20030064 (3).pdfDATE RECE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
OAPOA
�ZILING ADDRESS
I 2q3 RD Pb)cc SVV
CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY
ZIP I TELEPHONE
NAME
08 TA0k SEwiLF, Ce. W�6
ADDRESS
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
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0
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ADDITION
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COMPLIANCE OR
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(TYPE OF USE. BUSINI�SAOPI ACTIVITY) EXPLAIN:
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0 DWELLING AREAS
M OF UNITS
0 STORIES NUMBER
DESCRIBE WORK TO BE DONE
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HEAT SOURCE GLAZING % LOT SLOPE 1%
PLAN CHECK NO: IVESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
"APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE 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 AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE
,*D RCW 18.27,
DATE SVNEO
1/3 0/1D -6
PERMIT EXPIRES
USE
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PERMIT
NUMBE
JOB
ADDRESS
009 SUITE/APT#f
PLAT NAM E/SUBDIVI SION NO.
LOT NO.
LID NO.
I
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 0
RW Permit Required 0
Street Use Parma Req d 0
EXISTING - PROPOSED
inspection Required 11
Sidewalk Required 0
REQUIRED DEDICATION-
FT
Underground
Wiring required 0
METER SIZE
LINE SIZE
I
OF FIXTURES
P_
PRV REQUIRED
YES 0 NO 0
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
MUST BE P13FSI
ENGINEERING TANK FILL, REMOV
FIRE REVIEWED BY
VARIANCE OR CU I SHORELINE OR ADB#
OR CAP
DATE
INSPECTION I BOND
REO'D POSTED
0 YES 0 NO
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REO'D I PROVIDED
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
5/98
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TOTAL AMOUNT DUE
VALUATION
EIPT
FEE
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building Official or his/her Deputy: and Fees are paid. anti
FOR INSPECTION receipt is acknowledged in space provided.
0 vnc ALS SIG,��JURE DATE
(425�) /
771-0220 RELEASED BY Um L
EXT 1333
771-0221 ORIGINAL FILE - YELLOW - INSPECTOR
FAX PINK - OWNER - GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
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MEMO TO: PERMIT COORDINATOR, BU11-DING DIVISION
FIRE DEPARTMENT DATE-/�
FROM:
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ENGINEERINGDIVISIONDATE�
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PLANNING DIVISION DATE�
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ADB#� DATE INSPECTED--L:2
PERMIT
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DESCRIPTION OF WORK To BE INSPECTB]3T.!:(�A—,1P J X— d —
Final approval
A field inspection Was conducted to determine final compliance with approved plans.
above signed Department to the release of
s that there are no objections from the
denote
BONDS and the granting of
PERFO CE
_)�_GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inspector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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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 ........................
FIRST FLOOR FRAMING...
INSULATION ...................
floor Insulation ... .......
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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DATE
CITY OF EDMONDS
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CONSTRUCTIPN PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS vv
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CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY
ZIP ITELEPHONE
N NAME
AM PPfl TAQk SEW,ul:� CO
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ZIP TELEPHONE
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PROPERTY'TAX ACCOUNT FAHUrL NO.
0 NEW RE&DENTIAL 0 PLUM13ING MECH
A COMPLIANCE OR
ADDITION El COMMERCIAL F1 CHANGE OF USE
REMODEL 0 APARTMENT n SIGN
FENCE
n REPAIR 0 GRACING CY n X FT)
C] DEMOLISH is TANK o OTHER
RES'DENTIAL
0 COMMERCIAL
0 APARTMENT
GARAGE C] RETAINING WALL RENEWAL
CARPORT ROCU.Bj�
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(TYPE OF USE. BUSIN OR ACTIVITY) EXPLAIN:
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PLAT NAME/SU BDIVI SION NO. LOT NO.
-LID NO.
LID FEE S
TESC pprmed
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RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit R@qulrod
0
PU13LIC
Street use Permit Raq'd
0
inspection Required
0
EXISTING � PROPOSED
Sidewalk Required
0
Underground
REOUI RED DEDICATION - FT
Wifing req irred
(03,11
METE R SIZE LINE SIZE NO. OF FIXTURES
pRV REQUIRED
0
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YES 0 NO 0
3
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REMARKS
FOR EROSION CONTROL/DRAINAGE
OWNER/CONTRACTOR RESPONSIBLE
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FIRE REVIEWED BY
DATE
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VARIANCE OR CU
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SHORELINE OR ADIBIN
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INSPECTION BOND
REO'D POSTED
0 YES NO
SEPA REVIEW
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SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
ALLOWED PR
MPLLT X
COMPLETE EXEMPT
ECX P
LOT COVERAGE
REQUIRED SETBACKS (FT.)
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n cr FTS
PROPOSED SETBACKS (FT.)
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ALLOWED PROPOSED
FRONT SIDE REAR
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REMARKS CTI 5
TROGRESS INSPECTIONS PER UJBC 108/FINAL INSPECTION REOD _j
VALUATION I FEE
PLAN CHECK FEE
HEAT SOURCE GLAZING % LOT SLOPE % BUILDING
PLAN CHECK NO: VESTED DATE PLUMBING
MECHANICAL
RK TO
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADINGIFILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. VWA_wSURCHAR6r,?/
PERMIT APPLICATION- 180 DAYS
PERMIT LIMIT. I YEAR * PROVIDED WORK 13 STARTED WITHIN 180 DAYS ENG. REVIEW FEES
SLE BACK OF PINK PERMIT FOR MORE INFORMATION ENG. INSPECTION FEE
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING
EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES AND AGENTS FROM ANY AND INSPECTION FEE
�ING DIRECTLYOR INDIRECTLY RECEIPT
DAMAGES OF WHATEVER NATURE.ARI
ALLCLAIMSFOR ANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
FROM THEISSU ENT OF ANY CITY ORDINANCE
To MODIFY. WAIVE OR REDUCE ANY REQUIREM OVISION.* RECEIP
DEEMED WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PR
NOR LIMIT IN ANY TOTAL AMOUNT DUE 61,12
THE INFORMATION APPLICATION APPROVAL
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT RIZEDAGENTOF This application is not a pormit unlilsigned by tho
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHD
LY WITH CITY AND STATE LAWS REGULATING CONSTRUC' CALL Building Olficial or his/hor Dopuly; and Foos aro paid. and
THE OWNER. I AGREE TO COMP rovidod.
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED rocoipt is acknowlodgod in spaco P
N OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
IN VIOLATIO 0 1 ALS Sl N,, URE ATE
C W 18.27.
WORKMEN'S COMPENSATION INSURAN ;4co io
"�OND RC (425)
GENT DATE S!P!NED
SIGN T v 3v ID-6 771m0220 RELEASED BY DAOE&
K1 EXT 1333
Al !JM" I Im OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
IT IS UNLAWFUL TO USE AL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROV FAX PINK - OWNER GOLD - ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
519B
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