20040330.pdfI
DATE RECEIVED [PERMIT EXPIRES
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USE PERMIT -7
CITY OF EDMONDS ZONE NUMBER
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CONSTRUCTION PERMIT APPLICATION ADDRE::L/ 7dL
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OWNj?,AME1NAME 9; �USINESS LID NO.
PLAT NAME/SUBDIVISION NO LOT NO.
C. 111A RTI LID FEE $
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PUBLI.', RIGITr OF WAY PER OFFICIAL STREET MAP RW ",0q,::;od 11
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0 76 inspection Required
EXISTING - PROPOSED 91dowalli Required E3
CITY P TFLEP IONE underground
REQUIRED DEDICAHON_ FT Wiring required [3
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A /Y PRV REQUIRED
ETER SIZE LINE SIZE NO. OF FIXTURES 0
NAME YES 13 No [3 3
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W REMARKS
ADDRESS OWNERICONTRAClOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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CITY ziPl TELEPIiONE
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NAME CBL Is " kJ\[l
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EUNE 0 RAO N REO'D POSTED
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STATE LICENSE NUMBER ATION DATE CHECKPbBY RE D S POSTED
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OYES ONO S
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SEPA REVIEW SIGN AREA
F11 P OP SED ALLOWED PROPOSED
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PROP RTY TAX ACCOUNT PARCEL NO.
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LOT COVERAGE REQUIRED SETBACKS (FT) 0 T UR Sl R R
NEW 8� �RESIDENTIAL D PLUMBING I MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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0 CHANGE OF USE :5
PARKING LOT AREA PLANNING REVIEWED BY DATE CL
REMODEL El MULTIFAMILY 0 SIGN PROVIDED
GRADING FENCE
REPAIR 0 CYDS ( x FT) REMARKS
DEMOLISH [?rTANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
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MPE OF USE. BUSINESS OR ACTIYITY) EXPLAIN: 'BY STRUCTION D OCCUPANT
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U) NUMBER OF CRITICAL F r OCCUPANT
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a OF DWELLING AREAS SPECIAL INSPECTIO LOAD
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0 STORI _r UNIT
DESCRIBE WORK TO BE DONE
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D F3
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VALUATION
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit 15 City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
cc PERMIT APPLICATION: 180 DAYS
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IL PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review Plan Chk. Deposit
in *APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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Uj IN INTERE�T. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
-1 Receipt
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection
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 dscapeinsp. Total Amt. Due it�2,!2
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Lan k� 5
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Receipt # :��74 U
x Recording Fee . r� ir 07
1 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 This application is not a permit until signed by the
TIIE OWNER. I AGRLE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. 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 VIOLATICIP;-ef-T44-E LA13OR CODE OF,� STATE OF WASHINGTON RELATING TO FOR INSPECTIO receipt is acknowledged in space provided.
WORKMV'r§COMPENnON INSURAr ANP RCW 18,27, OF C" SIGNATUR)f ATE
i :R OR 4AENT) DATE �IGNED (425)
WNE 'al Z'
771-0220 L ASED BY D4TE
ATTENTION EXT 1333
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 YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
o9j03 PRESS HARD -YOU ARE MAKING 4 COPIES
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tNAL PROJECT APPROVAL FORM
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DATE:
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE—LY �—/
PLEASE SIGN
ENGINEERING DIVISION DATE —
PLEASE SIG14
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT (J,� 7- / ki,
SITE ADDRESS Q_ Q,"16p
PERMIT ADB# -DATE INSPECTED.
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DESCRIPTION OF WORK TO BE INSPECTED �2
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
2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1: temp:bldg: forms: ocaprvl 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..............................
Pier/Porch .................
Retaln'ind 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 FOi4-
GeMPANeY ..............
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