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CITY OF EDIVIONDS�
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
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[PERMIT EXPIRES
USE PERMIT
ZONE L NUMBER i�qj'
JOB SUITE/APT#
ADDRESS '71
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit PlOqUired
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13
SIrent Use Permit Roq'd
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EXISTING — PROPOSED
Inspection Required
13
Sidewalk Required
13
REQUIRED DEDICATION— FT
Underground
winng required
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METER SIZE
LINE SIZE
NO. OF FIXTURES
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PRV REQUIRED
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YES 13 NO 13
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STATE LICENSE NUMBER ff�Plw1_0_N Dear_-T d-PECIKED Bd
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RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
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DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
E] ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
G I MECH
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OF USE
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OTIJER
FIR SPRINKLER
Ft ALARM
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NUMBER NUMBER OF CRITItAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
ENGINEERING REVIEWED BY DATE
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INSPECTION
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POSTED
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SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP
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LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (IT)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LJR SIDE REAR
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LOT AREA
PLANNING REVIEWED BY DAT
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REMARIKS__�'
CHECKED BY I TYPE F CWONTION E OCCUPANT
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SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] 'OrL LOAD
YES
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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VALUATION
$
FEE
Plan Check
HEAT SOURCE
GLAZING %
LOT SLOPE %
DATE
Building Permit
Plumbing
PLAN CHECK NO: VESTE)
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMI
COVERS WORK TO
Mechanical
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.)
SEPARATE PERMISSION.
ON THE PUBLIC
WILL REQUIRE
4 180 DAYS
Grading
Engr. Review
Engr. Inspection
Ir PERMIT APPLICATION: 180 DAYS
UJI
IL PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHI
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Description
State Surcharge
City Surcharge
FEE
*APPLICANI ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIG;S AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTERE�T. AGREES TO INDEMNIFY. DEFEND AND HOLD HAR 4LESS THE CITY OF
MS
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND A FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRE TLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PE MIT SHALL NOT BE
Landscapelnsp.
Total Amt. Due
a DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF A
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Y CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CIlYS ABILITY TO ENFC
NANCE PROVISION.4
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Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT
THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AU
FHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY Willi CITY AND STATE LAWS REGJLATING
CONSTRILIC-
CALL
I his application is not a permit until signed by the
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSOt
WILL BE EMPLOYED
Building Official 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 COM PEN SATIO N-INSU RANCE AND RCW 18.27.
OFFIC�V SIGN
DATE
SIGNATURE (OWNER ORIAGENT)
DATE S�GNED
(425)
771-0220
PED BY
DAT
ATTENTION
EXT
1333
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPRO�Al_ OR A CERTIFI. ORIGINAL - FILE YELLOW - INSPICTC
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC S CTION 109 PINK - OWNER GOLD - ASSESSOR
04!02 1 GREEN - ACCOUNTING
PRESS HARD -YOU ARE MAKING 5 COPIES
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Project Info
0 9 2003
Project Address 9 9 -4L bo
Date
For Building Department Use
Applicant Name:
[Applicant Address: I-q 6 o 5 m-M^� iz c
I Applicant Phone: / cr , C? V S
ffl�e�f beiliscription C] New Building [I Addition [F(Alteration Ea"'Plans included
J If plans not included, refer to WSEC Section 1513 for controls and commissioning requirements.
Compliance Option I rescriptive (D(Lighting Power Allowance 0 Systems Analysis
(See Qualification Checklist (over). Indicate Prescriptive & LPA spaces clearly on plans.)
Alteration Exceptions
(check appropriate box)
11:1 No changes are being made to the lighting
I [51-ess than 60% of the fixtures are new, and installed lighting wattage Is not being increased
Maximum
owed Lighting Wattage (Interior)
Location
(floor/room no.)
Occupancy Description
Allowed
Watts per ft2
Area in ft2
Allowed x Area
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** From Table 15-1 (over) - document all exceptions on form LTG-LPA Total Allowed Watts
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Notes:
1. Use manufacturer's listed maximum input wattage. For hard -wired ballasts only, the default
table in the NREC Technical Reference Manual may also be used
2, Include exit lights unless less than 5 watts per fixture.
V�^��nnAl T ;"16"-nd3r WnifnerA, 1Tnf-Dv4rJAist all fixtures. For exempt lighting, not exception and leave Watts/Fixture blank.
Location
(floor/room no.)
Fixture Description
Number of
Fixtures
Watts/
Fixture
Watts
Proposed
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Total Proposed Wafts may not exceed Total Allowed Watts for Interior Total Proposed Watts
L/6 o 0
Maximum Allowed
Lighting Wattage (Fixterior)
Location
Description
Allowed Wafts
per ft2 or per If
Area in ft2
(or If for perimeter)
Allowed Watts
Xft2 (or x IQ
Covered Parking
(standard paint)
Xf Ik
0.2 Wlfe
Covered Parking
(reflective paint)
RM7
0.3 WIfe
Open Parking
0.2 W/ft2
Outdoor Areas
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0.2 W/ft2
Bldg. (by facade)
Af /v�
0.25 W/ft'
Bldg. (by perim)
/i 1A
1 7.5 W/If
Note: for building exterior, choose either the facade area or the perimeter method, but not both) Total Allowed Watts
Use mfgr listed maximum input wattage. For fixtures with hard -wired ballasts only,
Proposed Lighting Wattage (F.Xterior) the default table in the INIKEL; i ecnnicai Keterence manuai may aiso be used.
Location
Fixture Description
Number of
Fixtures
Watts/
Fixture
Watts
Proposed
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Total Proposed Watts may not exceed Total Allowed Watts for Exterior Total Proposed Watts
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Occupancy established by this ce
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Maximum Occul
Owner of Building _
The Pho-Noodl,
of the Uniform Building
occupancy Is classified.
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DEPARTMENT OF BUILDINGS
IVER UNIFORM BUILDING CODE SECTION
4Y 99 # 101
Load
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Dat The d*
has beelllWed
by f4
as adopted by fc
Issued this 2?
ling Units: **N/A***
of d& Imlon: I
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,ermit # 2004-0094
sto as: I
Basement:
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PW'
remain i0tosted at times.
the 9 requirements of the 1997 Edition
cy and the use for which the proposed
rc
2004
CHIEF BUILDING OFFICIAL
BY: -
This coMficate shall be Posted In a conspicuous public area and shall not be removed, mullIsted or obscured and shall be maintained In legible condition at all times, Any change of occupancy or use requires a building permit and a now
Certificate of Occupancy Issued by the My of Edmonds Building Offlclal.
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUELDING DIVISION
0
FROM: DEPARTMENT DATE-
PLEASESIGN
ENGINEERING DIVISION DATE
pLeASESION
PLANNING DIVISION DATE
pLWESIGN
PROJECT
SITE ADDRESS_L�_-
PERMIT # '2, ct
INSPECTED —
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 :
X GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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MEMO TO:
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FROM:
PROJECT,
FINAL PROJECT APPROVAL FORM
TO:
DATE:
PERMIT COORDINATOR, BUILDING DIVISION
<: FIRE DEPARTMENT DATE
KEASE SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE -
PLEASE SIGN
d
SITE ADDRESS 2- 1 L�_� Z 2 ' 0/
PERMIT B# DATE INSPECTED 3
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 :
X GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a 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 inspector
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch ................. Z�
Retaining Wall ...........
M
Slab Insulation ..........
PLUMBING:
3:
Underground ............. 0 M
C
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0
Rough -In . ................... __40
Commercial Final ......
3: M
M Z
HEATING:
C
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Gas Test ................... >
Gas Piping ................. Cn
0 -n
Equipment ................. _n
-------------------
Commercial Final .......
M M
0
EXTERIOR SHEATHING 0
0 M
NAILING ........................ C cn
FRAMING ........................ 9 C/)
Q 0
Z
FIRST FLOOR FRAMING ...
INSULATION ................... __4
Floor Insulation ......... >
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Wall Insulation ...........
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Ceiling Insulation ........ ---------------- z
SHEETROCK NAILING ...
0
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SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR Oq
OCCUPANCY ..................
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