20040249.pdfM
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
E8MME/NAME OF PUSINESS . % 11
MAILING ADDRESS
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CITY
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NAME
ADDRESS
C ITY
NAME
0 ADDRESS
ZIP I TELEPHONE
ZIP
Wly ZIP
STATE LICENSE NUMBER
TAX
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
0 GRADING CYDS
oDEMOLISH
TANK
oGARAGE
CARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE, B
ILSINESS
OR ACTIVLM EXPLAIN:
NUMBER NUMBER OF,
OF DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
CBL #
V-1
PLUMBING/MECH
COMPLIANCE OR
13 CHANGE OF USE
0 SIGN
FENCE
( _X—FT)
OTHER
0 FIRE SPRINKLER
FIRE ALARM
[PERMITEXPIRES
USE PERMIT
ZONE
NUMBER
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ADDRESS S+
PLAT NAME/S JBDIVISI N NO.
LOT NO.
LID NO.
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LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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EXISTING — PROPOSED
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REQUIRED DEDICATION FT
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METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YES0 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
BY
!I FIRE REVIEWED BY
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DATE W
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VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
BOND
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ALLOWED PROPOSED
ALLOWED PROPOSED
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REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
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REO'D I PROVIDED
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NUMBER
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PROGRESS INSPECTIONS PER UBC IGO/FINAL INSPECTION RE 'D
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Description
FEE
Description
FEE
1
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Permit
City Surcharge
PLAN CHMO- VESTED DATE
5:11
Plumbing
L 1
Mechanical
THIS PEnMrT AUTHORMES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
tz BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU13UC
3
Grading
3 DOM AIN (CURBEI, SIDEWALKS, DRIVIEWAYS, MARQUEES, ETC.) WILL REQUIRE
t: SEPARATE PERMISSION.
Engr. Review
PERMITAPPLICATION: IGO DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN ISO 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
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 #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscape Insp.
Total Amt. Due &5
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee
Receipt #
I HEREBY ACK14OWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
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 WILL BE EMPLOYED
Building 011iciall or 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.
WORKMEWS COMPENSATIO NCE AND RCW 18.27.
OF SIGN kTURE DATE
SIONAVJRE (OWNER.OR /of I DATE SIGNED
1A9
1,425)
jIALS
::� "h 1, A =M
771-0220
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F1 ARE!6ay
ATTEN1TION
Off 133
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 YELLON-INSiP/CT6
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 C
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TESTING & INSPECTION / ENGI
12919 N.E. 126TH PLACE
KIRKLAND, WASHINGTON gjay- 60 1,VIA25S-1 81213-9800
EVERETT (A 259-0817
SWT 7 AN
COMPRESSION REPO, SER141CF-S CIM
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ATTN:
THE FOLLOWING WAS NOTED -
FIELD TEST DATA
FIELD
REPORT No. 2-0 c 140-49279
DATE
CERT. NO.
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HEREIN TESTED. THIS REPORT SHAU. NOT I INSPECTOR(S), NIAME(
BE REPRODUCED EXCEPT IN FULL. WITH-
OUTTHE WRITTEN APPROVALOF CASCADE S�
TESTING LABORAMRY, INC. INSPECTOR SIGNATURE
REVISED 1/02
SIGNED BY
COPIESTOAA.gw -F-Z,-Z cf-2-1
CASCADE TESTING LABORATORY, INC.
TESTING & INSPECTION / ENGINEERS
12919 N.G. 126TH PLACE
KIRKLAND. WASHINGTON 98034 (425rB23 9800
w[ji EVERETT (425) 259-0817
FIELD REPORT
ATTN: RECEIVED
(2)
INSPECTION PERFORMED DEVELOPMENT SERVICES CTFt.
CITY OF EDMOND'S
—%.-RESTEEUCONCRETE RESTEEL ONLY
RESTEEUMASONRY STR.STIWELDING
— OTHER — STFLSTIROLTING
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LOCATION (AREAS)
PREVIOUS /120083
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TOTAL CU. YD. PLACED
SUPPLIER A
SLUMP (INCHES) SPECIMENS CAST -3
AIR CONTENT(%) SEE CYLINDER REPORT NO. 2- 7
.j::t<ES —NO _ITEMS INSPECTEDWERE IN CONFORMANCEWITH BLDG. DEPT. APPROVED PLANS
REMARKS: Ad -le- 6-
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A-41
TEST RESULTS APPLY ONLY TO THE
HEREIN TESTED. THIS REPORT SHALMOST INSPECTOR(S).
BE REPRODUCED EXCEPT IN FULL. WITH-
OUT THE WRITTEN APPROVAL OF CASCADE
TESTING LABORATORY. INC. INSPECTOR Sl(
REVISED a=
COPIES TO: P14,,992Vt 7'z--s-
SIGNED BY
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COLUMNS
WALLS
BEAMS
FIELD
REP&IT No.lZ008-3 No. 492/9
Ac-l-ADE TESTING LABORATORY, INC.
rriAt TESTING & INSPECTION I ENGINEERS
1 919 N.E. 126TH PLACE
XIRKLAND. WASHINGTON 9803A IA251 623-9600
EVERETT (A25) 259-0817
COMPRESSION REPORT
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THE FOLLOWING WAS NOTED: Illy",
DATA
DATE
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BE REPRODUCED EXCEPT IN FULL. WITH- I
OUT THE WRITTEN APPROVAL OF CASCADE
TESTING LABORATORY, INC. INSPECTOR SIGNATURE
REVISED 1102 1 SIGNED BY
COPIES TO: gIg4
(3 ASTM C-1231
Cl ASTM C-617
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ATTN:
JUL-Z?-2004 16:45 SUNDQUIST HOMES LLC
CASCA05,TES
..&"13 LABORATORY, INC-
TEST940 & I I ENGINEERS
139110 M.N. SUTM PLACE .;
PUKLAND.
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