20010645.pdf-T �5 02-2
DA RECEIV� �q
1 -1 1 PERMIT EXPI
USE
US
ZO
CITY OF EDMONDS ZONE
S
PERMIT
E
NUMBER2-001-0
A Ess SUIT APT'
/ao L,) C-- --,
CONSTRUCTION PERMIT APPLICATION JOB
ADOR
T'0 N
_1C
MEMAMEO��ESS
e--,
4( J curo- ��f e__
PI -AT NAMEISUSDIVISION NO. LOT NO.
FLA
I -I NO.
LID FEE S
JAJAOO
MA1LINGAD REDS
MA'L'o
6ADDF�S
--)Lo u) 4-c -� 9 �-
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
P E
U
a
0
M
X
EXISTING PROPOSED
E
REQUIREDDIEDICATION
s—
u-m—
Zip ITELEPHONE
A
4- Z:)-�
I z�, I I
-14 - I Z�-1 I
METER SIZE
LINE SIZE
-No, OF 611RES
PRV REQUIRED
IES 0 NO
IAIE��
REMARKS
REM
WNEFVCONTRACTOR RESPONSIBLE FOR EROSION CONTROI-oDRAINAGE
W,
ADGRESS�
qZ "t,
I
TELEPHONE L�zs�-
NAME
cr or
ENGINEERING REVIEWEDIDATE
ADDRESS
6b,-m
FIRE REVIEWED BY DATE
ZIP
0
r Of>v
TELEPHONE 4zL;s--
z>- -
VARIANqk�CU
SH REU�ZRADB-
INSPEEC�ION
(:IYR Q&_
ED
GO
14�E
STATE LICENSE NUMBER
BEIRA REVIEW
SIG AREA
ALL ED A OPOSED
HEIGHT
AULQ��PROPOSED
Irp, OPERTYTAX ACCOUNTPAR L
CEa,
I-APLETE EXEMPT
NEW PLUME'. I ME..
ALL OSED
RE011111D SETBACKS 1.)
mwr� FEAR
PRO 1ACKS (n)
R SIDE REAR
o COMPLIANCE OR
C] AUDITION CHANGE OF USE
F�.O.EL SIGN
ED
w I pRal
LR��EA
I NINO R VIEWED BY DAj%
GRACING (FENCE X FT)
0 REPAIR CYDS
P--�ST-0-
- DEMOLISH 0 TANK O—T-
2-Q
GARAGE 0 RETAINING WALL E] RENEWAL
C1 CARPO
0
Er (TYPECtUS1 ES OR AOTIV11111111
v
HECKEDBY 11y2i
OFJIDONSTRUCTION
C OCCUPA T
ROL P
NUMBER NUMBEAOF
OF DWELLING
I UNIT.
0 STORIES
CRI
A IS
N 'DER
SPECiALIN P CTOR AREA OCCU T
RED
REOU ..
DESCR18E WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC log/FINAL INSPECTION REG
,kc-, (21L)
n
PLAIN CHECK FEE
HEAT SOURCE LOTS PE%
BUILDING
L'y'l,
PLAN CHECK VESTEODATE
MECHANICAL
THIS PERMIT AUTHORIZED ONLY THE WORK NOTED. THIS PERMIT COVERS WORKTO
PRIVATE PROPER" ONLY. ANY CONSTRUCTION ON THE PUSUC
GRADINGIFILL
BE DONE ON
0 OMAIN (CURBS. SIDEWALKS. DRIVEWAYS . MARQUEES. STC.� WILL REQUIRE
SEPARATE PER�ISSION.
3 PERMTT APPLICATION: 180 DAYS
VF-
PERMIT SEE BACK 0 K IS STARTED WITHIN 190 DAYS
LIMIT: I YEAR- PROVIDED OR
REVIEW FEES
A *AppLCANTi.0AN.B,�NL;.0F HISOR HER SPOUSE. HERS. ASSICRIND AND SUCCE.."S
AN H D IM , THE CITY I
LANDSCAPING
IN IN MNI7 DNLESr
TERES ES IND.
N. I �,�LGEFE.NIOOYEES,"ANDA
I ED ONDS. ASHINGT
A C I F RDA ES F EVER NATURE. ARMIN DIRECTLYO INDIRECTLY
BE
R ISSUA E FT Is PERMIT. ISSUANCE F THIS PERMIT SHALL NOT
R. F ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
EEMED 001 Y. AIV R REDUCE ANY REQUIRE ENT
0 'SABILI ROINANCE P OVISON.,
TO ENFORCE ANY ROINANCE P
N INANY AYTHE ,
DRUM'
TOTAL AMOUNT DUE
I HERE ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION; THAT THE INFORMATION
By H DULY AUTHORIZED AGENT .1
,
GIVEN IS T AND HAT AM THE OWNER60RAT
-
COAREC S Ty AN ST TE LAWS FE.0 NG CONSTRUC
TO CO.PLYWITH
CALL
THE OWN I AGRiE 0 PERSON WILL BE EMPLOYED
TION, AND'RIN DOING THE WORK AUTHORIZED THEREBY. IT
7 HE STATE OF WASHINGTON RELATING To
FOR INSPECTII
IN VIOLAT N OF TIE CF
AND RCW 18.27.
WORNMENO CO.PENS��=�OE
-7--ATE SIG"I'Lflb
N1,(Ljb
(425)
SIGNATUR E (OWN A ADEN
65-7
771-0220
EXT 333
A 1, N
ZE"-�T
w, LT. USE OR ---U'y A BUILDING OR STRUCTURE UNTIL
LA,w
771-0221
L s, c NO APPROVAL OR A CERTIF1
A FINAL SP C I.N AS BEEN IVA E A
.
'T,
CATE OF 0 CUPANCY HAS BEEN GRANTED. UBC SECTION 109
c,
FAX
N�i
.�.,Thl � I ""d
d nII._ Y%�dt'F
IFIC NAIL D E
B By G E
y
ORIGINAL - FILE LLOW - INSPECTOR
PINK - OWNER\-120LO - ASSESSOR A
z
0
0
0 m
IT,
0
80
m m
z
ca
O"In
n
m M
0
0
0
c:
0
z
z
9
0
m
GARY HAAKENSON
CITY OF EDMONDS MAYOR
121 5TH AVENUE NORTH - EDMONDS. WA 98020 - (425) 771-0220 - FAX (425) 771-0221
WebSile: -dedmwftWauS
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
September 18, 2001
Mark Sutin
The Plumbers
FAX: 360-568-2641
RE: Permit #2001-0645
Castner Dental Care
120 West Dayton #C-2
Dear Mr. Sutin:
The following are clarifications of the requirements for the Medical Gas Pennit and
Request for approval to use Studor Air Admittance Valves.
Medical Gas Permit:
A separate Medical Gas Permit is required. A permit application form can be obtained at
the permit counter. Provide number of medical gas outlets and complete the enclosed
Special Inspection and Testing Agreement to provide with your application. A special
inspection report is required prior to final occupancy approval for the medical gas system
and medical vacuum system. Please note that a representative ofHarbor Square
Associates must sign the permit application or submit a letter authorizing you to sign on
their behalf.
Studor Air Admi tance Valves garding Studor Air Admittance Valves.
The Building Inspector wrote a correction today re C 301.2
Studor Vents are only permitted with Building Official approval under UP
Alternate Materials and Methods. Your request must site the previously mentioned code,
state why prescriptive venting methods cannot be used (vent to the exterior, or loop vent),
and provide a plumbing schematic. The Building Official will review your request in a
timely manner.
Should you have questions regarding the above items, please feel free to contact me at
(425) 771-0220.
Thank you
Ann Bullis
Assistant Building Official
- incorporated Aug -St 11, 1890
Sister City - Hekinan, Japan
FINAL PRO ECT APPROVAL FORM
TO:-
DATE: —
MEMO To: PERmrr COORDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DATE
FROM:
z
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE—
M
C
m 0
0 C
C
M
PROJECT
srrEADDRESs
PERMIT # 6 Co It �—ADB#--------DATE INSPECTED
M Z
7
z
DESCRIPTION OF WORK TO BE IN SpECTF D
C9
A field inspection was conducted to determine final compliance with approved plans. Final approval
the signed Department to the release of
o -n
n
-4
x
denotes that there are no objections from above
M M
E BONDS and the granting of:
pERFOgMANCE BONDS
U c)
0 r-
0 M
GRANT FINAL PROJECT APPROVAL
M
Z
z
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
--I
T
U)
C, Copy of CONDITIONS given to owner/contractor by inspector
z
0
1.
M
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE-INSPFCTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date— Sign__,
ocaprvl.doc.l:tenip:bldg:fornislO/01
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDA71ON:
Footing .............
Wall..........................
PlertPorch .................
Retaining Wall ...........
Slab Insulation ..........
8-:,
M:
PLUMBING:
Underground .............
RoUgh-In ...................
C
ma
84
i
Commercial Final
-4
or,
HEATING:
gas Test ...........
Gas Piping .................
--------
Cos
Equipment .................
Commercial Final
0
-n
EXTERIOR SHEATHING
M
NAILING.............. d ...........
FRAMING ...............
FIRST FLOOR FRAM ING
C,�
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
sHEFTROCK NAILING
—vn'
Z.
SPECIAL INSPECTION
M
MISCELLANEOUS ..........
FINAL APPROVAL FO
OCCUPANCY ..................
[PERMIT EXPIRES
eo-- Cco
CITY OF EDMONDS
us PERMIT
ZONE NUMBER )_Db 1-r"f 'd!��
CONSTRUCTION PERMIT APPLICATION
JOB SUITEMPT.
ADDRESS lao LA-) C., Zl_
:JWENAMEO��ESS
b�� 0 af (2- V cl
FLAT NAMEISUBDIVISION NO.
I LOT NO,
LID NO.
UGFEE,
.1
MAILING ADDRESS
ao (2, -
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
np
EXISTING — PROPOSED—
FT
ITELEPHONE
REQUIRED DEDICATION—
0
PRV REQUIRED
NAM�S,
LINE SIZE
NO.OigURES
YES C3 NO
-ADDRESS
REMARKS
NER/C
4 ,,4ELEPHONE
pt
Z-4
NAME _-Io rN
w
ENGINEERING REVIEWEDIDATE
ADDRESS
FIRE REVIEWED By DATE
ZIP
4_`IL7Z;_
0
ITELIPHONE
K 1crJ
-7
DATE C CK
VARIANC��CU
SHORELI�Zll ADBN
INSPECTION
BOND
P"Zo
STATE LICENSE NUMBER EXPIRATION
RE% NO
DYE
g
W9-V"Ck Nf 4 A ou 10
SEPIA REVIEW
SIGN AREA
HEIGHT
PROPERTY TAX ACCOUNT PAR CEL NO.
01-1 cp k oc')
COMPLETE EXEMPT
EXP I x
PROPOSED
ALLQ<�
ALL OPOSED
0 NEW
RESIDENTIAL
Pr LUMBING f MECH
L E
AL DEED
-
RE X1. AIT
F
PRO K (FkT)
FRO RSEA
0 ADDITION
COMMERCIAL
0 C IPLIANCE OR
CHANG OF USE
PARKING L,<
Pq
iEA
I PLONING REVIEWED BY
REMODEL
APARTMENT
C] SIGN
D
n-- 0 �"CE X FT;
RIPAI�
A
S 7
DEMOLISH [3 TANK OT%�� I
0 GARAGE WALL RENEWAL
0 0
0 C �u
RREOTAKINING
CARPORT C r
�Fy
(TYPE C�5 ES OR CTIVITY) EX- N:
HECKEO By C TION
-iff-CC UPAI�V
IWoFfONSTRU
1,'
'Up
177
746..Ell
OF
NUMBERO
DWELLING
CRITAICAL
ARE S
SEP
SPECIAL P CTOR AREA
b
REOUIRE'N 'YES
OCCUPANT
LOAD
_STO RIES
UNIT$
NU
DESCRIBE WORK TO BEGONE
REMARKS
.4-
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
AA r1i
-----------
r��lz LztL�
no
6,. L �,3 11ecjU.e(2
EL
VALUATION
FEE
z
0
�n
am
ca
mc
0
c
M
z
of
rn M
13
00
c
C,
z
9
PLAN CHECK PEE 5
TS OPE% m
SOURCE I'Z I � I
" I 't I. c� _ I
Ll L
BUILDING
IHEAT
ED DATE
PLUMBING
PLAN CHECKe:
-2_�-)
Ml
-
MECHANICAL
:zo
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED* THIS PERMIT COVERS WORK TO
BE ..... R IVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGWILL
B.. ETC.) WILL REQUIRE
DOMAIN (CURB , SIDEWALKS, DRIVE AYS. MARQUEES.
S ' W
3 SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATI N: ISO DAYS
180 DAYS
FEES
PERMIT LIMIT. I YEAR - ROVIDED W FIX IS STARTED WITHIN
P
SEE BACK OF PINK PERMITOF011 MORE INFORMATION
C
:'::
la"EkVIEW
—
ICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
INSPECTIO N FEE
;APPLC
AGRE TOINDEMNI DEF NO AND HOLD HARMLESS I
E EES T.'
IN INTEREST ES `Y. C
Ih
AND AGENTS FROM ANYAND
LANDSCAPING
FEE
E GTON I
2 EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES,
S WA H,
C 'M 0 IRECTLY OR INDIRECTLY
ALLCLAIMSFORDAMAGSS GFWHATEVER NATURE.ARIStNOD
OF THIS PERMIT SHALL NOT BE
INSPECTION
FtEll"I
_4q I
C) I
X FROM THE ISSUANCE OF THIS PERMIT ISSUANCE
M
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
AT
Fl-ANCHECKDEPOSIT
CEIPJ
NORU.'T IN Y WAY 'SA.�L�TYT.ENI...�AN'...��ANCEP�OV�.I.�.
0 AN THE CITY
NOFLUAITNAN�WAY
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION, THAT THE INFORMATION
APP [CATION J �13 I AL
GIVEN IS CORRECT. AND AT A. THE OWNER. 09 THE DULY AUTHORIZED AGENT 0;
TH
T u�
THEOWNER I AGREE TO COMPLY WIT. CIT AND STAT,ILAW, FSGN,��TIN.,E�E.NSTFUC
Y C
PLOYED
CALL
d,�g 0$1111 .1 h.11- DIP'll ... .. P_
TiON, AND IN DOING THE WORK AUTHORIZED THEREBY . PER L
OF WASHINGTON RELATING TO
FOR INSPECTION
......... .. p—ld...
IN VIOLATION OF THE LABOR CODE OF THE STATE
WORKMEN S COMPEN:2!!2t2MNCE AND RCW 1 .27
�OFFI NATU AJE
_7ATE
EMNATLRJ]L��
EI.JD
(425)
1 �oo
111",
C,-T (J 0 1
771-0220
v D&
I N
A' T'
EXT 333
IT IS . TF LTOLSE. OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
S P CT,.N AS BEEN MADE AND APPROVAL OR A CERTIFI
A FINAL SP C I
F,NAL�
ORIGINAL 'ILE LLOW INSPIiCTC�A
t
ATE OF 0 CUPANCY HAS BEEN GRANTED. UBC SECTION 109
C ATE�'O
FAX
PINK -