20040076.pdfV
DATE RECEIVED
PERMIT EXPIRES
CITY OF EDMONDS ZONE r� USE
PERMIT NUMBERAL,/7o
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CONSTRUCTION PERMIT APPLICATION JOB ADDRESS SUITE/A Tk
153 /�Well)�_
O�WN�E.R NAMEINAME OF pUSINESS C ([
19
qa�17 PLAT NAME/SUBDIVISION NO L NO. LID NO.
¢ MAILING ADDRESS / �(/U W LID FEE S
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Z 1 . TESCP Approved ❑
30a530 O/ ',n �� e' , �` PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required ❑
�,) Street Use Permit Roq'd ❑
CITY ZIP TELEPHONE EXISTING PROPOSED Inspection Required ❑
Sidewalk Required ❑
���� REQUIRED DEDICATION FT Underground
��' �CC///���"' Q U t/ � I wiring requires ❑
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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YES ❑ NO ❑ z
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ADDRESS REMARKS zz
= OWNER/CONIRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 17
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CITY ZIP TELEPHONE
NAME CBL N%
ENGINEERING REVIEWED BY DATE
ADDRESS
FIRE REVIEWED BY DATE w
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TELEPHONE /
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STATE LICENSE NUMBER EXPIRATION DATE ECKE y VARIANC CU SHORELINE OR ADBq INSPECTION BOND
REQ'D POSTED
1 `� r • r v V// �V I (/ _—��CJ YES ONO -s
SEPA REVIEW SIGN AREA HEIGHT
i PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT LLOWED PROPOSED ALLOWED PROPOSED
D ' EXP `p. Ci L_. Y . r
❑ NEW ❑ RESIDENTIAL ❑ PLUMBINGlMECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMPLIANCE OR ) z
❑ ADDITION COMMERCIAL ❑ CHANGE OF USE 4" 9L'1x- z
PARKING LOT AREA PLANNING REVIEWED B DATE ag
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
FENCE J-x C
❑ REPAIR ❑ GRADING CYDS ❑ (FT) RE K
OTHER � _ ^ T. .� 1
❑ DEMOLISH ❑ TANK _
GARAGE RETAINING WALL FIRE N R , �,� ~, l `
? ❑ CARPORT ❑ ROCKERY ❑ FIRE ALARM
i (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
= CHECKED BY TYPE OF CONSTRUCTION CO E OCCUPANT
Dral%64
GROUP
+� NUMBER NUMBER OF CRITICAL / I
D OF DWELLING _ AREAS SPECIAL INSPECTION AREA OCCUPANT
D STORIES UNITS `! NUMBER REQUIRED ❑YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
T PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D a
�r& S S 1/L
VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit City Surcharge
PLAN CHECK NO: / J VESTED DATE Plumbing
0/.
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
w PERMIT APPLICATION: 180 DAYS
n PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
N 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review C 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 #
Ir
a ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
= FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landsca a Ins ,
S DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE P P• Total Amt. Due
= NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt k
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVA
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTIIORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a pennit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building 011icial or his/her Deputy: and Fees 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 COMPENSATION INSURANCE AND RCW 18.27
O�CIAI: � 1i6NATU .� t TE
I ATURE (OWNER OR T) DATE SI ED (425) �`.�, r % - I i �l
VIL
I fir'/Ck. 771-0220 7 -L {, !
H LEAS D BY DATE
ATTENTION EXT 1333 ( / / , U
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 11
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CE T FI- ORIGINAL -FILE YELL • INSPE TOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 �V16
L('` l y'��/INK - OWNER GOLD ASSESSOR
0.1j02 PRESS HARD ' O ARE MA 5 CO / GREEN - ACCOUNTING
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TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM:_-��= FIRE DEPARTMENT DATE
PLEASE SIGN
PROJECT
SITE ADDRESS
ENGINEERING DIVISION DATE
PLEASESIGN
PLANNING DIVISION DATE
PLEASE SIGN
L K M-n r (.
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PERMIT #. J07( ADB# DATE INSPECTED C�-1 - 0S4
DESCRIPTION OF WORK TO BE INSPECTED
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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
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
❑ Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
❑ Copy of CORRECTION NOTICE given to owner/contractor by inpector
1.
2.
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3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT
Date Signature
1:temp:b1dg: fonns:ocaprv13/25/04
APPROVAL
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
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SETBACKS .....................
FOUNDATION:
Footing ....................:.
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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 FRMw
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