20040196.pdfDATE RECE
C1W OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
OtJe j4oN 10N� AHO (1
CC MATTING ADDRESS
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CITY Ij OS ZIP TEL.EPHONF
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NAME
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CITY ZIP TELEPHONE
NAME CB IF
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ADDRESS
CITY
PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB SUITE/APT#
ADDRESS
PLAT NAMEISUBDIVISION NO LOT NO LID NO.
LID FEE $
I ESCP Approwd 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit floquirod A
S!root Use Porroil Floq'd 13
EXISTING — PROPOSED
Inspection Requilrid
Sidewaik Roquifed
REQUIRED DEDICATION F1
Underground
13
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
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YES NO
REMARKS
OWN ER/CON TRACI OR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
P" �10WA"Jffivi 21WY
RING REVIEWED By _ DATE
Vr L Jo's
-4653
STATE LICENSE NUMBER
�XPIRAIION DATE CHECKED BY
V FIIANCE OR Q6
7
17N r U 4 0 01 4>1 M
fl / / eM 441-av
SEPA REVIEW
PROPERTY TAX ACCOUNT PARCEL NO.
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COMPLETE EXEMPT
0 03 6 L'I I OC�' 14) 0 OT-)
,
EXP y
NEW RESIDENTIAL
1:1 PLUMBING I MECH
LOT COVERAGE
ALLOWED PROPOSED
ADDITION COMMERCIAL
COMPLIANCE OR
13 CHANGE OF USE
0
REMODEL MULTIFAMILY
SIGN
PARKING
PROVI
REQ'D DED
GRADING FENCE
REPAIR CYDS ( x FT)
'L"-
REMARKSLI_,'
DEMOLISH TANK
OTHER
C,
GARAGE RETAININGWALL
CARPORT ROCKERY
FIRE SPRINKLER
El FIRE ALARM
C.,
11
CrYPE OF USE, Bu�� ESS OR APTIVITY) EXPLAJN: E C _�'_ . ' — -
, I /) h ) Y'�% A / / /I -, \ r,=ECKEDBY [E�of
NUMBER
OF 3
STORIES
NUM13ER OF
DWELLING
UNITS
CRITICAL
AR
NU
DESCRIBE WORK TO BE DONE
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HEAT SOURCE
GLAZING %
LOT SLOPE %
PLAN CHE
N�/ 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. I 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 INTERES r, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMi ESS THE Cl T-Y OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDiRECTI-Y
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF IHIS PERMIT SHALL NOT 13E
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILIFY 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 IHE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING 1-0
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27
6
SIGNAT(RE) R Ad N DATE SICINED
DATE
7�
SrRELINE OR ADIII
INSPECTION
BOND
REO'D
POSTED
OYES
ONO
HEIGHT
ALLOWED PROPOSED
ALLOWED PROPOSED
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REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT)
FRONT SIDE REAR
FRONT IJRSIDE HEAR
LOT AREA
I PLANNING REVFEWED 13Y DAT
CONSTRUCTION
SPECIAL INSPECTION JAREA
REQUIRED JK YES I
OCCUPANT
GROUP
OCCUPANT
LOAD
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REMARKS a
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D I �q
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771.nt3gn
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
7
Receipt #
Total Amt. Due
I Receipt #
APPLICATION APPROVAL
I his application is not a permit until signed by the
Building Otficial or his/her Deputy and Fees are paid, and
receipt is acknowledged in space provided.
DATE
RFI 'E��
ATTENTION EXT 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
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
1) fly
DATE
4
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OHIGINAL - FILE YELLOW - INSPE(iroR
PINK - OWNER GOLD - ASSESSOR
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PARKING DISRUPTION/CLOSURE FEE
CALCULATION
Project/Address: One Ten James 1110 James
calculated by Jeanie McConnell Date: 1 1-Mar-04
Bars#: 111.000.000.344.120.000-000-00
Assessed Land value (per County Assessor)
of abutting property
Area of abutting property (sf) x
Assessed land value per square foot of abutting
property (land value divided by area of property)
disruption/closure multiplier(l%)
I% of assessed land value per square foot
(land value per sf x disruption multiplier)
Parking area disrupted in square feet
8.5 ft wide > 88 ft long -
Monthly parking disruption fee
(1 % land value per square foot x area of sidewalk disrupted)
Estimated number of months of disruption
SUBTOTAL PARKING DISRUPTIONICLOSURE FEE
ADMINSTRATIVE PROCESSING FEE
(fee to be paid prior to permit issuance).
TOTALFEE
$ 700,000-00
(divided by) 30,056 sf
(equals) $ 23.29 per sf
(times) 0.01
(equals) $ 0.23 per sf
(times)
748 sf
(equals) $ 174.21 per mo.
(times) 12
(equals) 2, 0 �-5 0
(plus) $ 140.00
(equals) $ 2 2
NOTE:
The above fee must be paid prior to or at the time of permit issuance.
If actual months (or portion thereof) of disruption is more or less, then
a fee adjustment will be made at the time of Engineering final inspection.
as of 23 Apr 03
v.vnstr formsxd1sruption-closure fees
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FINAL PROJECT APPROVAL FORM
TO: C>�
DATE: 10 A 21,914
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
PLEASP SIGN
PLANNING DIVISION DATE 1c, — 1 o c4
PLEASE SIGN
PROJECT W-Awpf-AN-A re'7'�'rf
SITE ADDRESS
PERMIT# W24019 6 ADB#_ DATE INSPECTED i o — i a — o cA
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/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRE CTION NOTICE given to owner/contractor by inpector
2.
3.
RE-fNSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJ E CTAPPROVAL
Date Signature
1AetnP:b1dg:forms:ocaprv1 3/25/04
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
ME-ASF SIGN
k ENGINEERING DIVISION DATE_ZW
PLEASE SIGN
PLEASE SIGN —PLANNING DIVISION DATE
PROJECT
SITE ADDRESS
PERMIT#20(0q- Q19�6 ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED /I
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
I .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
o Copy of CORRECTION NOTICE given to owner/contractor by inspector
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3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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FINAL PROJECT,,kPPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLFASIF SIGN
olvc-2L,6C� 44_ ENGINEERING DIVISION DATE
PLWE SIG?4 v
PLANNING DIVISION DATE.
PIy_kSE SM
PROJECT____4Z0/ [A A A r-
SITEADDRESS___.,/_`�/`��
PERMIT (2)Q4- / 9
_6 _ADB# 'DATEINSPECTED ')(11140-5e
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 B.ONDS and the granting of:
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
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
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2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PEF2VVr'JQOO R, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
_7 MEASE SION V
ENGINEERING DIVISION DATE—
nXASF SIGN
PLANNING DIVISION DATE —
PLEASE SIGN
PROJEC k /1-1— C_(1
SITE ADDRESS__�� M4��
PERMIT # ADB# --PATE INSPECTED 2-
DESCRIPTION OF WORK TO BE INSPECTED —r-O <-,
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
1 .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
c3 Copy of CORRECTION NOTICE given to owner/contractor by inspector
1 .
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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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 ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING 11's
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
1,91
07-
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