20020932.pdfe
6ATE RECEIVED
PERMITFAIDIFIES
CITY OF EDMONDS
USE
ZONF M1 PERMI
/ NUMBI
CONSTRUCTION PERMIT APPLICATION
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PLAT NAMEtSUBDlVISION NO. L NO.
MAILINU ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STAEET MAP "'o"s
CITY ZIP ITEILEFFIGNE
EXISTING - PROPOSED -
REQUIRED DEDICATION- FT - ="
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NAME
ETER SIZE I LINE Si7lle).
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or FIXTURES
PRV REQUIRED
YES C3 No D
ADDRESS
REMARKS
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E..NT�... RESPONSIBLE .. BROsION C.NTROLJDRM.AGE
ADDRESS
Z 7, 1
DATE
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PFIRER�.'"EDSY
STATE LICENSE NUMBER
EXPIRATION DATE ECKE Y
to 'E
VARIANCEORCU I
SHORELINEORADBa
INSPECTION
REaO
BOND
POSTED
I
E3VEs ONG
1.
TAX ACCOUNT
PRO TAX ACCOUNT CEL NO.
$EPA REVIEW
BY
COMPLETE EXEMPT
SIGN AREA
ALLOWED PIIOPO81D ALLOWED
HEIGHT
PROPOSED
?i!M';) -7
EXP
,
NEWW
RESIDENTIAL
PLUMBING I MECH
LOT COVERAGE
REQUIRED SETBACKS (Fr.) PROPOSED
SETBACKS NT'
ALLOWED PhoposEo
FRONT SIDE HEAR FRONT
LIR SIDE REAR
ADDITION
grOOM..I1C.L
C MPILIA�CE.l
CHANGE OF USE
13 REMODEL
r] MULTIFAMILY
SIGN
PA 11ING LOT
SECID PROVnED
AREA
P NNING REVIEWED BY DATE
0 REPAIR
GRADING
E] FENCE
., ( X FT)
REMARKS
0 DEMOLISH
[j TANK 0 077 HER
o GARAGE
CARPORT
RETAININGWALL RINKLER
Roe, FE
FIRES
SY 'Er ALARM
ONt,01 USE, BUSINESS OR WITY) EXPLAIN:
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GROUP
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NUMI R
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NUMBER
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RITIC
AREAS
SPECIAL INSPECTION
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OCCUPANT
STORI:$
UNITS.
NUMBER
JAREA
REOU RE
13 YES
LOAD
DESCRIBE WORK TO BE DO NE
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REMARKS
PROGRESS INSPECTIONS PER USC IOS/FiNAL INSPECTION REO'D
ini� I vAelz')
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VALUATION
$ �5 zm2 .—
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Description
FEE
Description
FEE
Plan Check
Ilumbing
State Surcharge
HEAT SOURCE GLAZING
LOT SLOPE I
Building Permit
City Surcharge
Aalae_
lechanical
THIS PERMIT AUTHORMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU LIC
a BIRE
Grading
DOMAIN JCUROS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REDO
SEPARATE PERMISSION.
—
PER ITAPPLICATION: INDAYS
Engr. Revlevv
PERMIT UMM. I YEAR *PFI.Y ID110"KISSIARTED.17HIN 11).a
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION'
'APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCES,,,S
Fire Review
PlanChk.Deposft
IN INTEREST AGREES TO INDEMNIFY, BE END AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Receipt #
FROM THE ISSUANCE OF T IS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY WAIVE OR REDUCE REQUIREMENT
Landscapeinsp,
Total Amt. Due Z'z
ANY OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE A. ORDINANCE PROVISION.-
_U �M
Recording Fee
Receipt III D/,),- -q
I HERESY ACKNOWLEDGE THAT � HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE To COMP WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
This appt,union Is not a pormit-S signed by She
0
TION; AND IN DOING THE WORK AUTH RIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF T14E STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATIO�4qURANCE No RCW 18.27.
FOR INSPECTION
Suit ding 0=41 of 1,131her Deputy: and Res are paid, and
... ra 1, ackn.al.d,.d leap ... punlld.d,
is
�FFIGIA N RE DATE
RE (0 SIGNED
(4,25)
we:IQ 17,^)102
16--.?j
771-0220
j
RELEASED BY DATE
AtTENTION
Eliff 1333
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 log
ORGINAL�FILE YEIEC14 SP&OR
P=-OWNER COLD � ASSESSOR
04!02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: ___YIRE DEPARTMENT DATE_Z:1 �6_
ENGINEERING DIVISION DATE -
PLANNING DIVISION DATE-
T vyr
PROJEC
SITEADDRESS 2=1(eG
PERMIT # #__-----PATE INSPECTED
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
BONDS and the granting of
PERFORMANCE
Y-- GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractorby inspector
1. JAN 2003
2. PERMIT COUM7ER
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ..................
FOUNDATION:
Footing ...........
wall ........... ..........
Pier/Porch .............
Retaining Wall
Slab Ins ulation ..........
PLUMBING:
Underground .......... .
Rough -in ...........
Commercial Final
HEATING:
Gas Test .............
Gas Piping ................
Equipment .................
Commorcial Final
EXTERIOR SHEATHING
NAILING ............... . ...
FRAMING ......................
FIRST FLOOR FRAMING
)NSuLATK)N .............
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ................
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