20030016.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAMFINAME OF BUSINESS
1�) It I L, 'L,� - ) �� L, 1, 0 L-1- r
I I CITY
U NAME
I-APz I PERMIT EXPIRES
USE PE MIT
RM
ZONE NUMBER r_�tr
JOB SurreAPT,
ADDRESS L S"�t
tp,ATNAME1SUBDAnSI0N NO. NO,
LID FEE 3
11 a —
PUBLIC Fl-ITT OF WAY PER OFFICIAL STREET MAP -
A-
."..u." P="w,
EXISTING— PAOPOSEC� J RK-W
U
REQUIRED DEDICATION _ IFT
LN SZ P
METER SIZE I LINE SIZE NO- OF FIX11JRE1 YE PRV FINUIRE.
Y a , No .
E613 NO C3
R AF.qPONSISLE FOR EROSION CONTROUDRA,INAGE
C-11, NGINEERING REVIEWED BY
L L 121w-_f C rL
)U t_kv_� - v
NE
... 1Ep,,H1 0, 7 "t) 2
I E BE NUMBER Fly
[3 NEW
t3 RSSIDEIYrIAL
PLUMBtNG I MECH
0 ADDITION
K'COMMEACIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR IN. ,
,y.G
I""
[3 F — X
E3 DEMOLISH C3 TANK
rl
E3GARAGE , RETAININGWALL
CARPORT L_j ROCKERY
Q
ITYPE OF USE, BUSINESS OR ACI—) LAN
`UM
L 7;
.,7,EAL
H U-BER
OF
STORIES 3
OWELLI NO
U NITS
A. EAS
NUMBER.
DESCRIBE WORK TO BE DONE
D 2—
k
FIRE REVIEWED By
DATE
C) -L
VARIANCE OR CU
SHORELINE 08 ADS#
I INSPECTION
RED D
PBOND
OS`ED
E3YES
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
ALLOWED PROPOSED
"Xp
LOT COVERAGE
RED IRED SETBACKS (FT)
U
PROPOSED SETBACKS (FE)
HEAR
ALLOWED PROPOSED
FRONT SIDE
REAR
LIP
FRONT SIDE
PARKING
LOT"AREA
PLANNING REViEVVED
By DATE
1EGD I PROVIDED
_�";
=CHECKED By ORO P
�! I ARE A LDACDU PANT
SPECIAL INSPEC
REQUIRED [3 YEB
REMARKS
EROGRESS INSPEICTIONS PER 6BC 108/FINAL INSPEL;1 IUN
$
Description
FEE
Description FEE
Plan Check
State Surcharge
HEAT SOURCE GLA2 LOT SLOPE I
Building Permit
City Surcharg
—�'_ —CHECK No. VESTED DATE
Plumbing
Mechanical
ONLYTHE 5 PERMrr COVERS WORK TO
THIS PERMIT AUTHORIZES WOLK A`.OTIE�`D.�.Te .It ON 0 . THE P U SU c
BE DONE ON PRIVATE PROPER1 V
Grading
U
DOMAIN (CURBS, SIDEWALKS, DRIVIEVINYS, MARC EES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Rwiew
2 X MIT APPLICATION: See DAYS
PERMIT UNIT. I Y D RKI STARTEDWITHIN 10DAYS
PROVI EDIV
Engr. inspection
SEEBACK OF PINK PERMIT FOR MORE INFORMATION
Plan Chk. DePos
'A. N BEHALF OFHIS OR HERE1F`lCUSEjN111.1&ASSIGNS AND SUCCESCIRS
PPL' . DREES To nEMNIFY. G N G C HARMLESS T E I
Fire ReVieW
Receipt N
I INT EST - A 0 FICIAI , EMPLOYEES AND AGENT' FROM ANY AND
S, "AHIN'T "" B
.or E SH. pl�E.TIL, OR INDIRECTLY
A�
Fire Inspection
NA
ALL C� a FOR GA.A.EE OF WHATMI TUR .
0 ISSUANCE OF THIS PERMIT SHALL NOT BE
FRO F THIS PERMIT
LandscapeInSP.
Total Amt. Due
THE I NCE
MOO' IVE OR SEDUCE ANY RED UIREMENT 0 AHY C TY ORDINANCE
DEEMED TO'SUAFY WA
ORDINANCE PROVISION,'
0 NOR LIMIT IN A. WAY THE CI�S ABILITY To ENFORCE ANY
Recording Fee
Receipt N
I HERESY ACKNOW EDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL'
GIVEN IS CORREC% AND THAT I AM THE IIIE16 SCTR TIE DISLY AUTHORIZED AGENT .1
'HE WNEy.R- To COMPLY WITH CITY AN ATE LAW REGULATING CONSTRUC-
CALL
This application 15,01 a p,mit until 51g.ed by tha
= and F.
B O."I"'an"' Dep.ly: and IF— Afe paid. an
"ON AN. Do ON WILL BE EMPLOYED
; I "'. HE AUTHORIZED 1111REW. No PERE
REILKIING TO
FOR INSPECTION :AI,Ki; top... pmided.
HE S WASHINGTON
IN N . F TA I ODE OF T TAJE -1
HDO
DATE
;2A 6 P�.CE AND RCW IS 27.
E
EP "TA
S
E
61G"T7 DATE GNED
(425)
61--3-02-
low
7' t)o
I DATE
771-0220
/IT u If,
till
As
"
ATTI—ENTION t
E)ff 1333
IT IS UNLAWFIN TO Ic';4R OCCUPY A BUILD NO RSTRUCTUREUNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORGINAL.FILE YELLOW -IN ECTOR
Z.OWNER
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
P GOILD-ASSOSOI�
GREEN - ACCOUNTING
04/02 oor-Cc: WAg2n _vni I APr
RAAKIM111
r (1r)IDIF:q
z
0
=i "n
0
80
M
C
Cf)
0
r" M
C3 FA
0
0 Fn
(j)
0
X
z
0
1TI
I
FINAL _ ,tOJECT APPROVAL F0R,,1
TO:_
DATE: —
MEMO TO: PERM[IT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE,61=31.f�
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE —
PROJECT 92
SIT`EADDRESS 30 d"CLI—
PERM[IT 4_2�6�.ADB#____pATE INSPECTED— 4�—?(--G 3
DESCRIPTION OF WORK TO BE INSPECTED--1—:ZA.4������
as conducted to determine final compliance with approved plans. Final approval
A field inspection w ent to the release of
denotes that there are no objections from the above signed Departm
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL VaTH CONDITIONS NOTED
[3 Copy ofcoNDITIONS given to owner/contractorby inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 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:temp:bldg:fomLsIO/OI
z
9
0
in- -A
07-
C: rn
M 0
0
80
C:
M
M Z
0-4
C: 2
> -4
0
-A
2:
M M
0
0
0 M
C (n
K (n
M 0
z
A
-4
T
z
co
z
M
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wait..........................
Pier/Porch .................
Retaining Wall
Slab insulation ..........
PLUMBING:
Underground .............
0 M
C:
C
Rough -in ...................
IT,
0
—40
0
Commercial Final
IT,
IT!
HEATING:
C Z
Gas Test ....................
Gas Piping .................
5
oil
Equipment .................
Commercial Final
M M
EXTERIOR SHEATHING
NAILING ...................
0
FRAMING ....................
C
FIRST FLOOR FRAMING
p
f
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
z
SHEETROCK NAILING
SPECIAL INSPECTION
IT!
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..................
I
IPATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
IFEII71
MAILING PDR�
G
CITY
7EL, 11) f__ _1)1__I2_ _j I
ZIP
TEILE
;�ONE
[,,ftq WOO , - 77/ 2,2-
ENSE NUMBER E�PINAHQ D
IN—II'[PERMIT
EXPIRES
##�
USE PERMIT
ZONE NUMER412),�- ff
'.a SUIT
ADDRESS
'; -7- R2
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAR
EXISTING— PROPOSED —
REQUIRED DEDICATION— FT —
vas— 13
NO. OF FIMBES
M1 REQUIRBO
0 No C3
REMARKS
F 1nR EROSION CONTHOLMRAINAGE
FIRE REVIEV�-D By DATE
VARIANCE OR CU I SHORELINE OR ADEN I INSPECTION 1$ a.
REOO POE
OYES ONO
SEPA REVIEW PA
_.. __ ___ I __�IUN H'I'"I"R
nPnFn I ALLOWED
El
0 RESIDENTIAL
E H
[:] UMBINGIMECH
L COVERAGE
L OT COV E
ED
ALLO101TED PROPOSED
ALLO W P
QUIRED SMACKS (Fr.) I
I "EM 811, REAFL
PROPOSED SETBACKS (FO
FRONT L1 SIDE BEAR
ADDITION
C .. Enc.,.
0 R
C MIUANCEOR
'&CE
,UIE
CHANGE OF USE
I
By DATE
REMODEL
0 MULTIFAMILY
SIGN
PARKING -t
PARKIN"
REDD PROVIDE.
REOD PFC
LOT'AR
PLANNING REVIEWED
REPAIR E] Cy..
PENCE
FT)
REMARKS
REMARKS
0 DEMOLISH TANK
Ei OTHER
GARA"E F, uA.jN iNYG WA a
CARPORT FOC
'M
WMI
[TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN'
Jill 1'�l 1K/
L)LTi— hA-y,,,
CHECKED By
ITYNIF
M�
NUMBER
UMBER
NWELLING,
AITICAL
CAREAS
SPECIALINSPET
EC`AL 'N.PI
OF 3
STORIES
U
1
UMBER
JAREA:
REQUIRED [:] YES
UI C:
DESCRIBE WORK TO BE DONE
REMARKS
M
PROGRESS INSPS CTIONS PIER UBC 108/FINAL INSPECTION RECID
Ai-
$
Description
FEL
Description
FEE
k
Plan C1.K
P a Ch
I
stato Surcharge
HEAT SOURCE GLAZING % LOT SLOPE
In
Building Permit
U d n -
B I
b'
7) City Surcharge 5
PLAN CHECK NO: VESTED DATE
Plumbing
Ptum - g
_h-m I
Mechanical
Rrc
-1. PERMIT —a— ON- THE W.RWkoTED. wis PERMIT COVERS, WORK TO
I. UOTIONONTHEPUBLIC
BE DOME ON PRIVATE PRO,eR7y OHM AN,I, CONSTFUCT
Grading
a DOMAIN (CURELB, SIDEWALKS, DRIVEWAYS IMARQUEES, ETC.) MI.J. REQUIRE
t: SEPARATEPERNIiSSION.
Engr. Rwi-
0 DAYS
PERMaMPUCATION: I S
.E.
PERMIT LIMIT I YEAR - PROVIDED WORK IS STA 2 WITHIN 1. DAYS
n Ion
Engr. Inspection
gr I S:
SEE BACK OF NW PERMIT MR MORE INFORMATION
Fire Revim
Plan Chlk. Deposit
IRS N. C SOPS
ON BEHALF OF HIES OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
E T. Ty
IN INME EST, AGREES TO IND MMIFY, DEFEND AND NO- HARML 11 THE CITY 01
EDMONRS. WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS MOM ANY AND
Fire Inspection
Receipt #
ALLCMUS FOR DAMAGES OF WTtATEVER NATURE, ARSING DIRECTLY OR INDIRECTLY
PERMIT SHALL NOT BE
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS
DEEMED To MODIFY. WAIVE OR REDUCE ANY REQUIREMENT Of MY CITY ORDINANCE
Land.cap. In.p.
Total Am 1. Due
NOR LIMIT IN ANY WAY WE CnYS ABILITY TO ENFORCE ANY ORDINANCE PRO.—U..
Recording Fee
IFOR
Receipt #
I HEREBY ACKNOINLEDGE THAT HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPKUVAL
GIVEN IS CORRECT�AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
I
E OWNE . AGREE TO M WTTLL CITY AND STATE LAWS REGULATING CONSTRUC
PLY
EMPLOYED
CALL
.. N ., apu y: and Fads a's Paid,
B.11 'y
'ON; AND I DOING HE W RK ALmHORIZED THEREBY, NO PERSON WILL. BE
STATE OF WASHINGTON RELATING TO
INSPECTION -0.,..W.LdeB.
I VIO T N OF T E LA ODE OF THE
Wo E s')cbf, CE AND RCW 18,27.
W
OFFICIALS SIGNATURE DATE
IS
DATE GMEO
(425)
'7- --0 2-
IV
771-0220 -N, AS DATE
�)
AMNTION JOR JR
W 1333
1 - , &
L
STR
IT IS UNLAWFUL TO US UCTURE UNTIL
OCCUPY A BUILDING
ZZL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORII NAL. FILE - YELLOW INS4CTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 1 09
PINK OWNER - GOLD - ABSES'OR
04102 PRESS HARD -YOU ARE MAKING
5 COPIES GREEN ACCOUNTING
z
C
ma
0
80
C:
IT1
171
z
-4
0 -n
IT
MM
0 VS
0
C) Fn
C
Z
z
(b
z
9
0
M