20020837.pdfDATE REM'�
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAMEHIAME OF BUSINESS
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PERMIT EXPIRES
US' PERMIT
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ADDRESS
PLAT NAME/SUBDIViStON NO, I LOT NO. LID NO-,
LID FEE S
PUBLIC FIGHT 01 WAY PER OFFICIAL STREET MAP '-p
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REQUIRED DEDICATION- PT
METER SIZE KTURES PRV REQUIRED
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NAME
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ENGINEERING RF.VtEWED/DATE
IF ADDRESS
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FIRE REVIEWED BY DATE
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STATE LICENSE NUMBER EXPIRATION DATE C
�IECKI
VARIANCE OR GO
11-101111.11,1102 ADD,
INIP ION
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0
YESE 0 NO
BEING
POSTED
PROPERTY TAX ACCOUNT PARC L NO.
4 -002> -CLACI(a
SERA REVIEW
COMPLETE I EXEMPT
EXP
SIGN AREA
ALLOWED I PROPOSED
HEIGHT
ALLOWED PROPOSED
2`NEW 0 RESIDENTIAL t MECH
LO COVERAGE
ALLOWED PROPOSED
REQUIRED SET KS (FT.) PROPOSED
FRONT SIDEACREAR
SETBACKS (FT.)
FRONT UR51DE REAR
ADDITION COMMERCIAL c3 COMPL ANCE OR
CHANGE OF USE
PARKING
REDD
PROVIDED
LOTAREA]P!A
NINGREVIEWE DATE
D By
0 REMODEL CB -APARTMENT F1 SIGN
[3 REPAIR GRACING CYDS [3 (FENCE X FT)
0 DEMOLISH 0 TANK 0 OTHER
AGE
o GAP C3
CARPORT RETAlNI'NyG WALL
0 B EO 0 RENEWAL
P (TYFEOFUSE� BUSINESS OR ACTIVITY) EXPLAIN:
F
CONSTRUCTION
OF
0 STORIES
NUMBER
DWELLING "I
UNITS
rR.'TICAI
AR E
NUMBER
SPECIALINSPECTOR JAHEA
PEOU N 0 YES
OCOU*NT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQT
I
on, N,
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE KAZING I LOT SLOPE 1.
A.AT�PLUMBING
BUILDING
PLAN CHECK NO: 71.
THIS PERMIT AUTHO IZES NLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
MECHANICAL
tZ BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS. SIDEWALKS, DRIVE S, MARQUEES. ETC.) WILL AEOLIS E
WAYMISSION.
GRADINGIFILL
:3 SEPARATE PER
STATE SURCHARGE
PERMITAPPLICATI N: ISODAYS
A. PERMITLIMIT I YEAR. PROVIDED WORK IS STARTED WITHIN 180DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'A PLACANr. ON BEHAL
P OF HIS OR HER SPOUSE, HEMS, ASSIGNS AND SUCCESORS
INSPECTION FEE
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
A� DSCAPING,
C FROM
I E MONDS.WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS ANIAND
INSPECTION FEE
ALL CLAIMS FOR DAMAG S OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FR M THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
RECEW
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAYTHE GO [Y'SABILITY TOETIFORCE ANY ORDINANCE �ROVISION.
PLAN CHECK DEPOSIT
IOTAL AMOUNI DUE
7,1�,6
IHERES ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
GIVEN 15 GO RECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THEOWNEA IAGREETOC MPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
TION AND IN DOING THE WORK AUTHORIZED THERE BY NO PE RS.N WILL BE EMPLOY ED
CALL
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I N VIOLATION OF THE LABOR C BE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN S COMPENSA;Et�N'URANCE AND RCW 19,27
FOR INSPECTION 10 llAI.�9".l
L U DATE
(425)
771-0220
-RE 'OATE
7TTENTION
EXT 1333
ITIS UNLAWFULTO USEOR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
NFPlG'TGR
PINK OWNER GOLI`)WASSESSOR
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FINAL ZROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, 13LTILDING DIVISION
FROM: FIRE DEPARTMENT DATE -23
ENGINEERING DIVISION DATE
DIVISION DATE—,
PROJECT
SITE ADDREss—C '7 Co /LD
PERmrr # 9-002, - 0 ADB#--------PATEINsPECTFD-2���/
DESCRIPTION OF WORK TO BE INSPECTED )(;'M�
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
PERFORMANCE 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
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date_ Sign_
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Commercial Final
HEATING:
Gas Test ....................
Gas Piping .................
Equipment
Commercial Final
EXTERIOR SHEATHING
NAILING .....................
FRAMING ...............
FIRST FLOOR FRAMING
INSULATION ...........
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..................
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