20040153.pdfI
DATE RECEIVED
PERMIT EXPIRES
oil I I
USE PERMIT
01% 1 ^C! 0r%RA^K1nQ% ZONE A 1'.1-1/
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
i-I i t �:� A i "�.
MAILING ADDRESS
Oq
2 2 5 15
CITY ZIP TELEPHONE
7: 'ijo; -1
11J... IS 98026 425 670 1918
NAME
ADDRESS
CITY ZIP
NAME
ellu;ab Si,,ns lnc.
ADDRESS
909 S. 28t"t St.
CITY ZIP
T a c o ra i_�i 98/109
STATE LICENSE NUMBER
pr
.UUT"�BSI077QS
PROPERTY TAX ACCOUNT PARCEL NO
27042900307400
TELEPHONE
CBL H
TELEPHONE
253) 473 3323
EXPIRATION DATE Cq C
11/10/05
BY
NEW
RESIDENTIAL PLUMBING / MECH
ADDITION
COMPLIANCE OR
El OF USE
��COMMERCIAIL
CHANGE
REMODEL
MULTIFAMILY El SIGN
REPAIR
GRADING
CYDS
FENCE
0 ( X FT)
DEMOLISH
TANK
o OTHER
GARAGE
RETAINING WALL
El
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
Retail
Dru., Store
NUMBER
OF
NUMBER OF Ki �1
DWELLING
CRITICA
AREAS
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
t-.,.,o e,--.istin-. wall si.---is vad
install
t,w-o n,�Dw and an awnizzig owar
"rivs., ti-,ru window. R%-Ianiovc- e,zisting-
-ffaces in -jylon sign & install nn-w.
.9
HEAT SOURCE
GLAZING %
LOT SLOPE %
PLAN CHECK NO' -- / -. 1 (-�4 VESTED DATE
C', / I tj I
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.
cc PERMIT APPLICATION: 180DAYS
W
IL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS ANO SUCCESORS
iO IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 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
_j
P NOR LIMIT IN ANY WAY THE CI1YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY ACKNOWLEDGE THAX 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 LABOR.,CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATI(?N INSVANCE AND RCW 18.27.
7�AT FR E", N�Ell OR �612NTI DATE SIGNED
_NUMBER.�(.,,/
Inn I
9150_�
0"ITCIADT#
ADDRESS _. "", ? , . I i / .� .
PLAT INAMEISUBDIVISION NO. LOT NO. LID NO.
LID FEE $
TESCP Approved
13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Required
D
Street Use Por-mil Roq'd
E3
EXISTING — PROPOSED
I
Inspection Required
[3
Sidewalk Required
El
REQUIRED DEDICATION— FT
Underground
Wiring required
13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
I
YES 0 NO 13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
A,10 1&1SP- C0770� 15W)0
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
DATE
VARIANCE OR CU
SHORELINE OR ADBN
I INSPECTION
BOND
11A_ 0 3 _,-1,4
-03-1�j
k REO'D
YJ
YES ONO
I S
POSTED
SEPA REVIEW
SIGN AREA' N
HEIGHT
COMPLETE EXEMPT
ALLOWED PQJ;?SED
ALLOWED
PROPOSED
I V'
1 -7
, -1;t5 �
PaW41pel4l
putump�i
EXP
,O�
LOT COVERAGE
REQUIRED SETBACKS (�T)
PROPOSED SETBACKS (FT)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT
LJR SIDE REAR
A
PARKING
LOT AREA
PLANNING REVIEWED BY
DATE
REQ'D__j PH - OV to . E . D _
REMARKS
CHECKED BY TYPE OF CONSTRUC ION OCCUPANT
GROUP
_.j.COQjE
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED 0 YES I LOAD
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REMARKS j0K
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D- 9
ATTENTION L" "
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
04/02 PRESS HARD -YOU AF
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
FEE Description
/W State Surcharge
F / / )/ City Surcharge
a
FEE
PlanChk.Deposit
Receipt M d. 4
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building Official or his/tier Deputy: and Fees are paid, and
FOR INSPECTION— ., recuiptis acknowledged inspaco provided.
OF I iALSSIGNATURE DAT E
(425) 0:111/
771-0220 . E
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1333,
E/MAK1qq5 COPIES
T E
ORIGINAL - FILE YELLOW - INSPECTO
PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
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FINAL PRO-MiCT APPROVAL FORM
TO:
DATE: -
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: -FIRE DEPARTMENT DATE,
PLEASE SIGN
_ENGR-�EERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
>2�t
PLEASE SIGN
PROJECT_4�__�� I
SITE ADDRESS,;'��C,��)
PERMIT tt ADB# DATEINSPECTED ZT /co -
DESCRIPTION OF WORK TO BE INSPECTED
U
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
E] Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of CORRECTION NOTICE given to owner/contractor by inpector
1.
2.
3. ,
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbrms:ocaprv1 3/25/04
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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 ....................
GasPiping .................
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 ..................
02004. 01-55
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