20040205.pdfW
DATE RECEIVED
. 1 -1 �� '- k1 1-1 PERMIT EXPIRES
i USE PERMIT
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CITY OF EDMONDS NUMBER U:7,1-
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
OWNER NAME/NAME OF BUSINESS --- --c
PLAT NAME/SUBDIVISION NO. POT NO LID NO.
MMILINU AULIKESS
ul LID FEE
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3: TESCIR Apprvv�ed[3
0 a +Vs, do 6 i zl-, 1 il,� PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pormil Roquirrid 13
CITY I Street Uso Permit Bond E3
ZIP TELEPHONE EXISTING — PROPOSED Inspect,rin Requirod 13
kj.�*I-�,�,�)i�t.-- ki"Opt'r> Sidnwalk Required 13
REQUIRED DEDICATION— F1 underground
Wiring rarimrod
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES13 NO E3
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ADDRESS REMARKS z
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0 OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONtROLYDRAINAGE E5
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CITY ZIP 7T ELEPHONE
NAME cBLn
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ENGINEERING REVIEWED BY DATE
ADDRESS
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FIRE REVIEWED BY DATE
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STATE LICENSE NUMBER VARIANCE OR CU SHORELINE OR ADB,1 INSPECTION BOND
EXPIRATION DATE REO'D POSTED
EIYES ONO S
(T 7Y 1
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PM COMPLETE I EXEMPT ALLOWED PROPOSED ALLOWED , PROP
CEL NO.
OSED
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EXP
NEW rnn RESIDENTIAL PLUMBING I MECH LOT COVERAGE Rtr rt= h�'WPI&S��I`Y�'-PROPOSED SETBACKS (Fr.)
ALLOWED PROPOS LJR SIDE REAR
COMPLIANCE OR *�- JRTJITE P9 E K94 0
ADDITION z
COMMERCIAL r%N 14! -) �i r, E
CHANGE OF USE A rr z
PARKING Lot A! PIX41IIINib 'RiF�iliwED 13Y DATE 5
REMODEL MULTIFAMILY SIGN ROVIDED CL
GRADING FENCE
REPAIR CYDS El ( — X _FT) REMARKS
DEMOLISH TANK E] OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED 13Y TYPq-0E �ONST J TION E— OCCUPANT
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jcp� GROUP
LU NUMBER u MBER OF CRITICAL
M OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
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ci STORIES UNITS NUMBER REQUIRED LOAD
DESCRIBE WORK TO BE DONE
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 5
-221-/ Lt) 0
VALUATION
Description FEE Description FEE
HEAT SOUREF-7 GLAZING % LOT SLOPE % Plan Check State Surcharge
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
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
U) Fire Review Plan Chk. Deposit
113
-i IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
cc 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 Landscapelnsp.
Total Amt. Due
0
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.0
I - - Recording Fee Receipt iff
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION 11.
GIVEN IS CORRECT; AND T14AT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- I his application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official of his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR. -CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATIONI�ISMA�CE AND RCW 18 27. F if
1, OFFICIALS IGN/rt IRF DATE
SIGNATURE (OWNER OR (4NT) DATE SIGNED (425)
)4- 771-0220 FIFIE, DATE
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 - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK-O%VNER GOLD,ASSESSOR
09103 PRESS HARD -YOU ARE MAKING 4 COPIES
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NOTICE: IF THE DOCUMENT IN THIS FRAME IS LESS CLEAR THAN THIS NOTICE
IT IS DUE TO THE QUALITY OF THE DOCUMENT.
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DAT
PLEASP SIGN
ENGINEERING DIVISION DATE
PLEASESIGN
PLANNING DIVISION DATE
PLEASCSIGN
PROJECT_/?0J( CJ 3
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SITE ADDRESS -
PERMIT # 90 0 9 /JrO,�� ADB# DATEINSP ECTED r 4/o I A,,,,S e":" C7'
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
7
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:teni1):b1dg:f6rn1s: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 r ..................
C f-hrriercial Final'
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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 ...................
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