20040254.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
C 14 (� f � L C� t+ P., L7-
MAILING ADDRESS
,:�, / C) L L C_
CITY ZIP LEPHONE Z-12— _L�;
774
NAME
ADDRESS
CITY
ZIP I TELEPHONE
USE '
ZONE
JOB
ADDRESS
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PLAT NAME/SUBDIVISION NO
PERMIT EXPIRES
PERMIT
NUMBER'
SUTE/APT#
L
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LOT NO. LID NO,
LID FEE S
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 6
Street Use Permit Roo d 0
EXISTING — PROPOSED inspection Required 0
Sidewalk Required 0
REOUIRED DEDICATION— FT Underground
Wiring required 0
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I I I YES 0 NO 0
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
NAME
INEERING
'7'6, rn 62 ENGINEERING
ADDRESS
CITY ZIP
STATE LICENSE NUMBER
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PROPERTY TAX ACCOUNT PARCEL NO
TELEPHONE
EXPIRATIONDAIE CHECKEDBY
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NEW
L4,-<ESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
APARTMENT
REPAIR
GRADING CYDS
DEMOLISH
)KTANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINfi-)S OR ACTIVITY) EXPLAIN:
NUMBER NUMBER OF
0 _Z DWELLING
S945, _:; _�_ I I NITS
DESCRIBE WORK TO BE DONE
r r
HEAT SOURCE I GLAZING %
PLAN CHECK NO:
[:]
PLUMBING / MECH
COMPLIANCE OR
o
CHANGE OF USE
SIGN
FENCE
FT)
( X
OTHER
RENEWAL
CRITICAL
AREAS
NUMBER IV
/A
LOT SLOPE %
DATE
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.
PERMIT APPLICATION: 180 DAYS
Uj
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOn MORE INFORMATION
U) 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
W IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE C11Y OF
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Z EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHAT EVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMEDTO MODIFY.WAIVEOR REDUCE ANY REQUIREMENT OF ANY CII Y ORDINANCE
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0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
= I --- - —
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATlg�bl_INSURANCE AND RCW 18.27,
Z/— 4�0' C-c-o
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP I
LOT COVERAGE
ALLOWED PROPOSED
FIEVIEWED/DATE
SHORELINE OR ADB#
SIGN AREA
ALLOWED , PROPOSED
DATE
INSPECTION PBOND
REO'D OSTE D
0 YES 0 NO
HEIGHT
ALLOWED - PROPOSED
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REQUIRED SETBACKS (FT4 PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT UPSIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE
REO'D I PROVIDED I
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rill eAP;
CHECKEDBY
TYPE PF CONSTRUCTION
CODE OCCUPAN.
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9�7 GROUP 6
SPECIAL INSPECTOR
OCCUPANT
REQUIREDED YES
JAREA
LOAD
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REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RECI'Dj 3
A17ENTION
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
5198
VALUATION
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
ENG. REVIEW FEES
-f +q441 N'S/Pl�t� 10 N F E E
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
RECEIPT
TOTAL AMOUNT DUE
CALL
FOR INSPECTION
(425)
771-0220
EXT 333
771-0221
FAX
WAV�
FEE
APPLICATION APPROVAL
This application is not a permit until signed by the
Building 011icial or his/her Deputy: and Fees are paid. and
- receipt is acknowledged in space provided.
�FILIALS SJGNATURE - PATE
A/
RELEASED By
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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FINAL FROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DATE 0 Ct
FROM.
PLEASE SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT_LLS,� L<44-6-
SITE ADDRESS Q-0.210 LL (LL (-- (-2-ff SE 10
PERMIT ADB# -DATE INSPECTED Ll 0
DESCRIPTION OF WORK TO BE INSPECTED U� 7_1Z UA-Le I gle��Slr C��
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
11-GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by inspector
1 .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
1:1 Copy of CORRECTION NOTICE given to owner/contractor by inpector
1 .
2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fomis: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:TTYR-
Mee ln"eC4 . .................
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