20030917.pdfOv-&WID DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
2- -2- 02, 0 /11/y
CITY
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NAME
ADDRESS
CITY
ZIP ITELEPHONE
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ADDRESS
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STATE LICENSE NUMBER
EXPIRAT16N DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
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PLUMBING/MECH
1:1 ADDITION Vc-bMMERCIAL
COMPLIANCE OR
CHANGE OF USE
1:1 REMODEL 1:1 MULTIFAMILY
>a51GN
GRADING FENCE
1:1 REPAIR 0 CYDS 1:1 ( X FT)
[3 DEMOLISH 1:1 TANK
13 OTHER
ciGARAGE I RETAINING WALL 0 F RE SPRINKLER
CARPORT 13 ROCK5RY PRFALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
rd NUMBER NUMBER OF CRITICAL
OF DWELLING A AREAS
STORIES UNITS —NUMBER
DESCRIBE WORK TO BE DONE
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HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO:- I VESTED DATE
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THIS PERMIT AUTHORIMS 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: ISO DAYS
PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN ISODAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
PERMIT EXPIRES
USE
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PERMIT
NUMBERc&3 7
JOB
ADDRESS
SUITE/APT#
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PLAT NAME/SUBDIVISION NO.
LOT NO.
L�D NO.
L D FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
11
13
EXISTING — PROPOSED
Street Use Permit Roqd
Inspection Roquized
13
E3
Sidewalk Required
13
REQUIRED DEDICATION—
FT
Underground
Wiring required
METER SIZE
NO. OF FIXTURES
PRV REQUIRED
17�N�
YES 13 No 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
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VARIANCE OR CU
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BOND
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ALLOWED
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CHECKED BY I TYPEM CONSTR CTION CODE— OCCUPANT
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SPECIAL INSPECTION JAREA OCCU
REQUIRED [] YES I LOAD
REMARKS 0
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
Building Permit City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
'APPLICAK ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFX DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
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 Landscapelnsp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' �2,67
11 Recording Fee Receipt # 14
I HEREBY ACKNOW AT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
LEDGE )H JA APPLICATION APPROVAL
GIVEN IS CT. AND -AT IA THE OWNER, OR THE DULY AUTHORIZED AGENT OF
E(
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THE OWN 9"IRAGREE T OMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application Is not a permit until signed by the
T'10 N; A T If,,DOING TH WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
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IN I OF THE BOR CODE OF THE STATE OF WASHINGTON RELATING TO receipt Is acknowledged In space provided.
WORKifN! POMPEN ION INSURANCE AND RCW 18.27. FOR INSPECTION I
SIGNATT)rERtl
Cpfr�WALS SIC�NqURE DATE
in DATE SIGNED (42�5)
771-0220 RELWED BY
"ISEXT 1333 //?Z
0 USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 1�(y
ION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
IC I I OR�GINAL - FILE YELLOW - IN�PEC4
HAS BEEN GRANTED. UBC SECTION 109 PNK-OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
PRESS HARD -YOU AfR� AKING WCOPIES
A'TT E0
IT IS LIN 11
A FINAL I
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FINAL PROJECT APPROVAL FORM
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DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLLALSE SIGN
ENGINEERING DIVISION DATE -
?IMF SIGN
PLANNING DIVISION DATE
IWO M
PERMIT # DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine final compliance with approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of :
V GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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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:
Gas Test .....................
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 ..................
07
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
roof-J91tit �
MAILING ADDRESS
2_7 0710 Hvy qq
CITY ZIP ITE EPH
,I, ONE
7 75--75
NAME
ADDRESS
PERMIT EXPIRES
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USE PERMIT
ZONE
61 NUMBER �Ae,
JOB SUITE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID No.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
street use Permit Req.
EXISTING — PROPOSED
Inspection Required
Sidewalk Required E3
REQUIRED DEDICATION- FT
Underground
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YESE3 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP
TELEPHONE
I
Alk AIL 0 11111 mw_
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NAME
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ENGINEERING REVIEWED BY DATE
ADDRESS
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REVIEWED BY DATE
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CITY ZIP
TELEPHO
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VARIANCE OR CU SHORELINEORADBI INSPECTION BOND
STATE LICENSE NUMBER
DATE I __QHECKED 91Y
. O'D POSTED
f�fpoOA� MERSE 13NO $
I
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
U-Oq- 007,- olif-6301
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T I 1P I I 135.2 '6 1 -1 - 9,75-
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EXP \,.,-
NEW RESIDENTIAL
PLUMBING if MECH
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
XMADDITION V_COMMERCIAL
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COMPLIANCE OR
CHANGE OF USE
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MULTIFAMILY
PARKING LOT AREA PLANNING REVIEWED BY DATE
REO'D PROVIDED
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[3 FENCE
REPAIR GRADING CYDS ( FI)
REMARKS
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DEMOLISH TANK
[3 OTHER
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GARAGE RETAININGWALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIV" EXPLAIN:
CHECKED BY OF CONSTR TION OCCUPANT
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ITYPE
177 GROUP
1
NUMBER NUMBER OF
OF DWELLING
CRITICAL
AREAS
SPECIAL,INSPECTION OCCUPANT
—STORIES I UNITS
NUMBER
JAREA
REQUIRED [:] YE LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
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Description FEE Description FEE
Plan Check &0— State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
I Building Permit City Surcharge
PLAN CHECK NO:. VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PFRMITAPPLICATION: 180DAYS
CL PERMIT LIMM I YEAR - PROVIDED WORK 15 STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp.
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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0 NOR LIMIT IN ANY WAY THE CI1YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
ml
Recording Fee
Receipt # 0�1�
I HEREBY ACKNOWLEDGE T T I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS PRECT; AND T I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWN I AGREE Tq OMPLY WITH C17Y AND STATE LAWS REGULATING CONSTRUC.
CALL
This application is not a permit until signed by the
TION; AN I' DOING THEF� ORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
I— N OF T ODE OF THE STATE OF WASHINGTON RELATING TO
JOL
IN VI
FOR INSPECTION
Building Official or histher Deputy: and Fees are pald.'and
receipt Is acknowledged In space provided.
WORKM l�-OMPEHNES/fillOBNOIRINSCURANCE AND RCW 18.27.
Off(bkS SIGNAYTUR DATE
816NAT (OFN E R ENT) DATE SIGNED
(425)
771 -0220
ELEA�ED BY DATE
ATTE
2
1333
N L U
IT IS U V
f SE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A' v
A FINAL I SPEC ION HAS BEEN MADE AND APPROVAL OR A CERTIF -
-101
ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF CCU NCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
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