20040150.pdfDATE RECEIVED
CITY OF EDMONDS I
CONSTRUCTION PERMIT APPLICATION
OWN EINAME OF BUSINESS
NAM
7
AU/1 /1
VAILING ADDRESS
h12t // 4�
CITY ZIP LEPHONE
P4,
'z
NAME
ADDRESS
CITY/),/,// ZIP TELEPHONE
NAME
ADDRESS
CITY ZIP TELEPHONE
PERMIT EXPIRES
USE PERMIT
ZONE z
NUMBER
JOB SUITE/APT#
ADDRESS J .4 Z 'Ifi .4 ) . 7 1
PLAT NAME/SUBDIVISION NO.
LOT NO.
L�D V
L D $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 13
FIW Permit Required [3
street Use Permit Peq'd 0
EXISTING — PROPOSED
inspection Required 13
Sideivalk Required 13
REQUIRED DEDICATION— Fr
I Underground
I wiring required C3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
0
RE-INSPE
ON REQUIRED
li YES 13 NO 13
z
REMARKSO STREET TO BE CLEANED OF DEBRIS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE a
z
0 SIDE SEWER MUST BB CAPPED AT tu
CBL # HOSE BIB WITH AVB INSTALLED
ENGIN"FIVTWAT APPROVED DUMP S11WONLY
LICENSE NUMBER EXPIRATION DATE I CHECKED BY
TAX ACCOUNT PARCEL NO.
, /-,, a jo-, 7 Zoo, 1,2' A
NEW ESIDENTIAL PLUMBING / MECH
ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
REMODEL MULTIFAMILY SIGN
REPAIR GRADING FENCE
CYDS ( x FT)
DEMOLISH TANK E] OTHER
GARAGE RETAINING WALL FIRE SPRINKLER FIT)
CARPORT 13 ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN;
IF C-- � f 5 / 6 4 � �_/7 —/W
NUMBER NUMBER OF CRIIII CAL
OF DWELLING AREAS
I STORIES UNITS NUMBER
DESCRIBE WORK TO 13E DONE
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHEC"O:A 11"_7 .� �� I VESTED DATE
THIS PERMIT AUTHORIZES 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.
PERMIT APPLICATION: 180 DAYS
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
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 ENFORCE ANY ORDINANCE PROVISION.4
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DUtY 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 LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPIENSATION INSURANCE AND FICW 18.27.
SIGNAT�51((OWNER %iAGENT) DATE SIGNED
FIRE IEIIJED Uj
CHECKLIST ON BACK OF JOBDCARD
FOR INSPECTION REQUIREMENTS
VARIANCE OR CU SHORELINE OR ADBI I INSPECTION I BOND
REO'D POSTED
OYES ONO IS
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED I ALLOWED . PROPOSED
EXP I
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS FT)
FRONT SIDE REAR FRONT LIR SIDE REAR 0
z
z
PARKING I LOT AREA I PLANNING REVIEWED BY DATE _j
REQ'D I PROVIDED (L
REMARKS
CHECKED 13Y I TYPE OF CONSTRUCTION OCCUPANT
I V7 GROUP )e 5?
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REQ'D I �
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
FEE Description FEE
State Surcharge
City Surcharge
0
(425) 1(
771-0220 —R
AITENTION I 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
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
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.
71GIALS SIGNATURE DATE
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
GREEN - ACCOUNTING
:3
to
z
0
I
0
M
--i -n
M
M 0
0
__10
0C
I K
2: M
M Z
ID
C
z
--I
M
Cn
0 -n
n X
>
M M
0
0
M
rj)
Cn
Q 0
Z r—
.qT
X
--I
z
0)
z
0
q
0
M
FINAL PROM
PROVALFO
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILD
G DIVISION
FROM:
FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
FICAS11 SIGN
PLANNING DIVISION DATE
PLEASESIGN
PROJECT
SITE ADDRESS____� 60(,e Ow2 WOAA
PERMIT _,kDB#
DATEINSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
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
0 Copy of CONDITIONS given to owner/c
ntractor by inspector
FAILED FINAL INSPECTION - OUTSTANDINCJ ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GPANTF INAL PROJECT APPROVAL
Date Sigiiaturc
1:temp:b1dg:fomis:ocaprv1 3/25/04
z
0
M
--i -n
FA- -1
' X
0 M
C
M 0
0
--I (-)
0
M
M Z
M
CD
o -n
nx
>
M M
0 U5
0 r-
0 M
C Cj)
9 Cn
M 0
Z r-
M
X
—i
r
z
--I
X
C/)
z
0
i
0
M
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
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 FOR
OCCUPANCY ..................
z
0
1
0
ITI