20040481.pdfI
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E RECEIVED
ERMIT EXPIRES
FP 7—
USE PERMIT
IONE
CITY OF EDMONDS NUMBER,,��
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
OWNER NAMEINAMUF BUSINESS
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Re / r?ti�dtwtt rz:/5 LL6 PLAT NAME/SUBDIVISION NO, LOT NO. LID N6
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W MAILING ADDRESS LID FEE $
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TESCP Approved 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 0
/0 7 Street Use Permit Roq'd 13
CITY ZIP /rTELEPHONE EXISTING — PROPOSED inspection floquirad 13
Sidewalk Heritiarril 13
_�efi REQUIRED DEDICATION— FT Underground
Wiring required 13
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES NO 13 z
We, e 1- -5 0), Ir
UJI UJI
t= ADDRESS REMARKS z
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OWNEFIXONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 6
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CITY ZIP TELEPHONE
5 C& /7 -'3 Vcl-.5 7ov
NAME
DATE
Plnj 1C/ ENGINEERING REVIEWED BY
X ADDRESS
0
L/O
FIRE REVIEWED BY DATE
CITY ZIP TELEPHONE
0
U 5,4 OuI4 tl `iiSr0*X7
VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND ?.
STATE LICENSE NUMBER EXPIRATION DATE CH KED BY REO'D POSTED
SEPA REVIEW SIGN AREA OYES ONO S HEIGHT
-<j PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
W () 0 /C) X16
9,70 '3;�_ CFO EXP
1:1 NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
ADDITION COMPLIANCE OR z
COMMERCIAL z
1:1 CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE 5
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED CL
GRADING FENCE
REPAIR CYDS X FT) REMARKS
DEMOLISH TANK
oGARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
0
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY TY TRUCTION CO E OCCUPANT
U L) — - /r-�/ .// -5 & . Z?Iqs I k,�11
CA NUMBER OF "I'll - &/ 2C GROUP ell
tu NUMBER CRITICAL Z
OF DWELLING 3q AREAS SPECIAL INSPECTION I-AAEA OCCUPANT
0 STORIES UNITS NUMBER REQUIRED E] LOAD
YES
DESCRIBE WORK TO BE DONE
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 3
4-
7
VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit 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 PU13LIC
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
cc Engr. Review
1U PERMIT APPLICATION: ISO DAYS
IL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
in 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, IiEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
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-.1 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMI ESS I HE CITY OF
2 EDMONDS, WASHING1 ON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt N
ALL CLAIMS FOR DAMAGES OFWHxrEVER NATUHE, ARISING DIRECRYOR INDIREC[LY
FROM 'THE ISSUANCE OF THIS PERMIT ISSUANCF OF THIS PERMIT SHALt NOT BE
Landscapelnsp. Total Arnt D
_j DEEMEDTo MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY Cl FY ORDINANCE ue
0
I NOR LIMIT IN ANY WAYTHE CITY'S ABII.I1Y 10 ENFORCE ANY ORDINANCE PROVISION.- Recording Fee Receipt #
t HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, On THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COM13LY WIT11 CITY AND STATE LAWS REGULATING CONSTRUC- I 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 Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF TIIE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION ruccipt is acknowledged in space provided.
WORKMEN'S COMPENSATIOVkSURANCE AND RCW 18 27. f:f6l,)t.S SIGN TURE DATE
"y "I , .1
E (0 NER F�A.GENT�) DAT (425)
771-0220 HFi rASFD 13Y __;6_A_TE 7—
ATTENTION E)ff 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-ASSESSOTI
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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FINAL PROJECT APPROVAL
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TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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FROM: FIRE DEPARTMENT DAT
PLEASE SIGN
ENGINEERING DIVIS [ON DATE
I'LEASE SIGN
PLANNING DIVISION DATE
PUASE SIGN
PROJECT Conx,90,
SITE ADDRESSZ P,4,i/2C
PERMIT# (JVk/ _ADB#_DATE INSPEC ED
DESCRIPTION OF WORK TO BE INSPECTED_,e:�/�i, C
A field inspection was conducted to determine compliance with -approved plans. Final approval
denotes that there are no objections from the above signed Eepartment to the release of
PERFORMANCE BONDS and the granting of:
X GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/con tractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tcmp:b1dg:rorms: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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