20040236 (2).pdfI
FDATE �FIECEIVEO
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNE t4AMI�INAME OF BUSINESS
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STATE LICENSE NUMBER EXPIRATION DATE
.-IJ I PROPERTY TAX ACCOUNT PARCEL NO
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
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GARAGE
CARPORT
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RETAINING WALL
ROCKERY
(TYPE OF USE. BUSINESFjqRACTIVrTY) EXPLAIN:
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DESCRIBE WORK TO BE DONE
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PLUMBING / MECH
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CHANGE OF USE
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OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
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11013
ADDRESS
PLAT NAMEISUBDIVISION NO
PERMITEXPIRES IU,;4—�"
OWN -Now
PERMIT
N U M B E R
LOT NO.
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PUBLIC [TIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- FT
METER SIZE I LINE SIZE NO, OF FIXTURES
SUITEIAPT#
LID NO.
LID FEE $
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inspection firiqln(nd
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Wiring rorttiltod
PRV REQUIRED
YESO NO 13
REMARKS
OWNER/CONIRACIOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
ENGINEERING
FIRE REVIEWED BY
DATE
DATE
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VARIANCE OR CU SHORELINE OR ADBI I INSPECTION BOND
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COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr)
ALLOWED PROPOSED FRONT SIDE HEAR FRONT L/R SIDE REAR
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REO'D I PROVIDED
REMARKS
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SPECIAL INSPECTION AREA OCCUPANT
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PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REO'D
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Pert -nit Ix City Surcharge
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PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
W PERMIT APPLICATION: 180 DAYS
[L 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 Fire Review Plan Chk. Deposit
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Lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection 09 -,4w_ Receipt It
cc ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
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x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 1HIS PERMIT SHALL NOT BE
a DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY 1 HE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
ml Recording Fee Receipt #
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 APPLICATION APPRI VAL
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 Bnilding Official or his/her Deputy: and Fees are paid, and
IN V;6LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27.
IF,# S S G T DATE
(425)
SIGNATUR JO* 0 G
300flr-'qj/ 61ENT) ATE Sl NED
771-0220 RE,_f-kswBY TE
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 - OWNEF1 GOLD - ASSESSOR
09iO3 PRESS HARD -YOU ARE MAKING 4 COPIES
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05/16112004 14:17 2063321007 TANK WISE PAGE 01
RETURN ADDRESS
To Whom it May Concern: Date: -OY
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The unused underground residential heating oil tank or
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has been removed or back filled to the uniform fire code
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(Section 79.15) specifications set by the local Fire
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Marshall.
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The tank has also been cleaned, triple rinsed or has
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been steamed cleaned of all remaining sludge to insure
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E.P.A. standards of the tank.cleaning before back fill or
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tank disposal.
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TANK WISE LLC
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4455 35TH AVE. S.W.
9 CD
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SEATTLE� WA. 98126
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Contractor lic#
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I.C.B.O. 1017159-26
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PH#(206)937-3995
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TANK \MSE REPRESENTATIVE
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PROPER7Y OW�MR
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TW�MMECT APPROVAL FORM
MAY 2 0 2004
TO:
DEVELOPMENT SERVICES CTR,
CITY OF EDMONDS
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
4tEASE SIGN
ENGINEERING DIVISION DATE
PLEASESIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJEC
SITE ADDRESS (q� 2L 2
PERMIT #..240 (1 _-_0 2,3 C, -ADB# DATE, INSPECTED 0
DESCRIPTION OF WORK TO BE INSPECTED N
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
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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:temp:b1dg:fbmis: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 ...................
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 rfflr
ja4w*P0wCy ..................
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