20051129.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
PERMIT EXPIRES
PERMIT
NUMBER
'02
ADDRESS 6,T
PI -AT NAMEISUSMVISION No
LOT NO
LIDN'
LID FEE S
PU PER OFFICIAL STREET MAP
BLIC -To��PROPOSED�!�
EXISTjq:�.�
REOUIRED DEDICATION � FT _fn�
'=tUIRED
OF FIXIURES
YES 0 No 13
REMARKS E
OWINER,CO TRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAG
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FIRE REVIEWED By DATE
TILEPHO
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ITATELICINSINIMBER,,;, EXPIRATION DATE
CHECKED Y
VAMANCE OR CU
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YES
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STUDY
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SIGN AREA
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C] NEW 0 RESIDENTIAL rj PLUMBING I MECH
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LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SET ACK ET) PROPOS
FRONT SIDE REAR FRONT
0 SETBACKS (FT.)
URSIDE REAR
.ERCIAL E3 C ILI�N. on
ADDITION MIXED USE CHANGE OF USE
REMODEL MULTIFAMILY SIGN
REDID PROVID D
PARKING LOTARE 1�;N!j;;7�
F110E X
0 REPAIR X FT.)
OYES
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REMARKS
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EiGARAGE C] RETAINING WALL 0 '111 SPRINKLER
CARPORT ROOKERY RE ALARM
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til NUMBER
OF
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SPECIALIN PE TION
REQUIRED YES
OCACDUPANT
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_6ESCRIBFWORK TO BE DON.
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REMARKS
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Description FEE Description FEE
D Ipt on
IVI 1_77�,I-nql &y4yAiV (Agg?#s
a.
State Surcharge
HEAT SOURCE LOTSLOPE%
u'ld'ng Permit
Building Permit
City Surcharge
N.-
PLAN CHECK NO: //g:z
Plumbing
'Umb'ng
Base Fee
THE WORK THIS PERMIT COVERS WORK To
THIS PERMIT AUTHORIZES ONLY THE WORK NoyE6. THIS PERMIT COVERS WORK TO
Mechanical
M.ch.D,.a
",-FUZE.
VAE PROPERTY -Ly ANY C.-ST .. ".. ON THE PUBH`
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
Grading
Grading
'..WAL..' DRIVEWAYS . A..UEE. . are I WILL BE.UHtE
DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC�) WILL REQUIRE
a
S -N
SEPARATE FERMI ; -
, R
ng, Vew
Engr. Review
E MIT APPLICATION SEEECDc'9 . .IlA""
PERMITAPPLICATION: SEE ECDC 19A0.0051A)(5)
.
.IT LIMIT .. �CBC 1 ..5, 6,
PERMIT LIMIT,. SEE ECDC 19.00.005IA)(6)
1E A
Engr. inspection
Dg, mEpecton
zo
/P_ 10.
SEE a ILCK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIONS AND SUCCESSORS
Fire Review
Plan Chk. 0.P
IN INTER111 AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY or
AGENTS FROM ANY AND
Tre In;,.cI,.n
Receipt # -7
EDMONDS , WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND
ALLCLAIMIF R DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY 09 INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT $HALL NOT BE
ONot NAN
Landscapeinsp.
Due
OR REDUCE ANY REQUIREMEN
DEEMED TO MODIFY, WA T OF ANY CITY
HIVIECITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISIOC
NOR LIMIT IN ANY WAY 7 N..
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APTCATI ON; T AT T E INFORMATION
APPLICATION A PPROVAL
AN
0
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE ULY UTHORIZED AGENT OF
T A,PH,AI,,, A,k 111 �1 d L, III.
THE OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON OLL BE EMPLOYED
RELAT NG TO
CALL
FOR rINSPECTION
,jd, off,1 M,.,, Iv,,I F .1. P.1d, .,,d
A,0--96d P.� P-1d.d
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
AND Hew 18:2?.
E
WORKMEN'S COMPENSATION INSURANCE
(425)
OFF SIG
o-4p,
LSIGNATUREJOWN OR
1.0
771-0220
- EL A 8 PATE
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---- 7-7--
ATTENTION'
EXT. 1333
ITISUNLAWFULTOUSEOROCCUPYA BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
OR] INAL -FILE -
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 I IRCIIO�
PINK . OWNER - GOLD - ASSESSOR
101" PRESS HARD - YOU ARE MAKING 4 COPIES
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FIN, PROJECT APPROVAL I jRM
TO:
DATE:
MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE_,�
-PLANNING DIVISION DATE
C,
PROJECT
SITE ADDRESS.'5�
PERMIT # _L-_06-"3 21 ADB#____ DATE FNSPECTED__-�� 4Z1_4(-
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine 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
0 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
I:tcrnp:b1dg:rbrnis:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
z
Pier/Porch .................
Retaining Wall ...........
Stab Insulation ..........
PLUMBING: x
m
C
Underground ............. T,
0
Rough -in .............
3: IT!
Commercial Final ITI
10
HEATING: C
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Gas Test ....................
'Gas Piping .......... 0 _n
Equipment .................
3:
M rn
Commercial Final
0
EXTERIOR SHEATHING 0
C
NAILING .......................... K Cl)
M 0
FRAMING........................ Z r-
FIRST FLOOR FRAMING x
INSULATION ................... x
z
Floor Insulation
Wall Insulation ........... ra
z
Ceiling Insulation
SHEETROCK NAILING
IT!
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
X1wJ
OCCUPANCY ..................
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