20040274.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
C
MAILING ADDRESS
.9 7 �Z FE- 1.3 L
CITY ZIP TELEPHONE
CZ. 3 5L1.3 - 7 L! 3 - 55-2
NAME
1 11 / h 11
PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB
ADDRESS�26_`Z Ir -5
_ S%,
PLAT NAMEISUBDIVISION NO I LOT NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
r
METER SIZE LINE SIZE I NO. OF FIXTURES
-oZ:7
SUITEIAPT#
LID NO,
LID FEE $
TESCP AppfovDd
RW Permit Roquifed
street Use Permit Floq'd
Inspection Required
Sidewalk Requiled
underground
Wiring required
PRV REQUIRED
YES 0 NO 11
Ul ( cv.\,k—�-,-, _ REMARKS I I -
ADDRESS OWNERICON TRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
71)
CITY ZIP TELEPHONE
NAME CBLN
ENGINEERIN REVIEWED By DATE
ADDRESS
-7 0 S
CITY ZIP TELEPHONE
-7
STATE LICENSE NUMBER EXPIRATION DATE
Y
f 2 en Ay W_/
PROPERTY TAX ACCOUNT PARCEL NO.
-7 l!!�,7 f7f -7
NEW
RESIDENTIAL
El
PLUMBING / MECH
ADDITION
COMMERCIAL
El
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
t x Fr)
DEMOLISH TANK Z:,
OTHER
GARAGE
CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE,
BUSINESS OR ACTIVITY) EXPLAIN:
0.
NUMBER NUMBER OF L;Irn I IUAL
OF DWELLING IVA, S
11
STORIES UNITS j AREMA.ER q�2
DESCRIBE WORK TO BE DONE
FIRE REVIEWED By DATE
I
U SHORELINE OR I
VARIANCE OR C IB# INSFPEO DIN BOND
T'(
LE 6D 0 POSTED
OYES IN is
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
1� I " E MAR( HAL
EXP r -I _ 1.
LOT COVERAGE NT DAqiffl ACKS (FT)
r
ALLOWED PROPOSED WU"E ftblEl R FrIN R tgjql� r-REAR
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PARKING L AREA I PLANNING REVIEWED BY DATE
REO'D I PROVIDED I
HEAT SOURCE
PLAN CHECK NO:
GLAZING %
LOT SLOPE %
VESTED 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 JCURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 160 DAYS
Uj
a. PERMIT LIMIMI YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Ld NAPPLICAN1. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
(1)
W IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
_j
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Cr ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREC FLY OR INDIRECTLY
4
X1 FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
-1
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: 1HAT 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 LABQ ODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATlPf4 %]�Cuc RANCE AND RCW 10.27.
I DATE SIGNED
SI
GN 1, _711. (OWNER OFi h ENT,(L/__
AP"
REMARKS
CHE7CKED BY TYPE,?11FNST N C OCCUPANT
GROUP
=CI L ON AREA OCCL
TI LOAD
SPECIAL INTSPECTION AREA OCCUPANT
LOAD
REQUIRED [] YES
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D _I �
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp-
Recording Fee
FEE Description FEE
State Surcharge
city Surcharge
Base Fee
CALL
FOR INSPECTION
(425)
771-0220
-4 03 el 02
tPlan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building ollicial or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFFICIALS SIGNA RE DA
ATTENVON F.A I
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
09,103 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL -FILE YELLOW- INSPECTOR
PINK -OWNER GOLD -ASSESSOR
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NOTICE: IF THE DOCUMENT IN THIS FRAME IS LESS CLEAR THAN THIS NOTICE
IT IS DUE TO THE QUALITY OF THE DOCUMENT.
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FINAL PROJECT APPROVAL FORMgSCS
TO: p?,
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE LI—ly-0y
PLEASE SIGN
ENGINEERING DIV ISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
SITE ADDRESS- A VK S
PERMIT # W( )'/ 6 2,-7 ADB# DATE INSPECTED_���..
DESCRIPTION OF WORK TO BE INSPECTED 1zl�&ee-14L_
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: 0/0 a"d
GRANT FINAL PROJECT APPROVTW�
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
[:1 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
R&INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:f6mis: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 f""ftm,
. ..................
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