990372.pdfUS PERMIT
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ATTENTION
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 YELLOW INSPECTOR
HAS BEEN GRANTED. UBC SECTION 109
PINK OWNER • GOLD ASSESSOR
CATE OF OCCUPANCY
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EXPIRES �Z
PERMIT
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CITY OF EDMONDS 2ONE , 3 NUMBER
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OWNETR NAME/NAME OF BUSINESS /
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❑ NEW RESIDENTIAL ❑ PLUMBING IMECH REMARKS
❑ ADDITION ❑ COMMERCIAL ❑ CHANGE OF USE
❑ REMODEL ❑ APARTMENT ❑ SIGN
GRADING FENCE
❑ REPAIR ❑ CYOS ❑ ( _� X FT) CHECKED BY TYPF OF CONSiPUCTION CODE OCCUPANT
GROUP
❑ DEMOLISH ❑ TANK ❑ OTHER '
OCCUPANT
SPECIAL INSPECTOR AREA -
i ❑CARPORT ❑ RETAINING WALL ❑ RENEWAL REQUIRED ❑YES LOAD
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F ITYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: REMARKS
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
f BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADING/FILL
— DOMAIN (CURBS,SIOEWALKS, DRIVEWAYS, MAROUEES,ETC.) WILL REQUIRE
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SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: 1 YEAR -PROVIDED WORK IS STARTED WITHIN 190 DAYS STORM DRAINAGE FEES
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND GUCCESORB ENG. INSPECTION FEE
IN INTEREST, AGREES TO
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM:.
FIRE DEPARTMENT DATE �J— —QZ
PIfJ3e510N ..
ENGINEERING DIVISION DATE
PLlASC9GN
PLANNING DIVISION DATE
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PROJECT U/(�P
SITE ADDRESS
PERMIT # q 3� � —ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED C%� U ws s
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 ofthe described work
Performance Bonds associated with the project may be released
GRANT FINAL PROJECT APPROVAL GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NA*CC,�,,
o ✓UN d'`c`
i ��ryMfNTs 9199.9
FAILED FINAL INSPECTION - OUTSTANDING ISSUES it,,: o%t, or9
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
r.
Footing ...................... .
i..
Wall .......................... . .
Pier/Porch .................
Retaining Wall ...........
Slab Insulation .......... '
PLUMBING:
Underground .............
-
Commercial Final ......
HEATING:
Gas Test - -;
Gas Piping
_
..;. :Equipment .....:
Commercial Final ......
-
EXTERIOR SHEATHING ;.
- NAILING
FRAMING........................
INSULATION ................... ...
_Floor Insulation ......... ..:.
Wail Insulation ...........
Ceiling Insulation .......
- - SHEETROCK NAILING ...
SPECIAL INSPECTION -...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
"NOS42
/
PERMIT EXPIRES
CITY OF EDMONDS
PERMIT
io�E NUMBER 9�9037
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ATTENTION
TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
IT IS UNLAWFUL
AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW RJSPECTOH
A FINAL INSPECTION HAS BEEN MADE
HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER • GOLD- ASSESSOR
CATE OF OCCUPANCY
n,aP
z
PERMIT APPLICATION AOB SUITErAPL
CANSTRUCTION nooREss
OWNER NAME NAME OF BUSINESS 'A.I. o
�- LEGAL DESCRIPTION CHECK SUBOIJISION NO. Llp NO.
w MAILING ADD. EBS
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30 f� � � PUBLIC FIGHT OF WAY PER OFFICIAL STREET MAP O
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CITY ZIP TELEPHONE E%ISTING REQUIRED DEDICATION_ ° �
PROPOSED wa O
NAME METER SIZE LINE SIZE NO.OF FIXTURES PRV REQUIRED O
YES ❑ NO ❑ -
r ADDRESS REMARKS �
a
CITY ZIP TELEPHONE
NAME REVIEWED BY
ENGINEERING MEMO DATED
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ADDRESS
FIRE MEMO DATED REVIEWED By
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CITY 21P TELEPHONE
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VARIANCE OR CU ADBx SHORELINE n
STATE LICENSE NUMBER E%PIRATION DATE CHECKED BY
SEPA REVIEW SIGN AREA HEIGHT
L� I COMPLETE I EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
LEGAL DESCRIPTION OF PROPERTY -INCLUDE ALL EASEMENTS EXP
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_
LOT COVERAGE REOUIREp SETBACKS (FT.) PROPOSED SETBACKS (FT.)
FRONT VR SIDE REAP
ALLOWED PROPOSED FRONT SIDE REAR O
PROPERTY TA% ACCOUNT -PARCEL NO. LOT AREA N W DATE o
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❑ NEW l/ RESIDENTIAL ❑ PLUMBING /MECH REMARKS
,w'
❑ CHANGE FUSE ❑ ADDITION � COMMERCIAL
❑ REMODEL ❑ APARTMENT ❑ SIGN
GRADING FENCE
❑ REPAIR ❑ CYDS ❑ ( X FT) CIiECKEO BV TYPE OF CONSTRUCTION CODE -GROUP I
❑ DEMOLISH ❑ TANK ❑ OTHER I
SPECIAL INSPECTOR AREA OCCUPANT
LOAD }
❑GARAGE RETAINING WALL RENEWAL - REQUIRED ❑YES
CARPORT ❑ R Rv ❑
F (TVPE OF USE. BUSINESS OR nC,TIVITY)EXPLAIN: REMARKS
INSPECTIONS PER UBC 108
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_
PROGRESS
w NUMBER NUMBER OF CRITICAL
a pp DWELLING AREAS
p STORIES UNITS NUMBER
� DESCRIBE WORK TO BE GONE
(,, = FINAL INSPECTION REQUIRED
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE GLAZING%. LOT SLOPE": BUILDING
PLAN CHECK NO: VESTED DATE PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
BE GONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRAOINGIFIIL
- DOMAIN (CURBS,SIOEWALKS, DRIVEWAY S, MAROUEES,ETC,) WILL REQUIRE
J
SEPARATE PERMISSION. STATE SURCHARGE
E
PERMIT APPLICATION: 180 DAYS
FEES
PERMIT LIMIT: 1YEAR -PROVIDED WORK IS STARTED WITHIN 180 GAYS STORM DRAINAGE
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS ENG. INSPECTION FEE
� IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONOS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
OR INDIRECTLY
ALL CLAIMS FOR DAMAGE SOF W HATEVER NATURE, ARISING DIRECTLY
FRDM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
REDUCE ANYREQUIREMENT OF ANY C TY
� NOR LEMIT NnNDYIWAYyTHE CITY TO ANY ORDINANCE PROVNSIONE
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR
TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCCALL This application is nolapoemll unlll signatl by lho
THE OWNER.IAGREE
IN DOING THE WORK AUTMOR12E0 THEREBY. NO PERSON WILL BE EMPLOYED - B°Pilin9,011iciel or hlslpor Dopuly: antl Faes aio paid, Pntl
TION; AND
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION ro�mpli�a,waowlmBnal°sPacoprar�d°tl,
WORKMEN 'SCOMPENBATJ NSURANCE AND RCW 10.21. �yyI� OFFICIALS SIGN LIRE DATE
DATE BIG ED (YG5) `
SIGNAT IOWNERO GEN) � 7
771 'U22U
RELEASED OY DATE
�.