20040461.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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LM MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME Hot rti-je A r e ,5 Jisz P c LC
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CITY ZIP TELEPHONE
15��: at C-7 zc�f — I
NAME CBL#
Mi��Inll..ZUIPJ
ADDRESS
(2, 4 V ( -5 e., 7 x
CITY ( ( ZIP TELEPHONE
61'
STATE LICENSE NUMBER EXPIRATION DATE Y
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PROPERTY TAX ACCOUNT PARCEL NO.
NEW
_��RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GR.Vg CYDS
4
DEMOLISH
TANK
RETAINING WALL
,:��ARAGE
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
HE4T SOUj9CEj GLAZING %
1A A — .1116.0
E] PLUMBING/MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( x
0 OTHER
EFIRE SPRINKLER
I FIRE ALARM
FT)
PERMIT EXPIRES
USE PERMIT
ZONE
NUMBER
SUITEIAPT#
JOB
ADDRESS
PLAT NAME/SUBDIVISIONNO
IOTNO
LID NO
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$
FEE $
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LID
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SCP Pp"ved
f EsCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
f1w permit Requited
Use Permit Roq'd
EXISTING PROPOSED—
street
inspection Required
Sidewalk Required
REQUIRE[) DEDICATION FT
underground
witing required
METER SIZE
LINE SIZE
NO.7OF FIXTURES
PRV REO UIRED
F7
YES(3 NO E3
REMARKS
OWNER/CONTRACIOR RESPONSIBLE FOR EROSION CONIROL/DRAINAGE
RING REVIEWED BY
3
REVIEWED BY
DA1 E
DATE
W
VAI`41ANCE R CU SHORELINE OR ADBO I INSPECTION BOND
POSTED
RE 'D. - -------
------ EIYES 0 S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED PROP.OSED
I q';If
EXP !i— __j
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FF.)
ALLOWED PROPOSED FRON 91DE REAR FROPT L/P SID� REARe
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PARKING LOT AREA PaZ R DATE :3
RE ED
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REMARKS
VAJV Vqr1-AA(e 011-011
CHECKED By TYPE OF CONSTRUCTION
CRITICAL
SPECIAL INSPECTION JAREA
AREAS tj
NUMBER 2 1 REQUIRED [] YES
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
It: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Cr
W PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT., 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, HEIRS. ASSIGNS AND SUCCESORS
U)
ul IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND 110111 HARMLESS THE CITY OF
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2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGES OFwHATEVER NATURE, ARISING DIRECTLYOR INDIRECHY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALt NOT BE
DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
OCCUPANT .
GROUP 4L
OCCUPANT
LOAD
IREMARKS 0
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
VALUATION
$ j-�
Description
FEE
Description
FEE
Plan Check
State Surcharge
e
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
TotalAmt.Due
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 APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. I his application is [lot a permit until signed by the
TION AND IN DOING 111E WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
IN V6LATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S CQJJ�IENSATION INSURANCE AND RCW 18 27.
OFFICIAl S SIGNATURE DATE
SIGNATURE (OWN .0 OR AGEN I) DATE SIGNED (425)
F
771 -0220 FIELEAli
ATTENTIOI`i(I EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL t
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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OF31GINAL FILE YELLOW �NSPE70n
PINK - OVVNEn GOLD - ASSESSOR
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Suite 200
-7 Seattie, WA 98122
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ECEIVED rA
'ZCD' OAY 12 2004
4?-5 - 7 q 4
L PERMIT COUNTER
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: PUASESIGN FIRE DEPARTMENT DATE z
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ENGINEERING DIVISION DATE en /7
.s,
11141AIGN M
PLANNING DIVISION DATE
PLEASESIGN
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SITE ADDRESS— '?Ud4e
PERMIT # IM() 4 4 _ADB# DATE.INSPECTED 16Z:2 L
DESCRIPTION OF WORK TO BE INSPECTED
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 tile 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
I .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
El Copy of CORRECTION NOTICE given to owner/contractor by inpector
I .
2.
3.
RE -INSPECTED OUTSTANDING ISS . UES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tcn1p:b1dg:forn1s:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
(u.
SETBACKS .....................
FOUNDATION:
F)
21- 0 -4;
Footing ......................
Wall..........................
Pier/Porch .................
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Retaining Wall ...........
Slab Insulation .......... M
PLUMBING:
Underground .............
r
M
Rough -In ................... M a
0
__10
Commercial Final ...... 0
HEATING: :E M
rn z
Gas Test .................... JO --I
Gas Pi
ping .................
cl)
Equipment ................. 0 -n
Commercial Final .......
--I
rn rn
EXTERIOR SHEATHING
NAILING ..........................
A
0
0 rn
FRAMING ........................ C: Cn
FIRST FLOOR FRAMING... Q 0
Z
INSULATION ...................
Floor Insulation ......... r
Wall Insulation ........... z
--I
Ceiling Insulation ....... 3:
0)
z
SHEETROCK NAILING ... 0
SPECIAL INSPECTION ... 0
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
SideSewer#
Zooqw6441 AmoUtFWd$...�Ril!WPt
xPhT9 .:
Date LOU
WaterMeterSize_
Amount Paid---_. ReeelPt
DatePurchased
rzow # C
Receipt 17
Amount PJ-d'$