20031004.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS I
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CITY ZIP TEL PHONE
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NAME
ADDRESS
CITY ZIP [TELEPHONE
NAME ICBL#
ADDRESS
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STATE LICENSE NUMBER �l ION TIE BY
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PROPERTY TAX ACCOUNT PARCEL NO
LPERMIT EXPIRES
USE" PERMIT
ZONE NUMBER 2U963 - 06
JOB SUITE/APT#
ADDRESS 0 L 'I\J
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
street Use Permit R*q'd
EXISTING — PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT
Undwground
Wiring required 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 NO 13 Le
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE I
REVIEWED BY
DATE
FIRE REVIEWED BY DATE
"'5�3 //— 6—C
VARIANCE OR CU SHORELINE OR ADB11 INSPECTION BOND
RE POSTED
113YEs 1140 $
T
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
7.-703ZA4 - WZ.- VA.-;- W
EXP
NEW
RESIDENTIAL
PLUMBING / MECH
LOT COVERAGE
ALLOWED PROPOSEr,
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT L/RSIDE REAR
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
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PARKING
LOT AREA I
PLANNING REVIEWED BY E
REMODEL
MULTIFAMILY
SIGN
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DED
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REPAIR
GRADING
CYDS
FENCE
( x FT)
REMARKS
rl DEMOLISH
TANK
OTHER
GARAGE
RETAINING WALL
0 FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIWIVr"M LAIN:
v4vv�zl'.
CHECKED BY
IDW
STRUCTION
CQQE
OCCUPANT
GROUP
T�:']
NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
SPECIAL INSPECTION
UPANT
LOAD
DRIES
UNITS
NUMBER
REQUIRED 0 YES
JAREA
DVIBE WORK TO BE DONE
—REMARKS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
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HEAT SOURCE I . GLAZING % I / CO'r SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORRES 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.
PERMrrAPPUCATION: 160 DAYS
PERMIT LIMM 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 E14FORCE 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 OE�ZUE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S O"TION INSURANCE AND RCW 18.27.
#=ERA AGENT) DATE SIGNED .
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Description
FEE
Description
11-60
FEE
Plan Check
01 1
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt III
D41
Landscapeinsp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
(425)
771-0220
EXT 1333
APPLICATION APPROVAL
This application Is not a permit until signed by the
Building Official or histher Deputy: and Fees are paid, and
receipt Is acknowledged in space provided.
CIA I DATE
7
RELEASED BY DAtE
'I UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINALC-f!�V YELLIDWANSP
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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FINAL PROJECT APPROVAL FORM
TO:
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT
DATEZ-
0-JIF PLEASESIGN
ENGINEERING.D
SION DATE
PLEASE SIGN
PLANNING DIVISI
DATE
PLEASE SIGN
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PERMIT Q6-0 or--) C( —ADB# DATE INSPE
CTED
DESCRIPTION OF. WORK TO BE.INSPECTED 2-:2
A� field. inspection was conducted to determine. comp liance with i
pproved plans. Fi al'. approval,
den0tii that there are no objections from the above signed
Department to the release . of
PERFORMANCE BONDS and the granting of:
'.GPIIA�NT FINAL PROJECT APPRO
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION OUTSTANDING ISSUES
El Copy of CORRECTION NOTICE given to owner/contractor by
inpector
2.
3.
RE-rNSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbrms:ocaprv1 3/25/04
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FINAL PROJECT APPROVAL FORM
RECEIVED
o 4 2005
3.
RE -INSPECTED OUTSTANDING ISSUES -
Date 11,3 f L Signature
l:temp:bldg:fonns:ocaprvl 3/25/04
TO:
OVAL
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
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SETBACKS .....................
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FOUNDATION:
Footing......................
wall............ I .............
'/Porch .
.................
Retaining Wall ............
Slab Insulation ...........
PLUMBING:.,...
m:
Underground..............
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Rough -in ...... ..............
Comrnercial Final ......
HEATING:,
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� DATE RECEIVF.0
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
1�kg &'V L,L C.
MAILING ADDRESS
CITY
NAME
ADDRESS
CITY
ZIP ELEPHONE
ZIP TELEPHONE
CBL #
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2(kol -a.
CITY ZIP
My
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STATE LICENSE NUMBER
17
PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
'JOB SUITEIAPT#
ADDRESS
PLAT NAMEISUBDIVISION NO.
LOT NO�
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPfnAP
=ad
MY Pe In
EXISTING - PROPOSED
Street Use Permit R#qV
Inspection Required
Sidevralk Required
REQUIRED DEDICATION- FT
underground
a requ 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
I
YESE3 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY
DATE
FIRE REVIEWED BY DATE z
TELEPVNE 0
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'17 - IRK-/ 6- -1
V r T49111114 INSPECTION I 13OND 0
EX I ION ATE =BY 0 M
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q 0'"' Y
9 PROPERTY TAX ACCOUNT PARCEL NO.
2-703N Q&=?_q(0-ftW
SEPA n 1CVV
COMPLETE , E:7
Q1UF1 fin HEIGHT
ALLOWED PROPOSED ALLOWED PROPOSED
I - _I_.
P
I T
0 rn
0 NEW RESIDENTIAL
1:1 PLUMBING/MECH
LOT COVERAGE
REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
C
M
8
COMPLIANCE OR
ALLOWED PROPOSED
FRONT SIDE REAR FRONT LIRSIDE REAR
C)
ADDITION COMMERCIAL
13
0 r
CHANGE OF USE
PARKING LOT
AREA PI ANNING
REMODEL MU111FAMILY
[:1 SIGN
REOD PROVIDED
REVIEWED BY D WE
M
I
REPAIR GRADING
CYDS
FENCE
1:1
r
( _ X_ FT)
REMARKS
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DEMOLISH TANK
OTHER
11
GARAGE o RETAININGWALL
CARPORT ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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rliv.Wkw4f &'JA.,kd P4w
CHECKED BY F. CONSTRUCTION
OCCUPANT
!R
NUMBER F
NUMBER 01
OF WELLING
_2TORIES UNITS
DqfCRIBE WORK TO BE DONE
CRITICAL
AREAS
R
SPECIAL INSPECTION JAREA
REQUIRED 0
YES
GROUP
OCCUPANT
LOAD
qRECtD
In
8
6
o-(— ic4e,,4N,
REMARKS
12
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PgOGRESS INSPECTPNS
PER UBC 108/FINAL INSPECTION
M
361fil'Y10.1,01WAPOMA 1". FA I W 967177MI M Z
PU hu^ - Iota vi! Auk, tA e. VALUATION
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Q!ie $ el)
Description FEE Description FEE
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0
I o*-va, A-r-m ii, i
I AVCK7 141�5rrs I AlpV &)w Plan Check
state Surcharge
1"50 1
HEAT SOLI RCE GLAZING %
,e,
LOT SLOPE %
Building Permit
City Surcharge
2 A&I ^LA
M
VES D DATE
R
A_7
Plumbing
A da vh
IX
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THIS PERMIT AUTHORIZES ONLY THE WO RK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
BE DONE ON PEUVATE PROPEM ONLY. ANY CONSTRUCTION ON THE PUBLIC
1 Va CW
3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, LURQUEES, ETC.) ILL RE IRE
Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: jeoDAYS
L PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF
Engr. Inspection
PINK PERMIT FOR MORE INFORMATION
*APPLICAf,IT ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY. DEEEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER !1ATURE. ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Receipt #
FROM THE ISSUANCE OF THIS PERMIT —IbSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY WAIVE OR
Insp.
REDUCE ANY REQUIREMENT10KANY CITY ORDINANCt
NOR LIMIT IN ANIV, WAY THE CITYS ABILITY TO ENFORCEANY ORDINANCE PROVISION. -
4qggcape
Total Amt. Due Wit !Y�
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION' THAT THE INFORM'ATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DU& AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH C17Y AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
This appillcaltion Is not a permit until signed by the
IN VIOLATIO E LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMENS ION INSURANCE AND RCW 18.27.
FOR INSPECTION
Building Olficial or his/her Dopqty: and Fees are paid. and
receipt Is acknowledged In space provided.
SIG AGE DATE SFNED
OFFl I CIA IG A DATE
71,�
771-0220
-DA`rE
RELEASED BY
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 41�4 " /Z
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI. ORIGINAL�. �F YELLOW /INSPE&OR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GoLD-ASSESSOR
64/02 GREEN - ACCOUNTING
PRESS HARD -YOU A��KTNG 5 COPIES
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