HEAT SOURCE CILAIING LOT IILOIE I
LOT SLOPE
Building
Building '412
T". DATE
PLAN CHECK NO: ITED DATE
I
Plumbing
PumBU'g
Mechanical
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THIS PERMIT AUTHORIZES ONLY THE ING K NOTED. THIS PERMIT COVERS WORK TO
""T C`w .. W .. To
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THIS PUBLIC
t . G. PUBLIC
o
2
, .mg
Grading
Recording Fee
n DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS ETC.) WILL REQUIRE
SSROQUEES.
SUARATEPERM;M" N.
Engr. Review
ED., Review
City Surcharge
PERMIT APPLICATION: UIDDAYS
V6
ITH. 1. A,.
PERMIT LOIRE I YEAR � PROVIDED WORK 13 STARTED WITHIN 180 DAYS
ADO.
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
EDIT,
State Surcharge
ON BEHALF 01 "IS 01 HE" SPOUSE. HEIRS. AIIIIINI AND IUCCEIORI
Trallic Mitigation
Plan Chk Deposit
I-ILICA"
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARM EBB THE CITY Of
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
—
Fite Review
Receipt #
IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMBr. ISSUANCE OF THIS PERMIT SHALL NOT ME
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Total Amount Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION
Landscapainsp.
R..Gipt It
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION xpPk6VA
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE OULY AUTHORIZED AGENT OF
THE OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
.0.n 1, - A p—it v,Ufl,vP,.d by Uu,
TION; AND IN DOING THE We RK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
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d,.gOIIIZI., Wht,O�p,q.—dF .. ... pid, �nd
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WORKMEN'S COMPENSATION INSURANCE AND RCW 18,27.
OFFICIALS 10 ArURE DATE
DATE SIGNED
(425)
/I
L
771-0220
.,LkNjY) TE
ATTE ION
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-
OHIGINAL-FIIE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
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'FINAL PROJECT APPROVAL FORM
DATE: dwo
MEMO TO: PERMIT COORDINATOR, 13URDING DIVISION
FROM: FIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE�--
PLANNING DIVISION DATE
PROJECT 1XV,
SITE ADDRESS
PERmrrm�,-I'"-Z&—'Z--,ADB#-4W--Y'7 DATE INSPECTED—_
DESCRIPTION OF WORK TO BE INSPECTED
field inspection was conducted to determine final compliance with approved plans. Final approval
,denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
Al
-GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
I
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .............
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
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Retaining Wall ...........
Slab Insulation
PLUMBING:
Underground ............
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Rough -In ...........
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Commercial Final
HEATING:
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Gas Test ....................
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Gas Piping ...........
Equipment .................
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Commercial Final
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EXTERIOR SHEATHING
NAILING .................... -
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FRAMING ........................
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FIRST FLOOR FRAMING
INSULATION .. ..............
Floor Insulation
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Wall Insulation ...........
Ceiling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR No
43
OCCUPANCY ..............