20040380.pdfDATE RECEIVED
Z [PERMIT EXPIRES
USE PERMIT
ZONE
CITY OF EDMONDS NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAME/NAME OF 06SINESS PLAT NAME/SUBDIVISION NO LOT NO LID t NO.
LID FEE $
Ir MAILING ADDRESS/
z ,PS ied [3
3. PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Rw Permp 1OZ71
0 Sueril Use POfmil Roq'd 13
inSpection Required Q
APIRES L
CITY ZIP TELEPHONE EXISTING - PROPOSED Sidew','jk Req,,ited [3
1 REQUIRED DEDICATION— Fr underground 13
C� 9 W,nng equired
NAME METER SIZE LINE SIZE NO. OF FIXTURES pnv REQUIRED
YES C3 NO 13
U I I LU
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t ADDRESS REMARKS z
2: F3
U OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE z
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CITY ZIP TELLP$ik �jt-
NAME CBL#
I 1ENGINEERING REVIEWED BY DATE
cc ANDRESS
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-7-At .. FIRE REVIEWED BY DATE ul
CITY ZIP TELEPHONE
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VARIANCE OR CU SHORELINE OR AD13M INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY REG POSTED
I ----- I DYES RNO S r�
SEPA REVIEW SIGN AREA EIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE E)KT ALLOWED PROPOSED ALLOWED PROPOSED
-4 EXP
NEW MA RESIDENTIAL PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT 9DE REAR FRgpT, L/R 41DE REAR
9 r
COMPLIANCE OR 3 70 R5'a5 �6 �7 `3 �
ADDITION COMMERCIAL I z
El CHANGE OF USE 15 z
PARKING LOT AREA I PrZq R DATE 5
REMODEL MULTIFAMILY SIGN REQD I PRXIDED (L
REPAIR GRADING FENCE ?"_ yo
CYDS ( x FT) REMARKS
DEMOLISH E] TANK E:] OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
[TYPE OF USE, BUSINES_�,-9� ACTIVITY) EXPLAIN:
CHECKED BY TY OF CONSTRUCTION COD,E OCCUPAN
2/a /4 e I PX!��-eI4, I GROUP
NUMBER NUMBER OF CRITICAL
ION JAREA OCCUPANT
OF DWELLING AREAS SPECIAL INSPECT
ci 1`115r: UNITS NUMBER [] YE LOAD
STO REQUIRED
DESCRIBE WORK TO BE DONE
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG-D Ei
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VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % I
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
16 4 --- —
If Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t 13E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION. ------
Engr. Review
PERMIT APPLICATION: 180 DAYS
ui-------
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN ISO DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
M"MMMM—�
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
U)
uj IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
_j
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENI S FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTlY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF I HIS PERMIT SHALL NOT HE ----
0 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due 87i�q
-1 1
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
X1 Recording Fee Receipt
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 APPLICATI, N APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRLIC- f his application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building 011icill or his/tier Deputy. and Fees are Paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WOMMILN'ti COMPENSATION INSURANCE AND RCW 18.27.
OFFICIALS SIGNATURE DATE
SIGNATURE ( WNkli OR AGENT) DATE SIGNED (425)
C,
wi=lcl.,�_/ 771-0220 R _�B BY
I - I I ATE
AlTENT ION DIU 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
FILE
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL "YELLOW. INSPE TOR
_LLC?
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER - GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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APPIROV�-D. BY PLANINIINCi
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RECEIVED
Cl,r,y Copy MAY 14 2004
BUILDING DEPT.
.0Y order of the Building Official for the
'City of Edmonds
All persons Are Ordered to
'�r!iTOP WORK.
A"T ONCE
Address: -9*4� Z ---- --
Property Owner (if known):
Contractor (if known):
We are unable, to locate a valid permit for the ivork being done at this address.. A� permit
is required for this project. Work SHALL NOT continue' until a permit has been obtained
-ormance ith applicable codes and ordinances. If you
and the work. inspected for conf w
I I i ave already obtained tile perrnit, please contact us at (425) 771-0220 with the perrnit
number so we can revise our records.
An application must be submitted or a response in writing
must be made to our office no later than 4:00 PM 01,
A/
A VIOLATION FEE EQUAL OR UPTO FIVE TI IES
THE PERMIT FEE SHALL BE ASSESSED..
da e,
Posted Y of AR
ve
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f It
BUIlding 0-Ficial
Wa e to stop this work or activity and/or the
resUn n of' work without perulissiOn or the removal.
IL_E
mutil,ation., or concealment of this Nofl!je_is__pgniShab1e1 bv fine
a n djMp ij Mn nitn t,
City of E.dmonds Development Services Depailment Building Division
121 51" Ave N - Ednionds, WA 98020 - (425) 771-0220
office lJours M-F 9-12 and 1-4
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
NIS
d4
Pier/Porch .................
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Retaining Wall ...........
0
Slab Insulation ..........
0
M
PLUMBING:
Underground .............
-4
Rough -In ...................
M
C
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Commercial Final ......
0
0
0
C
HEATING:
M
M Z
Gas Test ....................
ID
Piping
C
> z
Gas .................
--i
Equipment .................
0 -n
Commercial Final .......
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EXTERIOR SHEATHING
M M
NAILING ..........................
0 Cn
0
FRAMING ........................
0 ITI
C: Cn
co
FIRST FLOOR FRAMING...
Q 0
INSULATION ...................
Z
Floor Insulation .........
Wall Insulation ...........
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Ceiling Insulation .......
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SHEETROCK NAILING ...
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0
SPECIAL INSPECTION
i
0
ITI
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
0