20040280.pdfa
EXPIRES
F
IVED
PERMIT
CITY OF EDMONDS
USE
ZONE 0
PERMIT
NUMBER,_�,�,
JOB
ADDRESS
14
SUITE/APT#
-)
d (a""( zj��
CONSTRUCTION PERMIT APPLICATION
OWN� R NAMEMAME USINESS
OF
PLAT NAME/SUBDIVISION No
LOT NO,
LID N&
j\ etN
LID FEE $
LCC
u
z
3.
MAIL [NO ADDRESS
04�_
--r
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
JESGP Approved L3
Fivq Primilt Requand
0
EXISTING — PROPOSED
Street Use Permit Fioq'd
inspection Required C3
Sidewalk Required
CITY ZIP
TELEPHONE
C.-O
REOUIRED DEDICATION.
FT
Underground
I wiring rowniod
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
NAME
YES NO EI z
cc
L)
U.1
z
REMARKS z
OWN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE E5
z
W
x
ADDRESS
L)
cc
L
-
I CITY ZIP
TELEPHONE
NAM CBL 0
ov?
ADDRESS
--I �0 o � k �1 -111
CIT Zip TELEPHONE
0 jij.0 r 7;�
q2
STATE LICENSE NUMBER EXPI TIO DAf ECKED BY
Lc_ C_a: -*- 4>n�)'S A-'�
PROPER-12f TAX ACCOUNT PARCEL NO. � - t
0
NEW
E] RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING CYDS
Ej
FENCE x
DEMOLISH
1:1
TANK
A
OTHER
r-11-14A
EiGARAGE
1:3
RETAINING WALL
FIRE SPRINKLER!
CARPORT
ROCKERY
FIRE ALARM
"PE OF USE, BUSINESS OR ACTAITY) EXVL,�IN:
uj NUMBER NUMBER OF CRITICAL
a OF DWELLING AREAS
Ca RIES,— I
0 STO UNITS NUMBER
DESCRIBE WORK TO BE DONE
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
FT)
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
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
in
W IN INTEREST, AGREES TO INI1FMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
i
2 EDMONDS, WASHINGTON, 116 OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF V.'HATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODII`71� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY THE cTTY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
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
VVnRKMEN'S COMPENSATIQN..LNSUPIANCE AND RCW 18.27.
TE SIGNED
(4w_ *'C' . �_
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CLI SHORELINE OR ADBI I INSPECTION BOND
REO'D POSTED
SEPA REVIEW SIGN AREA OYES ONO S HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
EXP I
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR 0
z
PARKING LOT AREA I PLANNING REVIEWED By DATE
REDO I PROVIDED I
REMARKS
CHECKED BY ITYPE OF CONSTRUCTION
SPECIAL INSPECTION JAREA
REQUIRED [:] YES
OCCUPANT
GROUP
OCCUPANT
LOAD
REMARKS
PROGYVESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REQi'D
�+I/q A
I
E
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
ATTENTION LAI IJJJ
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
FEE
Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit I /--)
Receipt 0 C
TotalAmt.Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid. and
receipt is acknowledged in space provided.
OFFICIALS SIGNATURE DATE
DATE
R EABED BY
09,'03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW JINSPVCTC
PINK -OWNER GOLD -ASSESSOR
z
0
M
_q =-
n
61
3:
0 M
C
M 0
0
0
0 C
4 K
:c M
M Z
—Z
3:
U)
0 _n
n
M M
0 i—n
01-
0 M
C U)
K Cn
M 0
Z
7-1
X
z
—i
3:
U)
z
0
1711
MEMO TO:
FROM:
FINAL PROACT APPROVAL FORM
TO:
DATE:
PERMIT COORDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DAT
PIRA ESIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLE&SESIGN
PROJECT
SITEADDRESS
PERMIT ADB# DATE INSPECTED _'0
DE SCRIPTION OF WORK TO BE INSPECTED H2�)6 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
1 .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
1 .
a
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fonns:ocaprv1 3/25/04
z
0
=i =�
U5 --I
r
M
0
0
-10
0
M
M Z
04
_z
cl)
o -n
n ;d
--i >
M 9
M M
0
0
0 rn
C Cn
9 Cn
M 0
Z r-
M
r
z
--I
3:
Cn
z
0
A
0
M
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 ...
qPF:r'lhf 1KJqPF=rT10N _
MISCELLANEOUS ..........
FINAL APPROVAL FeR"
0 QQU42A#4G-Y ..................
r_T_
,?ooqow
ozCPA
ow
ra--c'
z
0
1
0
M
--i -n
0 M
C
M 0
0
0
0
M
M z
n, -4
CE
3:
C/)
0 -n
n
3:9
M M
0
0
0 M
C: Cn
9 C/)
M 0
Z
3:
z
z
0
1
0
171