20030702.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMUNAME OF BUSINESS
L e '. C. kk eAt 0A Cr,�4 TA
MAILING ADDRESS
CITY - ZIP' TELEPHONE
f—J "A CAS70"tO 120C.'53-5 T'?P-D
grow
ADDRESS
1 3
44 G
CITY
zip ITELE
PHONE
?C62A t -74 7- 0
NAME
UIV
CBL#
ADDRESS
"k3en, r?�.,A
CIJY_
ZIP
TELEPHONE
4 S 0 f, Jk 0 oe)_ �
1-20L, 57-3
STATE LICENSE NUMBER
EXPIRATION qATE
I SME5R"Y
PROPERTY TAX ACCO PARCEL NO.
I
NEW
10—RESIDENTIAL
ADDITION
COMMERCIAL
ri
COMPLIANCE OR
01-11SE
rl REMODEL
MULTIFAMILY
SIGN
REPAIR
G
CYDS
FENCE
( X Fri
DEMOLISH
1:1 TANK
OTHER
AM�
I RETAINING WALL
3 ROCKERY
FIRE SPRINKLER
FIRE ALARM
UVE OF USE, BUSINESS OR ACTNgY)jgPLA14:
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES Z I UNITS I I NUMBER
DESCRIBE WORK TO BE DONE A 4/5-0,
V1
6r
% I - LOT OLOPE %
PLAN CHECK NO: VESTED DAT
L)o 3
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPUCATION: ISO DAYS
PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN ISO DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY. DEFEND 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
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CiTYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
I HERE13Y 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
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMENS CqMTSATION INSURANCE AND RCW 18.27.
SIGNATURE aWNEii OR AGENTI I DATE §IGNI�D
PERMITEXPIRES
USE PERMIT
ZONE
NUMBER
JOB SUITF/APT#
ADDRESS�jk
PLAT NAME/SUBDIVISION NO. LOT NO LID NO.
LID FEE $
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permil Required
Street Use Permit fWq'd
EXISTING — PROPOSED Inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT underground
Wiring required
METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRED
I YES0 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
. %—.-- . — 41__% — . ^. N OC'% —, , rn
11 - 16(Lfaz 21W10
FIRE REVIEWED BY I DATE
93
z
15
1
In
01
Iz
VARIANCE OR CU
SHORELINEORADBI
INSPECTION
BOND
REQ'O .
POSTED
[3YEs AND
S ---
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED
PROPOSED�
-2
,
I
EXIP
A_f__
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE
REAR
7—
z
PARKING
LOT AREA
PLANNING REVIEWED BY 6ATE
REQ`D I PROVIDED
.1000
REMARKS
CHECKED BY ITYPE OF g10NSTRUCTION CODE OCCUPANT
V_ IV GROUP
SPECIAL INSPECTION IVEA ptd I^Ijf OCCUPANT
or LOAD
REQUIRED [:] YES &1— 11 _
REMARKS
1PROGRESSINS OTI 0 I'm PER UBC 108/FINAL INSPECTION REO'D
I -5y�w.,&ftlAvAn. AlMe // AF A&711S
Description
FEE
Description
FEE
Plan Check
12
State Surcharge
ty,
Building Permit
lb/'
City Surcharge
Plumbing
Mechanical
Grading
2f
Engr. Review
Engr. Inspection
I�Y)
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
1A10
%425)
771-0220
EXT 1333
APPLICATION APPROVAL
This application Is not a permit until signed by the
Building Official or histher Deputy: and reas are paid, and
receipt Is acknowledged In space provided.
OFFICIALS SIGNATURE
DAtE
ar/'te.
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I I V_ 1 r.1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 11�_ A ORIGINAL - FILE YE�111W - 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
z
0
0
M
M
0
-40
0 C
10
o -n
M
0 Rn
C 0)
CO)
0
z
z
0
IT!
I
tog
LLJ
<
co) W
L)
0
too
I
Maggot
0
estate!
LfI 4goo 4
11foodom
i
PaID
Joe.
flogge"
61
1
"go'
RIEC \yREID
q
.�r%r-cQq�lGtA— fto� �
;;I kc
ffil E SS SIGN REL
PHE ft too go I Allen,
of
3404
B Cs III I Z57
ONSTRUCTION *3fa*Zo"7r
REQUIRED
F014r 'A'
110omAtific goo
to
Ta *3 4% of? 1110.Ilmm� A Ct%IcNk
zAv YA 411501 1 offervP
ext 4a m4% VbrM VVVaa:)pkCCF%
q%0;1v Mop
0 o7outwo. a 1 4 1 a 1 6 1 a 1 0 1 a I I I I 1 4 5 9 v 0 9 0 6 a 0 1 1 0 a 6 0 4 9 0 1 6 a 0 0 0 0 * 1 0 a 0 9 a 0 a 0 0 0 0 0 1 1 4 a 0 9 0 0 a a I a 0 6 4 9 0 8 6 0: 1
g gage, 4 0 1 0 0
a
to
to 0 4 1
a 0 a 0 0 0 0 0 0 6 4 0 a a 4 0 6 6 0 0 1 6 0 0 9 6 0 a 0 0 1 a 9 0 1 1 1 0 a 0 1 4 a 6 a 6 a 0 0 a a a 9 a 0 oleo a 46891186669 off D AS NOTED
1 0 0101 all 60*408 6 0 a 0 1 a 4 0 a 0 0 a a 6 4 0 a 6 a a 6 0 0 0 y
see 60*06 0 499% 04:09491. N INEERING
00000 660060,
0 0 a a 9 0 a 0 a to :0 0 0 0 9 -0 6 4 6 0 0 a 6 a a 4 0 all 0 0 0 X:
6049
0 6 1 1 1 6 0 0 6 6 0 0 a
0 60
1:4:6
of
00* 4
6 0 a 0 a 0 1 0 0 4 a 8 5 0 a 0 a 1 6 0 0 6 6 6 0 0 0 0
a 0 0 6 0 0 0 0 8 a a 0 0 0 6 1 a 0 1 0 6 0 0 0 0 1 0 0 a 6 0 1 1 6 a a 0 4 a 0 6 0 a a 9 a a 0 0 6 a 9 0 1 1 a 0 9 6 0 sell a I 1 9 0 1
0:6 0 0 1 9 1 1 0 4 9 0 a 8 0 0 0 0
It 1 0 a 0 0 0 0 8 a a a 6 a I sm 1 0 0 a 0 a 1 6 a 6 6 0 0 a 6 1 1 offogoose
6:0 4:4 4:f 0:0
feel I /1 0 4
OF 4 0 0 a 0 1 a 0 0 0 0 a 0 a a 0 0 1 0 a 0 0 0 1 4 a I a a 0 a a 0 0 a 0 1 0
600600*06 9 10/00
4 a 6 a 0 6 9 0 a 6 0 fee 0000 0 a a a /V 0 a a 6 1
0
a a 4 0 a 1 0 8 9 6 a 0 0 1 0 6604 1 a I a 0 0 0 a 0 0 0 MIX 0 0 GO 0 0 0 0 0 6 1
0 4 a 0 a 0 0 1 0 0 0 0 9 & 1 9 IN go 11 9 sea of* 0 1 0 0 1 0 0 0 0 0 1 1 a 0 1 1 4 0 $ 0 0 9 0 0 1 1
IF 0 0 0 9 0 0 0 4 9 4 0 a 6 a 4 a 0 0 0� 0 6 a I 1 0 111
0 0 1 0 1 1 1 1 0 1 9 1 . a all 00 so ate 0 4
a 6 1 go
x0 6 0 6 1 1 0 0 6 0 0 8 1 0 0 a a 0 0 0 1 1 0 . I . . . . I I I I I I I I I I I
a 6 1 1 1 1 1 1 0 1 4 to . 0 1 4 1 1 0 1 0 a 1 6 0 . I . . 0 1 6 0 1 0 . � 0
. . I I I I I . I . I I I I I I . .
CD NI . 0 1 0 . I I a . 6 . . I I 1 0 1
1 1 0 a 0 0 1 1 1 0 1 6 1 a 6 1 6 4 1 1 a 0 1 1 0 0 1 1 1 1 6 1 9 1 6 4 1 1
So go 0
off
1 9 to,
10 ol: , co
of 0 4 1 0 a I I . 4 1 1 a I I 1 6 6 0 0 1 1 0 0 a 4 1 4 0 1 0 0 1 2 0 a 4 1 6 0 4 0
41,1111.61tl. as
go
? .64010,
lt-g,,ob -I I I
7;;W MA v gwww 0
I 1 6 1 1 1 ego 8 6 0 0 4 6 6 1 0 0 9 0 0 a 0 0 4 1 0 0 1 0 ps I . I . I 1 6 1 4 0 1 1 1 1 1 . . . I I 1 4 1
41 6 6 1 0 1 1 1 1 1 0 malo-9 0 1 1 1 0 1 1 1 1 0 1 4 1 1 a I 1 6 1 0 1 0 1 6 0
411668 I'll 'Ile, to, I I I 1 0 6 .0 1 0 0 1 1 9 1 1 0 4 1 6 1 1 1 a a I 1 6 6 0 0 4 6 4 0 1 0 1 4 1 1 6 1 1 6 1
0. 6.4,0 6 0 1
-1/6444 6 a to q,%
Is 4 0 6 1 a 0 a 0 0 0 a 0 0 1 4 4 1 0 0 1 a 0 6 0 4 1 0 6 0 0 a I a I a 4 1 9 0 a 1 6 4 0 0 9 0 0 a I 1 0 6 0 a 0 1 4 6 6 6 1 0 0 0 1 6 1 9 0 0 a a 0 0 6 0 1 6 0 a 9 6 a 1 6 0 8 0 9 6 0 0 6 0 a 0 1 a
0:1 0 0 9 0 0 0 6 a 0 1 0 4 1 a 0 1 1 0 9 0 0 0 a p I
04 6 4 0 6 0 6 a 0 0 a a a 4 0 a 4 0 a 0 6 t a 0 0 6 a 6 a I I I 1 0 0 6 # 1 0 1 0 0 a 0 1 of
to I to $18 0 1 0 0 0 a 0 9 0 0 4 1 4 a a 1 0 111 0 0 0 0 a 1 9 0 0 0 0 4 6 $ 0 0 6 0 6 1 0 a 9 0 a a 4 a 0 0 a 0 0 0 1 0 0 0 a 6 4 0 0 1 0 0 0 a 0 1 0 6 0 4 a 0 4 6 a 4 0 1 0 0 a 1 0 9
foleffieffes 0 1 1 1 0 0 0 0 0 1 0 a 6 1 4 9 a a 6 a a a 0 0 6 a a 0 0 6 1 6 0 8 0 a a 6 1 a a 0 6 0 0 0 0 0 0 6 0 0 6 1 a 1 0 0 0 9 0 4 0 1 0 0 9 a 0 0 4 0 0 a 0 0 a 0 6 0 a 4 0 0 a I a 4
Lu 0 1 6 9 0 a 0 0 9 4 It 6 a 0 1 0 4 0 0 1 1 1 4 a 1 9 0 0 0 6 0 0 0 6, 1 0 0 0 6 a 8 9 0 0 0 a 0 9 0 0 a 0 0 0 8 0 1 a 0 1 9 0 0 0 0 0 0 a t 0 6 0 0 0 & a 6 1 1 0 a 0 1 4 6 4 0.0 6 1 1 0 1 0 0 0:0 P 1 a 0 1 1 a 1 9 0 a 0 4 1
1 0
00 1
0 6 a a 0 a 0 6 1 1 6 0 6 1 1 0 6 0 0 0 6 0 a a 1 6 a 0 4 0 6 0 a 0 0 a I a 6 4 0 4 1 6 0 1 1 1 1 0 0 a 1 0 0 a 0 9 6 6 0 1 a 0 0 6 0 0 0 0 4 0 9 0 0 0 0 0 0 6 a 0 1 0 a a 1 6 0 0 0 o 0 1 No 0 1 0 0 4.6 all 0 0 a a a 1 0 1 1 0 0 1 1 1 9 1 5 1 6 6 1
foolegooloo
16
0 6 9 6 0 0 1 0 0 4 1 0 0 6 4 1 1 0 6 1 1 a 0 0 a a a I a 4 0 1 a I 01 0 4 0 0 # 0 a 0 0 a a 0 0 6 a 0 8 a 8 4 1 0 0 6 9 1 0 0 0 0 a 0 0 0 a & 0 a 6 # a 4 a 0 0 0 1 0 0 0 eke a I a a 0 6 1 a 6 4 1 0 0 4 9 1
0 0 4 a 1 6 0 1 0 a 0 a 6 a 6 0 0 1 6 0 a 0 0 1 a 6 6 0 6 0 1 0 a I 1 0 0 1
:@I#I ts�ool X go f a 0 a 0 0 0 0 0 111 0 4 a 0 0 0 0 0 1 6 0 0 0 6 6 a 6 1 0 0 1 0 0 0 1 4 0 1 0 1 1 0 a 0
6 0 1 0 0 0 0 4 a a 41 a v 0 1 t 0 4 4 0 0 a 0 6 0 0 1 1 1 a
CL a a a 0 0 a 0 0 6 a a I I I
I 1 0 6 1 a 0 0 a 0 a 1 0 1 a 0 a 0 a 6 If 0 a 1 0 6 1 0 0 0 0 11 0 0 1 6 a 0 1 4 1 a a 0 4 a a 4 6 a 0 0 6 0 0 a 9 1 0 6 a 0 6 0 a 0 1 0 0 0 6 a a 1 6 a I 1 0 4 . I a
iT V
I a 1"a
OIRC 1 6 4 0 0 0 2 0 6 6 0 0 6 a 9 1 0 a 1 6 0 1 a a 4 0 8 0 6 0 0 a 0 a 1 6 0 0 4 0 4 a a 0 a 0 0 6 0 0
lob
6 a *1 0 0 6 0 6 0 0 6 a 0 0 9 a 9 a 6 IN a a 6 4 a a 1 0 5 11 0 4
wgmw� goommoloq, ,Ogg - - - - - . . . . . . .
0 6 9 t If 0 9 0 8 a 6 0 a a 0 0 pot 0 a a a 6 11
00 6 1 0 1 6 0 a 0 1 1 a 6 0 0 0 1 1 1 1 0 a 0 a 4 0 a 1 0 1
AL
No #b2,2 IOWL
*IPA III I
1PRIVIMAY
v
fettle
a
ti
ip I,
21 4
I og I--
p
If
ol�
th
felt effete
0)
M.
M
4
it
d
ID
Z
toffee
0
feen
m41
L
tL!L
p
d
r
I
0
go
FINAL PROJECT APPROVAL FORM
TO:t7�
DATE: I
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
z
9
0
m
=i 9
V5 ---r'
om
c
ma
0
80
c
M
M z
ID --I
c
E:
4 CO3
0 -n
n
m M
005
0
o Fn
a (j)
c ch
M 0
Z
z
z
9
0
m
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
D , ate- Sign,
6capr�l.doc.l:temp:bldg:fonnsIO/OI
0
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOU N*DATION:
Footing
......... .............
C-3
Wall...........................
Pier/Porch .................
Retaining Wall ...........
I ns uiation ..........
PLUMBING:
Undergroun d ..........
RoUgh-In ..... ..............
Commercial Final ......
HEATING:
:,Gas,TeStr ....................
Gas Piping ...............
Equipment ...... ..........
Commerc lal Final
EXTERIOR SHEATHING
1 A
NAILING . ............ ...........
FRAMING .... ..... ..... ......
YN
q yu
F RST FLOOR FRAMINU
11DATE RECEIVED PERMIT EXPIRES
N-4
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME"E OF BUSINESS
LeS tWW-m (_oA4
15
MAILING ADDRESS
CITY ZIP TELEPHONE
-k 0 720G
NAME
E
ADDRESS
3
CITY ZIP ITELEPHONE
1 -7 -74
po A, 6 206 - 'A t
CBLZ1NAME
ADDRESS
01K
ZIP TELEPHONE
60" 0 ro
1120& 1533
-STATE LICENSE NUMBER EXPIRATION qATE I
\5t NEW
RESIDENTIAL
rl ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
CYDS
DEMOLISH
TANK
o'GARAGE
CARPORT
o RETAININGWALL
ROCKERY
(TYPE OF USE, BUSINESS OR ACTW PML
r I<-,
NUMBER
NUMBER OF
OF
STORIES
DWELLING
UNITS
DESCRIBE WORK TO BE DONE A j z
USE PERMIT
ZONE o% NUMBER C2(Y)3
JOB SUITE1APT#
ADDRES:jj,:jjL 1A r) -f'h
no I PL 5 t,�
PLAT NAMEISUBDIVISION NO7. LOT NQ�l LID NO.
LID FEE $
TESCP
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Per=
Street Use Parrvilt Rsq'd
EXISTING — PROPOSED trispecdon RaqWW
Sidewa* RequirM
REQUIRED DEDICATION— Fr Und&rWMW
WWg required
METER SIZE LINE SI�E TNO, OF FIXTURES PRV REQUIRED
YES 13 NO 1:1
L
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
1ACPavri nPL)r Qgn�. fN '. M Prar-lao t4)_-Tzj4n IkV
IY�tyq o 0 dD 0Amy-4Q LOW. (100 h
S Q�Awtv% A
ENGINEERING REVIEWED BY PATE
I - 61 Lh= 1,0 10
FIRE REVIEWED BY rDATE
VARIANCE OR CU SHORELINE ORADIM I INSPECTION I BOND
REq.D P STED
13YES 41LNO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE E:X E 7MP ALLOWED PROPOSED ALLOWFY , PROPOSEDj
EXP
1
Ic
LOT COVERAGE
OT
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr)
PL6MBfNG/ MECH
LL WE'
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE
REAR
COMPLIANCE OR
[3
'0-'r 4Y.
�t-i-gh-57
CHANGE OF USE
.,05
PARKING
LOT AREA
PLANNING REVIEWED BY 15ATE
rl SIGN
R?ECrD
2-
rREMARKS'
I PROVIDED
E
oF NCE
( X
FT)
OTHER
FIRE SPRINKLER
FIREALARM
CRITICAL
AREAS
NUMBER
(C-10by I Z-,9 L-0 5 r-
j mi, 0 A6 ol '01V A �1 I "("N z'1"**
HEAT !DURCE GLAZINR % LOT SIL 1 4P
PLAN CHECK NO: VESTED DALio
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRWATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURISS, SIDEWALKS, DRIVEWAYS. MARQUEES, FTC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT UMM. I YEAR - PROVIDED WORK 16 STARTED WITHIN ISO DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED To MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
I HEREBY 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
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEWS C%WkNSATION INSURANCE AND RCW 18.27.
SIGNATURE "Ed OR AGENT) --FOATE SIGNED
OF CONSTRUg.TION
V— /V
CODE
OCCUPANT
GROUP P
SPECIAL INSPECTION
JAREA
OCCUPANT
REQUIRED [:] YES_
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD
CHECKED BY TYPE
VALUATION
I * 12' 9
Ul - 101 -11111111
-srMia
%Aj
Description
FEE
Description
Plan Check
77.
State Surcharge
MFEE
Building Permit
arge
City Surcharge
Plumbing
70
A9 ca
a540'
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapainsp.
Total Amt. Due
Recording Fee
CALL
FOR INSPECTION
(425)
% __
6'4EL
APPLICATION APPROVAL
This application Is not a permit until signed by the
Building Official or his/her Deputy: and Foes are paid, and
receipt Is acknovelodged in space provided.
OFFICIALS SIGNATURE OPTE)
-
81%
WY
ATTENTION EXT 1 3
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 YELL6. 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
11M
z
9
0
M
M
C
IT!
0 C
M
o -n
-n
M
ca
0
0
C
0
z
z
0
4
0
M