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DATE RECEIVED
CITY 0 - FEDIVIONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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street Use Formil Rocrd
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REQUIRED DEDICATION— FT WiOngrequifed
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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HEAT SOURCE GLAZING % LOT SLOPE %
VESTED DATE
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7—HIS PERMIT AUTHORIZES ONLY THE WORK NOTED- THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY- Amy CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION -
PERMIT APPLICATION: ISO DAYS
PERMIT UMM I 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 CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I ALI 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
WORKMENS COMPENSATIOSN!U�IURANC! AND RCW 18.27.
NERO AGE DATE SIGNED
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APP ICATION APPROVAL
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This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTIO
receipt is acknowledged in space provided.
Fl [A NATUR1571 DATE
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771-0220
RELE D BY DATE
1: V T I !3a
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ATTENTION U UCTURE UNTIL
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STR R A CERTIFI- ORIGINAL - FILE YELL PE TOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL 0 PINK -OWNER GOLD -ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 COPIES GREEN - ACCOUNTING
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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DEPARTMENT OF BUILDINGS
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PER UNIFORM BUILDING CODE SECTION 109
At: 7320 21e St. SW Suite 310 Building Permit #: #200 0927
Occupancy established by this certificate: Dwelling Units: 0 No. Stories: 3
B Type Construction: 11-1 Hr Sprink Basement: NIA
**33**
Maximum Occupant Load _(Per U.B.C. 1002)
Room capacity signs, when required, must remain posted at all times.
Owner of Building: Teutsch Partners Address: 2001 Western Ave-- Sgggil WA 98121
THE Puget Sound Neurolony AS BEEN INSPECTED AND APPROVED AS COMPLYING WITH THE REQUIREMENTS OF THE 1997
Edition of the UNIFORM BUILDING CODE AS ADOPTED BY THE CITY FOR THE GROUP AND DIVISION OF OCCUPANCY AND THE USE FOR
WHICH THE PROPOSED OCCUPANCY IS CLASSIFIED.
Issued this Sixteenth dayof January 2004
CHIEF BUILDING OFFICIAL
K) BY:
Thils certificate shall be posted In a conspicuous public area and shall not be removed, mutiloled or obscured and shall be maintained In legible condition at all times. Any change of occupancy or use requires a btgldng permit and a new
Certificate of Occupancy issued by the City of Edmonds Building Official.
RECORD OF INSPECTIONS
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
-20 0 1 W LA F_
CITY ZIP TELEPHONE L% —
C—_?�TTLF, W 4 6N 171 —7 Z 9) —11-3
NAME
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ADDRESS
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CITY ZIP TELEPHONE
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128-7 W9-:�ICLU
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CITY
ZIP
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STATE LICENSE NUMBER
EXPIRATION DATE C ECKED BY
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PROPERTY TAX ACCOUNT PARCEL NO.
61-00
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1:3 RESIDEtTV PLUMBING/MECH
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tg C COMPLIANCE OR
COMMERCIAL 1:1 CHANGE OF USE
REM E
muLnFAmiLy SIGN
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GRADING FENCE
CYDS ( — X-9
DEMOLISH
[j TANK OTHER
GARAGE
RETAININGWALL F
F RE SPRINKLER
CARPORT
RqqKERY F RE ALARM
WOE W USE USIN 88'6
Nft
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NUMBER
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CRITICAL
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STORIES
UNITS
NUMBER
DESCRIBE WORK TO B4 DONE
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JOB 7320 7_1 L-12 LIL) SLirTOAPT#
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PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
26
I - toD FT/M&/ T LID FEE S
T65CP APPI=ad
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pa." R
Strw. Use Parmh Raced
EXISTING — PROPOSED inspection Required
Sidwalk Required
REQUIRED DEDICATION— FT UnderWound
Wring required
METER SIZE LINE SlZi7. OF FIXTURES PRV REQUIRED
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REMARKS YEsI3 NO 13
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRif R DATE w
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1) h - -7 tO
E OR CU SHORfINE OR ADBN I I CTION I BOND"
I�V� RFn'n J POSTED
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED PRO ED
EXP _X
LOT COVERAGE REQUIRED SETB)kCKS (Fr.) PROPOSED SETBACKS (Fr.)
WED PROPOSED FRONT SIDE REAR FRONT LIR 91DE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE
REQZ.1� IDED I e__,,_=4_ /--) I
U� Tz�_, E�L)l L4D I i-)G
CHECKED BY ITYPE CONSTRUCTPN CODE OCCUPANT
Of fllh2ft 36-ka 53 GROUP, iB
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [3 YES LOAD
R ARKS
Pifd�SS INSPECTIONS PER U13C 108/FINAL INSPECTION REO'D
$
Doscription FEE Description FEE
F)Ian 9heck
qtate Surcharge
r
HEAT SOURCE GLAZINd %
LOT SLOPE %
Buildl
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City Surcharge
PLAN CHEC 0:
VESTED DATE
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THIS PERMrr AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
!=E P!jjISSION1.
_ A
-Enr. Review
PERMIT AVWaT%k: I i iidAys
, . , , V
PERMIT UMM I YEAR - PROVIDED WORK 16 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 AW AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapeinsp.
Total Amt. Due
2? 50
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
11 NOR LIMIT IN ANY WAY THE crrys ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
aRecelpt
#
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
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-
CALL
This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Foos are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
WORKMEN'S COMPENSATIO!!�URANCE AND RCW 10.27.
Fl IA NATURW DATE
SIGNAT RK !OW ER 0 AG NT)
)
DATE SIGNED
14.2-5)
11-11-0-5
1� . 1
� In7j-1, ( 1 �Q
ID — &L9 _05
771-0220
-9
I P
RELE D BY DATE
ATTtNTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -_�I! YELLOW - IN6PE6ToR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
04/02 GREEN - ACCOUNTING
PRESS HARD -YOU ARE MAKING 5 COPIES
...... . . . ..