20040197.pdfDATE RECEIVED
hell z/ ERMIT EXPIRES
�L I FP
USE PERMIT
CITY OF EDMONDS ZONE NUMBER,:!2�z'�/�/_-6/z�7
,JOB SUITE7AP1 #
CONSTRUCTION PERMIT APPLICATION ADDRESS CIC�� Vj
OW E NAM -/NAME OF VWSINESS
if PLAT NAMEISUBDIVISION NO. LOT NO LID NO
Lx MAItING ADDRESS LID FEE $
u
IESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Rooluned
O_ Street U50 Permit HO(I'd 0
CITY EPHONE EXISTING - PROPOSED Inspection Required 13
TEI. Sidewalk Roquired 13
REQUIRED DEDICATION- FT Underground
ZIP Wiring required 0
NAME METER SIZE LINE SIZE NO OF FIXTURES PRV REQUIRED
qN
7�F �FIURE,' YES 1:1 NO 13 z
U tu
W� z
It= ADDRESS REMARKS z
3:
OWNER/CON11RACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
z
cc LU
CITY ZIP ___—ITELEPHONE
NAME CBL
C' cmMazc" zf
ENGINEERING REVIEWED BY DATE
Cr
0 _�DDR ��s
AU-1b" Q) x FIRE REVIEWED BY DATE ul
CITY TELEPHONE E
U.
0 Lt-
:Z�_/ t-1 ..2 _5
bn� vwm qZ" -51 , �6 - (10 VARIANCE OR Cu HOREL7177 OR 7ADB# INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY REO'D POSTED
0 SEPA REVIEW SIGN AREA OYES 11NOIS HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
W
_j 7 EXP
El NEW RESIDENTIAL 1:3 PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
COMPLIANCE 08 z
z
El ADDITION COMMERCIAL CHANGE OF USE z
PARKING LOT AREA I PLANNING REVIEWED BY DATE 5
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED
GRADING FENCE
REPAIR CYOS ( X. FT) REMARKS
DEMOLISH TANK OTHER
GARAGE E] RETAINING WALL �KLER
z CARPORT ROCKERY IEPF�IREALAR
(TYPE OF USE, BUSINESS OR ACTIV�T)COE
CHECKED BY jTYfEjOF CONS�RUCTIO CO OCCUPANT,,�3
RE S�10 GROUP
0 A IT I
CRITICAL
rj NUMBER NUMBER OF
OF DWELLING AREAS
SPECIAL INSPECTiON AREA OCCUPANT
0 STORIES UNITS NUMBER REQUIRED [] LOAD zlq
i YES
DESCRIBE WORI< TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
M
CA - C) C 00-� [I-y', VALUATION
$
+e no n-�_
Description FEE Description FEE
Plan Check State Surcharge E Z17,5 e2
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE'WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURDS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REGuinE Grading
SEPARATE PERMISSION.
Engr. Review
Ir
W PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
OAPPLICANT. ON 13EHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS Fire Review R4afi4glal�-Deposit e�
Lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMI ESS THE Cl FY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt N 44(
ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF "THIS PERM17 SHALL NOT BE
0 Landscapelnsp. Total Amt. Due
_j DEEMED TO MODIFY� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR I IMIT IN ANY WAY THE CITYS ABIL11-Y TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee eceipt #
=R
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR T14E DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by the
TION AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON W11. L BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VI'OLATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION rLceipl is acknowledged in space provided.
WORKMEN'S COMPENSATION - INSURANCE AND RCW 18 27.
OFFICIALS, I NATURE DATE
SIGNAM� 0 WEN DATE SIQNED (425) -14 3A -
41- !kn Ill n 771-0220 RV.FASED BY DATLT
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- ORIGINAL FILE YELLOW - 41NSS -CIOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD ASSESSOR
09iO3 PRESS HARD -YOU ARE MAKING 4 COPIES
z
0
11
0
M
--i -n
&5 --1
X
0 ITI
C
M 0
0
--1 0
0
M
M Z
IC) --i
C
o -n
n
M M
055
0 r-
0 M
C= C/)
9 (n
M 0
z
7-1
z
U)
z
0
i
3
IT!
I
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: <L— FIRE DEPARTMENT DATE cLLC,--G�f_
PLEASESIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJEC
SITE ADDRESS_1=L2A1
PERMIT �)_00 (-/ — 0
�ADB#________PATE INSPECTED
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
I .
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:fomis:ocaprv1 3/25/04
z
0
4
0
M
--i -n
0 M
C
M
0
--i C-)
0 C:
-4 K
M M
M Z
r') --i
C
Cn
0 -n
nx
__q >
M ?.
MM
0
0
0 M
Cf)
Q C-)
Z r-
M
x
--I
X
z
--I
M
Fn
z
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:
GasTest ....................
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
M
—i -n
0 M
C
M 0
0
0 C
M
M Z
C
C/)
o -n
n
M M
0
0
0 M
C W
M 0
Z
z
Cl)
z
0
_q I I
0
M