20040087.pdf9
0 e!!5- 6 (C-�67
TELEPHONE
16111M.
TELEPHONE
=&Ac7Oj? W0 55!�; 60VO
STATE LICENSE NUMBER EXPIRATION DATE r CHEC
PROPERTY TAX AC(;OUNT PARCEL NO.
0;77 0 ;2� -L- -:�; 0 0 e+ Ol (::5) 0 0
1:1 NEW 1:1 RESIDENTIAL
ADDITION 10 COMMERCIAL
REMODEL 1:1 MULTIFAMILY
REPAIR 11 GRADING CYDS
DEMOLISH TANK
GARAGE RETAINING WALL
CARPORT ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
I X FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
ul
I PERMITEXPIRES LWif�r
USE PERMIT
ZONE 54�� ' M -117
NUMBER 008
JOB SUITEJAPT#
ADDRESS Ve, !�;P.
PLAT NAMEISUBDIVISION NO,
LOT NO.
I
LID NO�
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
ILSCP Approved 11
RW Prifind Floquired 13
EXISTING - PROPOSED
Surial Use Parinit Roq'd 13
Inspection Required 13
sidewalk l4equired 13
REQUIRED DEDICATION� FT
Undargratiod
Wiring required 13
METER SIZE LINE SIZE NO. OF FIXTURES
PRV REQUIRED
YES 13 NO
cc
W
REMARKS
z
OWNER/CONTRACIOR RESPONSIBLE FOR EROSION CONTROLYDRAINAGE
z
F3
z
w
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP I
LOT COVERAGE
ALLOWED PROPOSED
N .
PARKING
REO'D I PROVIDED
'Af L, I
REMARKS
W
cc
a:
SHORELINEORADB#
I INSPECTION
BOND
IREQ*D
EIYES 13NOIS
POSTED
—
SIGN AREA
HEIGHT
ALLOWED PROPOSED
ALLOWED PROPOSED
7-,A 0 2,73P
I
/\/c,
,
REOMED SET13ACKS (Fr)
PROPOSED SETBACKS (FT)
FRONT SIDE REAR
FRONT L/R SIDE REAR
N (1,
IV6
z
E
z
LOT AREA
PLANNING REVIEWED BY
DATE
I
I 17,117,of
CHECKED BY ITYPE OF POP
NUMBER NUMBER OF CRITICAL
OF G
M DWELLIN AREAS SPECIAL INSPECTION JAREA
0 STORIES NITS NUMBER t��
04 REQUIRED [] YES
DESCRIBE WORK TO BE DONE I
h-4 5-T-1z L-1—
HEAT SOURCE
GLAZING %
LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Etc
Lu PERMIT APPLICATION: 100DAYS
IL PERMIT LIMIT 1 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
W 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 INDIRECT LY
FROM THE ISSUANCE OF rHIS PERMIT ' ISSUANCE OF THIS PERMIT SHALL NOT 13E
-j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 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 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 OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
iii;Q
NATURE IWNER96AGENV DA7TE ,IGN7E0,
e
il-ic. I / 0 0
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNE� NAME/NAME OF BUSINESS
4�;7 e:�,2 1,e-, A Lz�
MAILING ADDRESS
706
CITY ZIP TELEPHONE
7A 'ME
uj
L- ADOR SS
x
0
CITY ZIP
NAME
ADDRESS
682,1�
CITY ZIP
OCCUPANT
GROUP
OCCUPANT
LOAD
REMARKS a
z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D S
VALUATION
Description
Plan Check
Building Permit_
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
FEE
Description
ii;? 0
State Surcharge
/00
City Surcharge
Base Fee
,,� CALL
OR INSPECTION
(425)
771-0229,---.,,
ATTENTION " r E)a 13
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE TIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL Oil A CE R I-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09/03 PRESS HARD -YOU ARE MAKING 4 CC
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
I I ��-
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 providud.
F ALS SIGNATURE DATE j
ES
BY ^ - I' DA
ORIGINAL - FILE YELLOW - INSPL&TC
PINK - OWNER GOLD - ASSESSOR
z
0
4
0
ITI
=i =55
zii --j
3:
0 M
C
M 0
0
10
0 C
—4 K
X M
M Z
10 —4
c
x
Cn
0 -n
n
--I
x
m rn
0
0
0 rn
C Cn
K Cn
111 0
Z
7'
r
z
cn
z
0
1
0
M
r
FINAL PROJECT APPROVAL FORM
TO: Pt
DATE-_�//a
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PIX.ASE SIGN
ENGINEERING DIVISION DATE—
PLZASF SIGN
PLANNING DIVISION DATE �25
PLEASKSiGN
PROJECT
SITE ADDRESS-J
PERMIT itpuo- �Oo�v� ADB# DATEINSPECTED 4121of
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:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
C3 Copy of CONDITIONS given to owner/contractor by inspector
I
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
c3 Copy of CORRECTION NOTICE given to owner/contractor by inspector.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
ocaprvi.doc.l:temp:bldg:fomisIO/OI
z
0
i
0
M
--I -n
V5 --i
3:
0 M
C
M 0
0
--1 0
0 C:
--i K
7- M
MZ
0-4
C: —Z
Cn
0 -n
n X
>
M M
0 U5
0
0 M
C U)
?. Cn
Q
Z
71 M
3:
z
U)
z
0
M
'I
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
z
Retaining Wall ........... 0
--I
Slab Insulation .......... 0
M
PLUMBING:
-n
Underground .............
Rough -in ................... M
M 0
0
Commercial Final ...... 0
0 C
HEATING:
M
M z
Gas Test .................... ID
C
Gas Piping ................. > z
Equipment .................
o -n
Commercial Final ....... -n
EXTERIOR SHEATHING M M
NAILING..........................
0
0 r
FRAMING ........................ M
C: CD
FIRST FLOOR FRAMING ... K Zn
M 0
Z
INSULATION ...................
Floor Insulation .........
Wall Insulation ........... >
z
Ceiling Insulation .......
Cn
SHEETROCK NAILING ... z
0
SPECIAL INSPECTION ... --i
0
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................