20020734.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
CITY
7AME
fiz I
26,L`c, 14 5 L-\.)
ZIP
r
I T611PHIINI
0z(1 qzy-'?')5
PERMIT EXPIRES
USE
ZONE PERMIT
7
NUMBER 3�1
ADDRESS SUGE1APT#
I S C) &zw-,30
PIUST NAMEISUBDIVISION NO.
LOT NO.
L�D NO.
I
L DFE S
LIC RIGHT OF WAY PER OFFICIAL STREET MAP
Tfisal AS—.
0
EXISTING — PROPOSED-
1 111*11,
S._.Fha�
REQUIRED DEDICATION— PT —
L,.,S—a
w-a Swfad 13
METER SIZE
'IN' 1111
NO- 01 FIXTURES
PIV REQUIRED C,
I
YES NO
15
DATE
ZIP TIUEP11011 FIRE' RENREWED BY DATE
, 0 z
EXPIRATION GAT I CVC 00
a �5WBy VARIANCE OR CU _I SHORELINEORADB# I INSPECTI N I PS SNO
. ;j REOD TE.
OLIMI 09
tAdv V&
r4f L
EXP .4 1� . �w
x ".1, , , _b�K:a�g Ii +i
ri NEW
RESIDENTIAL
PLUMBING i mecH
LOT C=E _REQM9n%'1`8ACWjft.) MtIP69 BEIRA
ALLO ED QISEa.. NT SIDE REAR FRONT UR SIDE
ADDITION
COMMERCIAL
C MPLIANCEOR
CHANGE OF USE
REMODEL
[j muLnPAwy
rl SIGN
D EKING I LOTAIEA IP NNINGREVIEWEDBY 0
RECr PA
PROVIDED
REPAIR
GRADING CYDS
o F NCE
I X_ FT)
I
RE —
REMARKS
171 DEMOLIS14
TANK
OTHER
EiGARAGE
CARPORT
RETAININGWALL
LJ RocKERY
0 F SPRINKL R
2811 ALARM
(TYPE OF USE, BUSINESS �WZ I P N:
NUMBER _T NUMBEII OF
OF I DWELLING
STORIES I UNITS
RITIC L
AREAS
ONUMBER.
Plf� �NTr N JC?�) J'OCCU
GROG
SPEC61ALINSPECTION JAREA OCCI NT
LOAD
FISO RE []
DESCRIBE WORK TO
BE DONE
YES
IRB"AIKI
IPAOGRES..&r.er..k..5Q14 WMOINAL INSPECTION REDID
1 A A" zlji" 'JAZIlLE , A
C) : 1111 Inlit:h
$
Description
FEE Description FEE
Plan Check
State Surcharge
GLAZING %
I
Building Permit
City Surcharge
Z;.-
PLAN CHECK NO:
VESTED DATE
Plumbing
t: THIS PERMITAUTHORIZES ONLYTHE WORK NOTED. THIS PERMIT COVERS WOR KTO
BE DOME ON PRIVATE PROPERTY ONLY. ANY CONST LICTION ON THE PUBLIC
DOMAIN (CURSE SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATEPERMISSION,
PER ITAPPLICATION: INDAYS
S. PERMIT LIMIT. I . - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Mechanical
Grading
Engr. Review
Engr. Inspection
ON BEHALF OF HIS OR HE" SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS . WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AMD
IALL LARVIS FOR DAMAGES OF WHATE�ER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROCM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED To MODI
91 WA E OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY ZW-AY TIV
se HE C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,
Fire Review
Fire Inspection
Landscapehisp.
Plan Chk. Deposit
Receipt #
Total Amt. Due /I
— 65-
Recording Fee
Receipt If
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
I N VKHAT ON OF THE LABOR C E OF THE STATE OF WASHINGTON RELATING TO
WORKMEN!S c ll��URANCE AND RCW 18.27,
-L,7,Tu
Re���,]ATE SIG:
�A I- 1�1 I 1A 0 _L_
ATTENTION
CALL
FOR INSPECTION
(425)
771-0220
EXT 1333
-23111
APPLICATION APPROVAL
on,, This applicall.n I, net . pariah achl signed D,
arg Official or hisihe, D,phry: and FO'S Set, paid, and
let I, seck-M,algad In Space pirwided.
OFF DATE
_ -
ro-A
RELEASED BY OfTE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04102 PRESS HARD -YOU ARE
OR GINAL - FILE YELLOW INSPECTOR
P�NK - OWNER GOLD -ASSESSOR
MAKING 5 COPIES GREEN - ACCOUNTING
z
T
:;5i
C ITT
rn 0
0
80
C
-49
M M
z
jo
co
0 -n
'n
IT ITT
0 U5
0
C be
9 U)
M 0
Z
M
z
U)
z
0
f
c py
_I t7
51 2 3
MHU)ING DEPT.
Wft
-i72
V p 0
App OVED AS NOTED
BY ENPIN.�-ERING
t: : iAl
RECEIVED
keEVELOPMENTSERVICESCM
CITY OF EDMOND,'
WWI W—
tol
yyto,�(nwm
+
G i-z,6,0
15',f ,
5�1,7-aval A�r
,)OT ftCew
0 to )G
t S7
qa 00v/ I
or- ,�k
wj�c I mwow\)� AAZA,,
t - 7F;
C-f an- CC -1 1 FUli I
Ov.���4
oul)
am
m 0
10 ve-
10 w f�f
MOW
APPROVED BY PLANNING
(oks+ (0��,r,�)00+10D=
kt,
W'S
wk ��qbc,�f
4 (j)A. keT- P,�
6 00
2 -1
PTY Copy Etil
�-1 0-
4
oko K-�ej�
I At-r—tzj�-
ma
0
80
c
m m
'o � , ,
—co
0
m M
0
0
m
0)
90)
M 0
X
z
CA
z
0
m
e
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: DEPARIMENT DATE
---�ENGINEERING DMSION DATE
0
PLANNING DMSION DATE--
PROJECT
M
9) 5"b 0 S+-QAZ
M 0
0
SITE ADDRES
PERmu#aji6&-04u—L—ADB#--DATE INSPECTED 3
3: m
M z
DESCRIPTION OF WORK TO BE INSPECTED--A���...
'0--1
z
Cl)
A field inspection was conducted to determine final compliance with approved plans. Final approval
0 -n
n
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
M M
065
0 M-
C: co
GRANT FINAL PROJECT APPROVAL
9 CD
M 0
Z
z
GRANT PROJECT APPROVAL WTM CONDITIONS NOTED
M
u Copy of CONDITIONS given to owner/contractor by inspector
CD
z
0
M
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 Sign_
ocaprvl.doc.l:tenip:bldg:forrnsIO/OI
Micro
12608-6 INTERURBAN AVENUE SOUTH
Corn TUKWILA, WA 98168
TEL �206) 24&3191
Systems Washington Ltd. FAX 206) 248-3313
ATTEM I IWN
Z'
I;
O�
ki
Mi
C
MO
000:�
A MT,
114
> z
Co
01
The next image may be a
Cc 83
rn
duplicate of the previous
C)
image.
;U1
zi
z
Other: v-'r- e
0
M
www.microcomsys.corn
... .... ... ..
-v
M
m cy
-40
0
m
M
c:
>
ZONE
m M
0
$ETD=-.
FRONT
o F,
Mol
SIDE
REAR
OTHER
HEIGHT
Zi
RECEIVED
m
QT F:
v REET ILE
MAY 3 1 2002
BUILDING
A
DEPT.
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO To: PERmrr COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE —
ENGINEERING DIVISION DATE
PLANNING DIVISION DATE —
PROJECT
�4- (Al -
SITE ADDRESS
PERMIT #4&LQAW —ADB 3 . ......
DATE INSPEC
DESCRIPTION OF WORK TO BE INSPECTED ....... . ......... . . .... . . .
A field inspection was conducted to determine final compliance with approved plans. Mnal approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WrM CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
1
2.
3.
RE-INSpECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date_ Sign_
ocaprvl.doc.l:tenip:bldg:forinsIO/OI
z
0
ffl
C ra
ma
0
-4 K
M
'0-4
0 -n
M M
1J
0"o
0
a M,
9 0)
Q 0
Z r-
>
z
-4
03
z
M
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall ........................
Pier/Porch ..............
*Refalning Wall ...........
Slab Insulation ..........
M
PLUMBING:
"n
Underground .............
f
Rough -in ...................
rn
Commercial Final
M
0
0
C
HEATING:
Test
to
ITI z
Gas ....................
Gas Piping
10 —1
C
............
Equipment .................
Commercial Final
0 -n
x
EXTERIOR SHEATHING
M M
NAILING ..........................
0
0
FRAMING ...............
0
FIRST FLOOR FRAMING
C
0
INSULATION
Floor Insulation
;0
Wall Insulation ...........
>
z
Ceiling Insulation
SHEETROCK NAILING
z
SPECIAL INSPECTION
171
MISCELLANEOUS ..........
FINAL APPROVAL FOR vr��
OCCUPANCY ..................