940374.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
` OWNER NAME NAME OF BUSINESS
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ADDRESS
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NAME _
ADDRESS
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STATE LICENSE NUMBER
al Description o
Property
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ZIP TELEPHONE NUMBER
9FLA0 1 77/-al0a
PERMIT �^ 0.•ry-�^
ZONE � �, — NUMBER .;X-� �/�^"
JOB SUITE APT it
ADDRESS / v y.•l�� ""T �L y_)1ii�/L U��it� �/%�
LEGAL DESCRIPTION LEGAL DESCRIPTION CHECKI SUBDIVISION NO LID NOSUBDIVISION NO LID NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved ❑
RW Permit Required ❑
EXISTING _ _...__-- _ REQUIRED OEDICa110N Street Use Permit Reqd ❑
Inspection Required ❑
PROPOSED -------------__----- Sidewalk Required ❑
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METER SIZE LINE SIZE NO OF FIXTURE: ; PRV REQUIRED
TELEPHO!/
6-r v <s r
5+ IS
ZIP TELEPHONE NUMBER
v\fA 5q0-S`l9a
EXPIRATION DATE
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erty - include all easements r k
ENGINEERING MEMO DATED
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YES ❑ NO ❑
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REVIEWED BY
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SIGN AREA SEPA REVIEW ADR r�
ALLOWED PROPOSED COMPLETE EXEMPT EE SHO .L N .
EXP ,(jIA�
VARIANCE O P ING W BY D T
SETBA
FRONTCKS/ FEESIDE t J REAR Li� �/ / LOB �/
Tax Account /� _ �D '��D HCMAni�J
Parcel No.
41
NEW ® RESIDENTIAL ® PLUMBING
ADDITION COMMERCIAL El MECHANICAL
ElREMODEL 'APT BLDG. El SIGN
GRADING FENCE CHECKED BY TYPE O
CYOS F I x FT) `i "VA
OCCUPANT
GROUR
REPAIR
DEMOLISH ElWOODSTOVE SWIM POOL SPECIAL INSPECTOR AREA IF OC UPANT
INSERT El HOTTUBiSPA REQUIRED O YES I LM
/�LOAD
NOGARAGE ❑ RETAINING WALL/ ❑
CARPORT ROCKERY RENEWAL REMARKS
(TYP�jOF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER ., NUMBER OF CRITICAL
I OF d I DWELLING -� I AREAS
I STORIES UNITS �f� NUMBER jr 7,3
1
' DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
07"� 51/5/ �S% fv 7' 1//2k1
hb-7L, //owed- 6 2
PROGRESS INSPECTIONS PER UBC 305
7�/P�irIRL Pp.2i G � UJ14I9
PLAN CHECK FEE
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BUILDING
HEAT SOURCE GLAZING
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5 �?2 PLUMBING
Plan Check No. L —�) MECHANICAL
This Permit covers work to be done on private property ONLY.rGRADING/FILLAny construction on the public domain (curt:s, sidewalks,
driveways, marquees, etc.) will require separate permission. RGE
Permit Application: 180 Days
Permit Limit: 1 Year - ProvidedWork is Started Within 180 DaysGE FEE
"Apolicant, on behalf of his Or her spouse, heirs, assigns and ENG INSPECTION FEE
In successors in interest, agrees to Indemnify, defend and hold
W harmless the City of Edmonds, Washington. Its officials,
employees, and agents from any and all claims for damages of
u whatever nature, arising directly or indirectly from the issuance
T of this permit. Issuance of this permit shall not be deemed to PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
o nor limit In any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE
provision "
hereb acknowledge that I have read this application; that the
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y ATTENTION APPLICATION APPROVAL
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 THIS PEOVI.
state laws regulating construction; and in doing the work authoriz- AUTHOPl,ES This application not i permit until
ed thereby, no person will be employed in violation of the Labor ONLY T"E signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa• :OPK NOTE_ Deputy: and fees are paid, and receipt is
tion Insurance and RCW 18.2 5PECTIc0, acknowledged in space provided
SIGN a• c —/ DATE SIGNED pEPaRT:rE•.'
(� /�� OFF 5'G•. `vAE
CITY -
EDh10NDS
CALL FOR
ATTENTION INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE ��� ®��®
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIG" 4%._ — vELlO:'! — Ins:ector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3. PI.&:K — 0:.�e' GGLD — ASSeSSC'
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FROM:
OWNER
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Permit Coordinator, Building Division
FIRE DEPARTMENT
ENGINEERING DIVISION
PLANNING DIVISION
ADDRESS 10:0 0i',W0
OWN
PERMIT# `14''s? 4ve ADB# INSPECTED ON * ti�qAs
A field inspection was conducted to determine compliance with approved plans.
Final approval denotes there are no objections to the granting of:
'Occupancy for the building Performance Bonds may be released
Maintenance Bonds may be released Landscaping is approved
Other inspected
PASSED FIRST INSPECTION - CONDITIONS NOTED
1•
2.
FAILED INSPECTION - OUTSTANDING REQUIREMENTS a RECALL FOR INSPECTION
1.
2.
3.
4.
OCCUPANCY APPROVAL
FAILED FIRST INSPECTION
RE -INSPECTED - APPROVED
RE -INSPECTED - FAILED
RE -INSPECTED APPROVED
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OCCAPRVL/TXTRECEP/October 132 1993
DATE BYLC�
DATE 'BY
DATE BY
DATE BY
DATE
FEES RECEIPT#
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E.
70
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1.
•,...,.� yea ,
1
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
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SETBACKS.,,,,
J • �3 '
FOUNDATION:
Footing .........
G •fie `�¢
Wall ....................... �--^•"`� �—S� � ' Z ° ` Q �.
Pier/Porch ............... .
Retaining Wall............
t
Slab Insulation ............
PLUMBING:
u `u/ Underground. , _
Rough -In .................
Commercial Final, .......
HEATING: q
Gas Test .............. _' '� O • C.
Gas Pi m
Equipment.,,,,,,,,,,,.,.,
Commercial Final....r....
EXTERIOR SHEATHING
d'Z�•��tr-!� NAILING.
sG,
FRAMING ............... .. .,,...��� �� �..'r . �'�-`•'Su"� • To. ��..�o.-�•',
INSULATION:
Floor Insulation ..........
Wall Insulation ..........r-—� _ �¢i
Ceiling Insulation. r .......
SHEETROCK NAILING r .....
SPECIAL INSPECTION ......
RADON MONITOR AT SITE .
FINAL APPROVAL �---- •- �S_ __
FOR OCCUPANCY..........
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