20020768.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMIUNAME OF 0 SINESS
(14CT2
MAILING ADDRESS
CITY ZIP
ITILIPHON1
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ADDRESS
CITY ZIP
ILIPHONI
N AME —7-714
67123
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CITY ZIP
TEL PHONE
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STATE LICENSE NUMBER EX7 DATE
CHECKED BY
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW RESIDENTIAL E] PLUMBING/MECH
C MPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
rl REMODEL MULTIFAMILY 0 SIGN
M REPAIR OFN�CYDI El ','_ x_m
0 DEMOLISH TA K OTHER
ORT RETAINING F
CARRAGE WALL FIR SPRINKLER
A ROCKERY IRE ALARM
ITYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER
OF
12�M
UMBER 0 FL,
DWELUN
rUNDE
CRITICAL J.�WV V
AREAS
41�
STORIES
NUMBER
DESCRIBE WIRK TO BE DONE
PERMITEXPIRES
PERNIF
ZONE —NUMBER ��
JOB SUITEIAPT#
ADD = / g,17
FLAT NAMEISUBDIVISIION NO, LOT LID NO�
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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EXISTING — PROPOSED— R. 1-
REQUIRED DEDICATION— M
METER SIZE I LINE SIZE I NO- OF FIXTURES 11V EQUIIEO
EsC3 No 0
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIORAINAGE
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ENGINEERING REVIEWED BY D E
FIRE REVIEWED BY DATE
VARIANCEORCU BOND
IMOF12LINI On ADBI I INSPECTION I P.ar
HE ED
E3YES 0&/0 S ___
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT LL OWED PROPOSED I ALLOWED PROPOSED
.XP 0.5'
LO COVERAGE REOUIRED SETBACKS (FMT) I PR05POS 0 SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR I FRONT URSIDE REAR
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RE PARKING 01 LOT AREA XIG REVIEWED 82::: Z11;
1. 6e). 6 ion
CHECKED BY ITYPE OF CONSTRUCTION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
LOT a �'F�yr)
Building Permit
City Surcharge
PLAIN CHECKNO: aTED DATE
4-0-4
Plumbing
—
Mechanical
THIS PERMIT AUT ORIZILS ONLY THE WORK NOTED. TH S PERMIT COVERS WORK TO
—140-
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
Grading
DOUNN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL R EQUIRE
SEPARATEPERMISSION.
Engr. Review
PE MITAPPLICATION: I.DAYS
PERMIT LIM111 I YEAR . PROVIDED WORK is STARTED WMH14 '80 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
'APPLICANT, ON BEHALF OF 1418 OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
1. INTFFI�.l AGREES 1. IN.E.Hrl DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WAIHINGTON, ITS OFFICIALS, EMPLOYEES, AND A15ENTI FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Receipt It
FROM THE I SUANCE OF MIS PERMIT ISSUANCE F THIS PERMIT SHALL NOT BE
DEEMED To MODIFY WAIVE 0 REDUCE ANY REOUIREMENT OF ANY CITY ORDINANCE
Landscapoinsp.
Total Amt. Due IFL
NOR LIMIT IN ANY WAY THE CITYS AB1U1Y TO ENFORCE ANY ORDINANCE PROVISION.-
— —
Recording Fee
Recoil
IHERE 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
T E OWNEFL I AGREE TO COMPLY WITH CI AND STATE LAWS REGULATING CONSTRUC,
CALL
Thi. I� r. A p.,.;, .01.1gn.d by M.
TION; AND IN DOING TH WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
11.11.1n, Cft�.I o, WWW1 Mpty� -d F.—I. p.1d. no
FOR INSPECTION Ipt i� dn—I.dpd 1. �p pid.d.
WORKMENa COMPE NSATION INSURANCE AND RCW 18.27.
OFFI LS SIGNATURE, IIA11
$IGNAT WNE ' OR AGENT) DATE SIGNED
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771-0220
__lfATE
ATTENTION
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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 - YCLLCV�-INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER - GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE
MAKING 5 COPIES GREEN ACCOUNTING
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RECEIJ
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OCT 0 3 2002
PERMIT COUNTER
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FINAL PROJECT APPROVAL FORM
TO:
DATE.
MEMO TO: PERMrr COORDINATOIZ, BUILDING DIVISION
FROM: —FIRE DEPARTNIENT DATI�_
&,2�NGINEERING DIVISION DATE
PLANNING DIVISION DATE
PROJECT_g"J4&Z_,
SITE ADDRESS
PERmrr #LgIW---417�/�Ai)Bk--DATEINSPECTFD
DESCRIPTION OF WORK TO BE INSPECTED.
A 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
PEELORMANCE 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
I
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
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing....................
wall ..............
Pier/Porch .................
Retaining Wall ...........
Slab Insulation
PLUMBING:
Underground .............
3:
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Rough -in .............
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Commercial Final
C
HEATING:
X M
ITIZ
10-4
Gas Test ...........
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Gas Piping .................
Equipment ............
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Commercial Final
-4
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M M
EXrERIOR SHEATHING
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NAILING ................
0
0
FRAMING ........................
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IT! 0
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
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Wall Insulation ...........
calling Insulation
SHEETROCK NAILING
0
SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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