20040476.pdfI
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DATE RECEIVED ( Cl j (,7
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BYSINESS
Cil, 1--,7 / � 5-Ach
MAILING ADDRESS
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CITY
NAME
ADDRESS
CITY
NAME
57--511)
ZIP TELEPHONE
ADDRF:.q-q
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CITY N ZIP
5 OV-14) -7 .
STATE LICENSE NUMBER
L bfOCI(7 ?Oft.
PROPERTY -TAX ACCOUNT�PARrEl_ NO.
TELEPHONE
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TELEPHONE
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IRA ION DATE
716k �;-
NEW
Me-A-ESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
El GRADING CYDS
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DEMOLISH
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GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE BUS N
�S OR fCTJVI LAIN:
Tl�n
NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
HEAT SOURCE
GLAZING %
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ADDRESS
PLAT NAME/SUBDIVISION NO.
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PERMIT EX IRES LZ_-J-L-7 —
PERMIT C/� Ll V U
NUMBER
SUITEIAPT#
LOT NO. LID NO
LID FEE S
TF.SCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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gW permit Requited
W Permit Roq
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ant Us 0 p one " "oq 'd
Street Use Permit Roq'd
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EXISTING PROPOSED
inspection Required
pe non Roq'rirod
SIdowills, ROqUired
5-d walk 4
R' L red
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REQUIRED DEDICATION- Fr
Unde(ground
Wiring required
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METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES NO
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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REVIEWED BY DATE
FIRE REVIEWED BY DATE uj
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VARIANCE OR CU SHOREL114E OR ADBY
SEPA REVIEW V11,J .1 1 L.;;SIGN AI'llh
COMPLETE I EXA�l "Vowq 1 0 1
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EXP
INSPECTION I PBOND
1W_Q'D s OSTED
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IN 11 1-Uh HEIGHT
ED _.AII0WED, . PROPOSED
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT)
FRONT URSIDE REAR 0
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PARKING
REO'D I PROVIDED
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LOT AREA
PLANNING REVIEWED BY DATE
FENCE
( X FT)
REMARKS
OTHER
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FIRE SPRINKLER
FIRE ALARM
CHECKED BY
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ror,
OCCUPANT
GROUP
ITYP
CRITICAL
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SPECIAL INSPECTION
OCCUPANT
N
REQUIRED 0 YES
JAREA'
LOAD
REMARKS
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PROGRESS INSPECTIONS PER UBC 108 ir IBC109 IRC109 FINAL INSPECTION REO'D
a
Co
fAl
LOT SLOPE %
PLAN CHIECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
tz BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: IBODAYS
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IL PERMIT LIMIT 1 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
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
W
,X ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECT LY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 1111S PERMIT SHALV NOT BE
0
_j DEEMED TO MODIF_'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
GIVEN IS CORRECT. AND T14AT 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
WORKMEN'S CQMPQNSATION INSURANg-,AND RCW.18.27.
DATE
VALUATION
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 I
IT IS U N LAWFULTO U S E OR OCC U PY A BU I LDI NG OR STR UCTU R E U NTI L A FI NAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt III
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or hisitier Deputy: and Foes are paid, and
receipt is acknowledged in space provided.
0 1 IAL IGNA4TURE DATE
L
RELEAS66'H'Y' DATE
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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MAC tPffdXC-T APPROVAL FORM
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JUN 2 2 2004 6 TO:
6 Soo
DEVELOPMENT SERVICES ;TR.
CITY OF EDMONDS DATE: —
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJEC
SITE ADDRESS qS_1 3 2-2,
PERMIT #222L� — ADB#________PATE INSPECTED L 2-_���
DESCRIPTION OF WORK TO BE INSPECTED_U_�,�(—A--, P'- Ile— C-4-0
approved plans. Final approval
A field inspection was conducted to determine compliance with
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
E] Copy of CONDITIONS given to owner/contractor by inspector
1 .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of CORRECTION NOTICE given to owner/contractor by inpector
PA
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbrms:ocaprv1 3/25/04
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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 ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ........ .
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