20040245 (2).pdfN
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
L4
um MAILING ADDRESS
z
3: 160
0
CITY ZIP TELEPHONE
Lz�b nizo N 0 S' V_I CLf2,q?-77f?-'35-Lt(,-,
NAME t4
0
ADDRESS
0
CITY ZIP TELEPHONE
NAME
CBL#
pt\'p - <-,-
� I A Ff
111.4 6-ct4-�
ADDRESS
P6 Go)c, 3-53-70
CITY
carl L C
I-
ZIP
q K 133
TELEPH�4E -71
1 361
STATE LICENSE NUMBER
—IAl:r *7
. EX11RATION DATE
CtIECKED BY
PRO S 0
2.14&
6
PROPERTY TAX ACCOUNT PARCEL NO.
()OZ3z-7o '740 5-�01
NEW
RESIDENTIAL
1a'_PZUMBINGCME:C�)
ADDITION
2-'COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
Yru,ila
GRADING FENCE
di Cie,
CYDS
( x FT)
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL FIRE SPRINKLER
1:1 ROCKERY E] FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
R%rRL--ra cii.(AG
NUMBER [NUMBER OF CRITICAL
D U'
OF DWELLING litio AREAS
W
STORIES U NI! NUMBER
DESCRIBE WORK TO BE DONE S' —jj At
4) - TD4 C. 4-s. / Lr t- i:-C M1 C A-C Lov I r
T
IN 11�11 rvLrw '20-Tvrj et-k- C'm I C_
A- c Lf mi r fte-c- Flo rr� L, I
HEAT SOURCE GLAZING % LOT SLOPE %
Chi I I
PLAN CHECK -NO: I VESTED DATE
i / r�f_' 1./ 109 /-) I —
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.
W PERMIT APPLICATION: 100 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANI, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
U)
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIr. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABIL11Y TO ENFORCE ANY ORDINANCE PROVISION.,
x
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
0fr
I I PERMIT EXPIRES f IJ/ Ly
PERMIT
ZO E NUMBER
JOB SUITE/APT#
ADDRESS -T /it
PLAT NAMEISUBDIVISION NO
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
IESCF Approved
Hw Permit Rocillifed
Street Use Perinit Req'd
EXISTING — PROPOSED
inspection Required
Sidewalk Hequired
REQUIRED DEDICATION— FT
Undeigtound
I Witing rortirifed
METER SIZE
LINE SIZE
N& OF FIXTURES
I PRV REQUIRED
YES 13 NO 13
REMARKS
OWN E RICONTH ACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
vARIANCE OR CU SHORELINE OR ADBN I INSPECTION I BOND
REO'D POSTED
OYES )WfNO IS
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.�
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
po 612�� I V-�i C) Q
PARKING ' I LOT AREA I PLANNING REVIEWED BY DATE
REO'D I PROVIDED
REMA
I
CHECKED BY I TYPE OF
SPECIAL INSPECTION JAREA
REQUIRED [] YES
C
0 'T
CP-N G WPMR, t
- I R
LOAD
REMARKS ]
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
APPLICATION APPROVAL
:1 : Ai- 6
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a perin i unt s gne y i c
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building 011icial or hisitier Deputy; and Fees are paid, and
[IN V1 ' OLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged ift space provided.
WORKMEN'S COMPENSATI21!!�URANCE AND RCW 18.27. OFFICIALS SIGNATUR DATE
SIGNA`rp� (OWNER OR DATE SIGI)ED (425)
L fn Sn j J,9 xj
1-% ==�� 1-1 V L 771-0220 FIELEAS
ATTENTION //- z
) -,rl,.) 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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
OF!Iqf�*[�- FILE YELLOW IINSPECTO
PINK - OWNER GOLD - ASSESSOR
0
9
tr
uj
z
z
ui
W
0
z
z
z
:3
CL
:3
M
z
0
i
0
IT1
:; 95
M
C
IT!
0
0
0
M
ITI Z
0-4
C
0
M M
0 _(j)
0 r-
0 ITI
C Cn
9 Cn
M C.)
Z
z
C/)
z
0
ITI
ASSOCIATED MGT 42S7714SIB 03/19/04 10:S2am P. 001
Harbor
RECEIVED
Square
MAR 1 9 2004
PERMIT COUNTER
Z,
March 19, 2004
0
0.
M
Attention: Marie Via Facsimile: 425/771-0221
65
Building Department
0M
C
rn 0,
City of Edmonds
0
121 5th Avenue
01
Edmonds, WA 98020
M,
M z
RE: Harbor Square Athletic Club
C 2
160 W. Dayton
C
C1)
Application is subm itted to replace a. rooftop HVAC for the above tenant.
0 -n,
-n
The owner's agent, namely myself, approves of the mecha nical permit application. The
M M
tenant's contractor is authorized to proceed.
C) vi.
0
0 M
C CD
Please call me if you require anyt hing further.
9 0)
M 0,
Z
Sincerely,
z
J n C ner
rect
r of Operations
z
01
disk #6HSA, flapp.doc
M
MICROFILM
120 West Dayton, Suite B-6, Edmonds. wastiington 98020 (425)774-t5ii Fax771 -4518
W I
N
FINAL PROJE VALFORM
2 ZU11 TO:
DEVELO
011', OF DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: PI EASE SIGN -FIRE DEPARTMENT DATE -§—
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE,
PLEASE SIGN
PROJEC Lf 9
SITE ADDRESS.
PERMIT —ADB# INSPECTED
Cf C;T a�,p PC rAl
CTED
DESCRIPTION OF WORK TO BE INSPE b4
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
15( copy of CONDITIONS given to owner/contractor by inspector
0 ') L-
1 11v 'cc
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:fbnns:ocaprv1 3/25/04
z
0
M
-4 -n
0 M
C
M 0
0
--I C)
0 C:
-A K
= M
M Z
JO
En
o -n
" X �11
>
M M
0
0
0 M
C: Cn
9 Cn
M
Z
M
z
z
0
i
0
M
RECEIVED FINAL PROJECT APPROVAL FORM
TOJ�_�
AUG 18 2004
DEVELOPMENT SERVICES CTR. DATE: KNJoi
CITY OF EDMONDS
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
1-;:7 g
FIRE DEPARTMENT DATE. i
VROM
PLEASESIGN
ENGINEERING IVISIOINDIN't
PLEASE SIGN
PLANNING DIVISION DATE
PLEASESIGN
PROJEC a,
SITEADDRESS_�Uo Lo.
IT49 OOL-P M 4,�) ADB# 6C
PERM _________pATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
-approved plans. Final approval
A field inspection was conducted to determine compliance with lie release of
denotes that there are no objections from the above signed Department to t
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fonns:ocaprv1 3/25/04
z
0
i
0
M
--i -n
C M
M 0
0
C)
0 C
—i K
= M
M Z
—Z
Cn
0 _n
n;0
__4 >
x 9 11
M M
0
U0
M
Cn
Cn
M
Z
z
z
0
M
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch ................. z
0
Retaining Wall ........... --I
M
Slab Insulation ..........
PLUMBING: --I -n
Underground .............
171
C
Rough -In ............. M
0
0
0 C
Commercial Final ......
--I
:r M
HEATING: M z
Gas Test .................... C
Gas Piping .................
C/)
Equipment ................. o -n
n
Commercial Final .......
m m
EXTERIOR SHEATHING _Cn
NAILING .......................... 0
0 M
C Cf)
FRAMING ........................ Cn
Q 0
FIRST FLOOR FRAMING ... Z r-
7'
INSULATION ...................
3:
Floor Insulation ......... >
z
Wall Insulation ...........
Ceiling Insulation .......
z
SHEETROCK NAILING ... 0
SPECIAL INSPECTION ... 0
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .................. I v M
00 t1- 021-15