20040222.pdfrz/
-zl [PERMIT EXPIRES
USE PERMIT
C1W OF EDMONDS ZONE N U M B E R
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
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OWNER NAME/NAME OF BUSINESS LL ?�—tl
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
cr MAIL ING D 11
U1 111,111, SS
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP FESCP Approved 0
0 RW Permit Required 0
Street Use Permit Floq'd [3
CITY ZIP TELEPHONE EXISTING_ PROPOSED inspection Required 13
Sidewalk Required Ell
REQUIRED DEDICATION— FT underground
�3 Yvinng required 13
NAME METER SIZE LINE SIZE 0. OF FIXTURES PR - V REQUIRED 0
L) YES 11 NO 13 9
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0 OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE z
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CITY IP TELEPHONE W
NAME CBL#
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CITY ZIP TELEPHONE FIRE REVIEWED BY DATE ul
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STATE LICENSE NUMBER EXPIRATION DATE Y VARIANCE OR CU SHORELINEORADB#j INSPECTION BOND
I REO'D POSTED
FILI-Coa �*Cpa /91--f 10YES EINOI$
�x PROPERTY TAX ACCOUNT PARCEL NO. SEPA REVIEW SIGN AREA HEIGHT
0 / /�) -- COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
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NEW ff"RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FF.) PROPOSED SETBACKS (FT.)
1:1 ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
ADDITION COMMERCIAL COMPLIANCE OR z
0 CHANGE OF USE 2
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REMODEL MULTIFAMILY PARKING LOT AR%EA PLA;NNING REVIEWED BY DATE 5
1:1 SIGN REQ'D PROVIDED
GRADING FENCE
13 REPAIR CYDS 1:1 X FT) REMARKS
SHAL
DEMOLISH M'- 'TA N K OTHER
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RETAINING WALL FIRE SPRINKLER Mr-k �. a
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ff GYPE OF USE. BUSINESS OR ACTIVI EXPLAIN:
RE CHECKED BY ITYPE OF CQNSTRUCTION Cop OCCUPANT
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GROUP
ill NUMBER NUMBER OF CRITICAL T"X!!��
M OF DWELLING AREAS SPECIAL INSPECTIOW JAREA OCCUPANT
o STORIES UNITS NUMBER )VIA REQUIRED LOAD
DESCRIBE WORK TO BE DONE __ I - [I YES_
122V E REMARKS 0
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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Description FEE Description FEE
HEAT SOURCE GLAZING % LOT SLOPE % Plan Check State Surcharge
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
73 Grading
SEPARATE PERMISSION.
Engr. Review
Lu PERMIT APPLICATION: 180DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
V APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Plan Chk. Deposit
) Fire Review
Uj IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection Receipt iff
< ALL CLAIMS FOR DAMAGES OF WHATEVER NAI URE, 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 I HE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY ACKNOWLEDGE THAT I IIAVE READ THIS APPLICATION; THAT THE INFORMATION Recording Fee R - eceipt #
GIVEN IS CORRECT; AND THAT 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- This 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 or his/her Deputy: and Fees ate paid, and
IN VIOLATION OF TIiE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO /-I`Z�eipt is a
WORKMEN'S C 101�� RCW 18.27. FOR INSPECTION cknowledged in space provided.
Y �ANCE AND
OFFI 'A�A GN�TU E,,/f DATE
771-02
SIGN ER 0 �6NEC
R GENT)\ DATE S
(425'
'20 RELEASED BY 6AT;:/
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- ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES PINK - OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
RECEIVED TO:
MAR 3 0 2004 DATE:
DEVELOPMENT SERVICES CTR
MEMO TO: PERMIT COORDINATOR, BUILDIN69MON
FROM: FIRE DEPARTMENT DATE,3-3e-)-o�
PLEMESIGN
ENGINEERING DIVISION DATE
PLEME SiGN
PLANNING DIVISION DATE
pLLASP SIGN
PROJECT L 17
SITE ADDRESS_�)-
PERMIT —ADB#----------PATE INSPECTED 3 -3 D— e) ce
DESCRIPTION OF WORK TO BE INSPECTED
A fleld inspection was conducted to determine final compliance with approved plans. Final approval
release of
denotes that there are no objections from the above signed Department to the
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
FA . ILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
1 .
PA
3.
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
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL.MR —A&
Oqf1wRA4#ey ...... ...........
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