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CITY OF EDMONDS ZONE PERMIT
NUMBER 9 3()5/ 7
CONSTRUCTION PERMIT APPLICATION '09 sG A
OWNER NAME NAME OF BUSINESS ADDRESS [-> /1 / / , / Y •
1 116MA.5 To k A Ie): F r- LEGAL DESCRIPTION CHECK SUBOIV N NO LID NO
PUBLIC RIGHT OF WAY
PER
Of FICIAL STREET MAP
TESCP APProreo
❑
LEA
RW Per I Raounee
❑
l
ExISnNO ___
REDUIRED DEDICATION
SAaei Uee PeImK RN d
❑
3 L��
PROPOSED
InepeCllon Reaulle0
❑
'
Bld—IL Reoueeo
❑
METER SIZE:
LINE SIZE
NO.OF FIXTURES
PRV REQUIRED
I
YES ❑ NO ❑
3
TELEPHONE
STATE LICENSE NUMBER Y E1<PIRA N O��
VARIANCE OR CU
ADB a
Legal Description of Property - include all easements
SERA REVIEW
COMPLETE I EXEMPT
EXP
LOT COVERAGE
SIGN AREA
ALLOWED I PROPOSED A
REQUIRED SETBACKSPRI
E1/NON S Se,& tr euj !R/+cT Is
ALLOWED PROPOSED
FRONT BIOE REAR F
Progeny
Tax earn. // (2/0 /I-,�� .x�^^}
Parcel No. 'y A' ii//LL// l/!7�
LOT AgEA
PLANNING REVIEW By
NEW RESIDENTIAL O PLUMBINCJMECH
REMARKS
COMPLIANCE OR
El
ADDITION COMMERCIAL CHANGE OF USE
REMODEL APT. BLDG. SIGN
CHECKED BY
TYPE OF CONST CTION
CODE
❑ GRADING ❑ FENCE
El
REPAIR CYUS K—,
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DEMOLISH NSSWIM POOL
ERT TOVE HOT T,LUBB'SSPA
RETAININ WALL/ aWgLN
SPECIAL I R
REGUIREONSPECTOGARAGE YES
AgEA
CARPORT ROCKERYG
gEMARKS
PROGRESS INSPECTIONS PER UBC 108
(TYPE OF USE BBBLrSSORAD IVITYI EXPLAIN.
t ��(
NUMBER
OF
NUMBER OF
OWELLING /
CRITICAL
AREAS
'
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DOVE
(ATTACH PLOT PLAN)
PONT L/R SIDE
LOAD
= u '
FINAL INSPECTION REQUIRED
'
PLAN CHECK FEE
VALUATION
FEE
BUILDING
` /^
ill
HEAT SOURCE-
GLAZING
e�p
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
mit PerLimit: 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
w successors In interest, agrees to indemnify, defend and hold
W harmless the City of Edmonds, Washington, its officials.
aemployees, and agents Irom any and all claims for damages of
a whatever nature, arising directly or indirectly from the Issuance
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
°x nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision."
/ 9
I hereby acknowledge that I have read this application; that the
i formation given is correct; and that I am the owner, or the duly
ATTENTION
APPLICATION APPROVAL
uthorized agent of the owner. I agree to comply with city and
THIS PERMIT
tate laws regulating construction; and In doing the work aulhoriz•
AUTHORIZES
This application is not a permit until
d thereby, no person will be employed in violation of the Labor
ONLY THE
signed by the Building Official or his/her
ode of the Stale of Washington relating to Workmen's Compensa•
WORK NOTED
Deputy; and fees are paid, and receipt is
:on Insurance aria RCW 18.27.
INSPECTION
acknowledged in space provided.
;NATURE (OWNER OR AGENTI DATE SIGNED
DEPARTMENT
TY OF
OFFICI 1S SIGNATURE DATE
'
o'
DIMON S
lag
CALL FOR
RELEASED eY DATE
A
TENTION
INSPECTION
%
IT
S UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UN
IL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
��� �OLLO
ORIGINAL — File YELLOW — Inspector
A
CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SE(
for
TION 109
T
PINK — OAner GOLD — Assessor U
f
OI
GI
N
rGt3v� ,
Wt FINAL PROJECT APPROVAL FORM
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
�� P 991GN
ENGINEERING DIVISION DATE
nesesmN
PLANNING DIVISION DATE
N.e. SIGN
1�
SITE
PERMIT # I % % ADB# DATE INSPECTED --
DESCRIPTION OF WORK TO BE INSPECTED /IS�ePIL2 2(ml! I- LA-P
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 granting of
_Final approval of the described work
Performance Bonds associated with the project may be released
GRANT FINAL PROJECT APPROVAL
GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
ocaprvl.doc.l: temp:bldg:fonns6/98
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ...................
FOUNDATION:
Footing ....................
Wall.......................
Pier/Porch................
Retaining Wall............
Slab Insulation............
PLUMBING:
Underground .............
Rough -In .................
Commercial Final ........
HEATING:
GasTest .................
Gas Piping ................
Equipment ................
Commercial Final .........
EXTERIOR SHEATHING
NAILING ....................
FRAMING ....................
INSULATION:
Floor Insulation...........
Wall Insulation ...........
Ceiling Insulation.........
SHEETROCK NAILING ......
SPECIAL INSPECTION ......
MISCELLANEOUS
FINAL APPROVAL
FOR OCCUPANCY..........
10
32 X I