20040292 (2).pdfU
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FDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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�7 9,01 9? D
CITY ZIP TELEPHONE
NAME
NAME
ADDRESS
16111illill
STATE LICENSE NUMBER
E] NEW
ADDIT,f,,,h
REMODEL
E] REPAIR
DEMOLISH
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CARPORT
21
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ZIP I TELEPHONE
ZIP I TELEPHONE
EXPIRATION
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0 RESIDENTIAL
COMMERCIAL
MULTIFAMILY
GRADING CYDS
TANK
RETAINING WALL
ROCKERY
NUMBER NUMBER OF
DWELLING
OF I
STORIES UNITS
DESCRIBE WORK TO BE DONE
r/ 14,
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HEAT SOURCE GLAZING %
CBIL #
CHECKED BY
0 PLUMBING / MECH
COMPLIANCE OR
1:1 CHANGE OF USE
1:1 SIGN
1 FENCE
3 ( x FT]
M OTHER
EiFIRE SPRINKLER
FIRE ALARM
USE
ZONE
JOB
ADDRESS 7qo I
PLAT NAME/SUBDIVISION NO.
PERMIT EXPIRES
PERMIT
NUMBER
'70T NO. I LID NO
LID FEE $
IESCP Appro�ed
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
FjW Permit Required
Street use Permit Roq'd
inspection Requiied
EXISTING PROPOSED
Sidewalk Required
Underground
REQUIRED DEDICAFION� FT
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES NO
[REMA�RKS
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0 OW [11
WNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/D RAIN AGE
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EERING REVIEWED BY
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RE REVIEWED BY
DATE
DATE
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____ 5B#INSP CTION
VARIANCE OR CU SHORELINE OR AD E BOND
RE D POSTED
[3YE NO S
SEPA REVIE SIGN AREA HEIGHT
COMPLETE EXE T ALLOWED , PROPOSED ALLOWE� PROPOSED,
EXP
KS (FT)
SHORELINE
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SIC
E T ALLOWED
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBAtS (FT)
11 �
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ALLOWED PROPOSED, FRONT SIDE, REAR FR9NT [4R SID . R R
REAR
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PARKING LOT AREA PMNNING
RfkD PROVIDED
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REMARKS
CHECKED BY I TYPE OF
CRITICAL rq,41 m- '
AREAS I SPECIAL INSPECTION JAREA
NUMBER j REQUIRED [:] YES f)�
LOT SLOPE %
PLAN CHECK NO: VESTED DATE
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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
PERMIT LIMIM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEMS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CIT . Y OF
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 PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CFTY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
OCCUPANT
GROUP
OCCUPANT
LOAD
0
REMARKS z
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REO'D 5
1.4 Ila le <,bm � 4- 1,107 / V,/L1 /V Y�?AWI
VALUATION
$
Desdiption
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
I C_
Plumbing
Base Fee
49 Z:)
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
-S 6
Landscapeinsp.
Total Amt. Due
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE 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
-Y AND STATE LAWS REGULATING CONSTRUC- I his application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CIT CALL Building Official or his/her Deputy: and Fees are paid, and
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN ViCiLATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S SqWENSATION INSURANCE AND RCW 1827. OFFICIALS SIGNATURE DATE
SIGNAT�, �E(OWN A G E N T�)///. DATE SIGNED (425)
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it. -N.EASED BY
11-7, :00 771-0220 R
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ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 1__LTL0A1 IA—
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 0131GINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COP S
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLrASI: SIGN
ENGINEERING DIVISION DATE
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT -
SITE ADDRESS— 140 1 qq-b St SV�
PERMIT# ADB#_DATE INSPECTED k/A llv_�
DESCRIPTION OF WORK TO BE INSPECTED
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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
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
F� Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fonns:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
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Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
-In ...................
Rough
Commercial Final ......
HEATING:
GasTest ....................
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 FOR
OCCUPANCY ..................
?Mq4w_az,? 10�
The initials MT are Milton
Thompson, a temporary contract
inspector For the clity.
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