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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME NAME OF BUSINESS
TORN t C'HC15TINA fAC161Ej2
MAILING ADOq ESS
174ZZ L'LYMr)tc VIE",t 1%<
CITY ZIP TELEPHONE NUMBER
EnMO'=PS�f�.SOG% 42i 7Y2 OSD'o
ADDRESS
PAC Y FIC. GAr-Acr ES I N L-
ADDRESS
ON,
CITY 21P TELEPHONE NUMBER
ENERDI- %VA g9Zo, 41i 25�1/3i/
STATE LICENSE NUMBER EXPIRryTION
PAC -TF 6a on ly aN 0&t. 3�3 D / 911
I anal flucrrintinn of Prnnnrlu - innlllAn nil nncemPnic
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ramel No.
NEW RESIDENTIAL PLUTABINGMECH
El COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
REMODEL APT. BLDG, El SIGN
PEPAIP ❑GRADING CYDS ❑ I PENCE x_F
DEMOLISH ❑ INSERT TOVE ❑ SWIM POOL
US SPA
GARAGEPORT ❑ RETAINING WALL/ ❑
CARROCKERY RENEWAL
NUMBER 1 NUMBER OF CRITICAL
OF / DWELLING AREAS
STORIES 1 UNITS / NUMBER
DESCRIBE WORK TO BE DONE ('TTACH PLOT PLAN)
N
N
ior+EPERMIT
L,C� /�L NUMBER 9300
ADDRESS I �1 11, / _ 014 avp I G I
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP APPrPYed ❑
RW Per... Repu" ❑
EMISTING REQUIRED DEDICATION--_. slrael Ufe P.—, Reed ❑
PROPOSED _ 1^EPe<IIDn Reauxe0 ❑
Sldewelk Repuued ❑
METER 512E I LINE SIZE I NO OF FIXTURES I PRV REOUIRED
YES ❑ NO ❑
1 EN/INE�87 MEMO DATED VI ED BY
AR OR U�
ADS a
SHORELINE Y
SERA REVIEW
COMPLETE EXEMPT
SIGN
ALLOWED
AREA
PROPOSED
HEIGHT
ALLOW/QED
PR/OPOSED
EXP x
I
--
Z.5
ILLS. 5
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE HEAR
PROPOSED SETBACKS (FT.)
FRONT VR I REAR
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CHECKED BY TYPE OF CONSTRUCTION
CODE
OCC T
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OR
SPECIAL INSPECTOR I
REQUIRED
n YES
AREA
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/
OCCUPANT
LOAD
MARKS
PROGRESS INSPECTIONS PER UBC 108
Sfiu/&,w/b H#2-/ 2e,
FINAL INSPECTION REQUIRED
PLAN CHECK FEE
HEATSOURCE �/�
GLAZING�
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PLUMBING
Plan Check No. Gi} - ?� 9--�
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINQFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Penult Limit: 1 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant, On behalf Of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
u, successors in interest, agrees to indemnify. defend and hold
—
w harmless the City of Edmonds, Washington, its officials,
aemployees. and agents from any and all claims for damages of
¢ whatever nature, arising directly Or Indirectly from the issuan CB
CHECK DEPOSIT
T Of This permit. Issuance of this permit shall not be deemed to
omodify, waive or reduce any requirement of any city ordinance
PLAN
x nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
;.
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
ATTENTION
APPLICATION APPROVAL
awhOfQed agent of the owner. I agree to comply with city and
THIS PERMIT
state laws regulating construction; and in doing the Work authoriz.
AUTHORIZES
This application is not a permit until
ed thereby, no person will be employed in violation of the Labor
ONLY THE
signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa•
WORK NOTED
Deputy; and fees are paid, and receipt is
tion Insurance al,o RCW 18,27.
INSPECTION
acknowledged in space provided.
51GNA ENT)
DAiEZ SIGNED
DEPARTMENT
-
s
•.•,NATURE I
CITY OF
�D°FtIrlAl f
EDMONDS 11"
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Cl
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ATTENTION
CALL FOR DATE
IINSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
n
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
��� _oLL® ORIGINAL — F11e YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTION 109
PINK — Oaner GOLD — Assessor
107 B)
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NAME JOH>I ' GN2l5 i�NA 1�i42K.112 616 Laurel Drive PACIFG1088JN
JOB SITEIADDRESS ) 74 ZZ (> Ly m � �r L•� l�l; Everett, WA 98201 (206) 259.1311
CoMoNns WA 5302io PACIFIC GAMGES. INC.
"The Wood Frame Specialists"
TAX NO. Si3/ - moo - t y6- oZoy
LEGAL DESC T.B.L. 4 �' y " Q- /
CITY COPY
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TO: Permit Coordinator,
Building Division
FROM: FIRE DEPARTMENT
=ENGINEERING DIVISION
PLANNING DIVISION
OWNER_ 2GIV k e 1_
,/
ADDRESS I j' 42 2 C) V (1)
PERMIT# % b DVy ADB#
INSPECTED ON
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 - RECALL FOR INSPECTION
1.
2.
3.
4.
OCCUPANCY APPROVAL
DATE 2 2v Q d BY
FAILED FIRST INSPECTION
DATE BY
RE -INSPECTED - APPROVED
DATE BY
RE -INSPECTED - FAILED
DATE BY
RE -INSPECTED APPROVED
DATE
OCCAPRVL/TXTRECEP/October 13, 1993
FEES RECEIPT#
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
'--tS • l• t11�
SETBACKS ..................
FOUNDATION:
Footing ..............
Well.......................
Pier/Porch................
RetainingWall ............
Slabinsulation............
PLUMBING:
,
Underground .............
Rough -In .................
..
Commercial Final........
HEATING:
Gas Test_ ................
Gas Piping..... ...........
Equipment ................
Commercial Final.........
EXTERIOR SHEATHING
NAILING ....................
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FRAMING ....................
INSULATION:
Floorinsulation...........
Wall Insulatlon ...........
Ceiling Insulation.........
SHEETROCK NAILING ......
SPECIAL INSPECTION ......
MISCELLANEOUS
FINAL APPROVAL
FOR OCCUPANCY ........
0
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