20040061.pdf' DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME RF BU?I�ESS
01 Lu MXILING ADDRESS
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NAME
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ADDRESS
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STATE LICEN
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PROPERTY TAX ACCOUN'
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ADDRESS
PERMIT EXPIRES
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PERMIT (�6q
NUMBER
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PLAT NAMEISUBDIVISION NO. I LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
41
SUITE/APT#
LID NO.
Lio FEE-$.
TESCP APP(OVOC
RW Permit Roqulfvd
street Use Permit Roq'd
Inspection Required
Sidewalk Required
Underground
Wiring required
PFIV REQUIRED
YES El NO 1:1
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CBL 4
ENGINEERING REVIEWED BY
ZIP I TELEPHONE
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?7101 1 j A
PARCEL NO
NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
El
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYOS
FENCE
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g TANK � 1-0.1
up wen
OTHER
EjGARAGE
CARPORT
o RETAINING WALL
ROCKERY
E:]
FIRE SPRINKLER
FIRE ALARM
(TYP�,.OF USE, BUSINESS -OR ACTIVITY) EXPLAIN:
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uj NUMBER
NUMBER OF
OF
DWELLING
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DESCRIBE WORK TO BE DONE
HEAT SOURCE I GLAZING %
PLAN CHECK NO:
DATE
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FIRE REVIEWED BY DATE
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-VARIANCE OR CU
HORELINE OR AD11,1
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I INSPECTION
REO'D
BOND
POSTED
I
BY
OYES ONO
S
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
EXP I
,
,
LOT COVERAGE
REQUIRED SETBACKS (IT)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/R SIDE REAR
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PARKING
LOT AREA
PLANNING REVIEWED BY DATE
REO'D I PROVIDED
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FT) I REMARKS
CHECKED BY
ITYPE OFjG(ASTRUr
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OCCUPA NT f-)
GROUP
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CRITICAL
AREAS
NUMBEpt?
SPECIAL INSPECTION
REQUIRED
j;%REA
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
LOT SLOPE %
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
uj PERMIT APPLICATION: 100DAYS
IL PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Ito OAPPLICANI, ON BEHAt F OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
W
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
-A
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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ALI CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
0
_j DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY 1 HE CITYS ABII I1Y TO ENFORCE ANY ORDINANCE PROVISION."
I HEREBY ACKNOWLEDGE THAI I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM I HE 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 Vi6LATION OF THE LA13011 CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATIDN-4�ANCE AND RCW 18 27.
AGENT) DATE IGNED
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III fir I RInjAc
ATTENTION E)ff 1333
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
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
77-1 noon
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
P) Plan Chk. Deposit
Receipt #
Total Amt. Due
I Receipt 9
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
:FIC KlIGNATURE ATE
BY
DATE
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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RECEiVED
10� 1A
JAN 2'0* 2004
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PERMIT COUNTER
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PLOT PLAN
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SIDE
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OTHER
1/ .2 41
FINAL PROJECT APPROVAL FORM
TO: eDL�ci
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D A T E: F��o
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
-50 FIRE DEPARTMENT DATE 6
FROM: ____L 2�_�
PLE(��N
-ENGINEERING DIVISION DATE -
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT__!_0
SITEADDRESS. Loj,07 54- c5a�)
PERMIT 6"-- ADB#________-PATE INSPECTED_j���
DESCRIPTION OF WORK TO BE INSPECTED s5kLOkl d1Z
A field inspection was conducted to determine 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 :
_.���GRANT FINAL PROJECT APPROVAL 1
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
1 .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
PA
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbnns:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
ITI
PLUMBING:
I
Underground .............
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C:
Rough -in ...................
rn 0
0
-40
Commercial Final ......
0 C
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HEATING:
M
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Gas Test ....................
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Gas Piping .................
Equipment .................
0 -n
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Commercial Final .......
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EXTERIOR SHEATHING
M
0
NAILING ..........................
0
0 rn
FRAMING ........................
1= Cn
Cn
FIRST FLOOR FRAMING...
ITI 0
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INSULATION ...................
Floor Insulation .........
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Wall Insulation ...........
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Ceiling Insulation .......
CD
SHEETROCK NAILING ...
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0
SPECIAL INSPECTION ...
0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
1 �4