20040176.pdfU
W
0
a:
4
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER N E/NAME OF BUSINESS
r,77,OS7'?�� pi-n-5611111vo
:41
MAILING ADDRESS
CITY
N171(l)V-d f
NAME
I CITY
NAMEF
,&0 r
11�
IIIN 4 Ito /"4)fs r
ZIP TELEPHONE
ZIP I TELEPHONE
C)
PERMIT EXPIRES
USE PERMIT
ZONE
NUMBER
JOB
ADDREt�e,,,--5-
PLAT NAME/SUBDIVISION NO.
SUITE/APT#
LOT NO LID NO.
LID FEE S
IESCP Appiowod
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
P '
RW Permit Required
— PROPOSED
Silent Use Permit Req*d
Inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT
E
underground
Wiring required
1EXISTING
METER SIZE
M
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES NO
iEMARKS
I R
WNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
0 OV
ADDRE
01.,&x 31;�
CITY ZIP T—TEL PHONE
T
-,;>—
roe,
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
FX�4rac / aer Rc,( lelllle-ee MQ,,/ I
PROPERTY TAX ACCOLINT PARCEL NO
NEW
�RESIDENTIAL
PLUMBING I MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
( X_
DEMOLIS H
NK OTHER
�TA
EiGARAGE
RETAINING WALL
13
Ej FIRE SPRINKLER
ALARM
CARPORT
ROCKERY
FIRE
CrYPE OF YSE, BUSINESS
OR ACTIVITYI,-.qPLAIN:
il"I
//- ZAIV)
Ilece'api-s-nolvIltie
IN
NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
STORIES
UNITS
NUMBER
DESCRIBE WORK 10 BE DONE
FIT)
Sefai:24t UPT
r r
C AP I-Zleln
a4w- 6�e44
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: 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.
ul PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
in 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Cn
!I IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
W
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
C3
_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
2 NOR LIMIT IN ANY WAY THE CITY'S 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 QF_JHE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S,C0MPCNsATION INSURAbjCE AND RCW 18.27.
AGE
MU "T B� "RESENT FOR
ENGINEERVAHrFFEY, RL(71`10VAL OR CA PATE
FIRE REVIEWED BY
_111-14CE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP I
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D I PROVIDED
REMARKS
DATE
SHORELINEORADBN INSPECTION BOND
REO'D POSTED
OYES ONO I S
r SIGN AREA HEIGHT
I ALLOWED I PROPOSED I ALLOWED I PROPOSED
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT UR SIDE REAR
LOT AREA I PLANNING REVIEWED BY DATE
CHECKED BY ITYPE O=FSTRUC ION OCCUPANT
z V� GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES I LOAD
0
W
z
z
a
z
w
W
0
z
z
z
5
CL
REMARKS I a
Z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D FS
J!
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
TT-
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. DeposiT
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
:3& 9,
CALL
FORINSPE
c7
(425)
771-0220
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
-IN,, receipt is acknowledged in space provided.
_YF�l 15S SIGNATUf D7ATE
,j __7
ED BY 16ATE
A17ENTION 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
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
GREEN - ACCOUNTING
z
0
i
0
M
I .
0 M
C
M 0
0
0
0 C:
-1 K
X M
M Z
g) --I
C
M
Cl)
0 -Ti
n
M M
0
0
M
In 0
Z
X
z
z
0
i
0
M
RECEIVED
FINAL PROACT APPROVAL FORM MAR 0 4 2004
DEVELOPMENT SERVICES CTR.
TO: CITY OF EDMONDS
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE3— (�,d
PLEASE SIGN
ENGINEERING DIVISION DATE—
PLEASESIGN
PLANNING DIVISION DATE
PI EA E SIGN
PROJEC
110
SITE ADDRESS A,1
PERMIT _ADB# INSPECTED
DESCRIPTION OF WORK TO BE INSPECT V3 7— (2 CJ A-1 Il A'� Ai7 si= -L�
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
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
1 .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
ocaprv1.doc.1:temp:b1dg:fbnns 10/01
z
0
A
0
M
--i -n
U5 --I
0 M
C
M 0
0
-4 ()
0 C:
M
MZ
01
C
3:
o -n
n;u
_4 >
x ?.
MM
0
0
Q M
C Cn
9 Cf)
M
Z
M
z
--A
a:
Cl)
z
0
1
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 .................. 40��_ 3)
z
0
1
0
M
--f -n
0 M
C
M 0
0
-10
0 C
--I
M
M Z
n, -1
C
0 -n
M M
0
0
0 M
C)
0)
M 0
Z
-A
z
0)
z
0
i
0
M