20040509.pdfI
DATE RECEIVED � L;-/ 7V 611-
(e I ILL I I PERMIT EXPIRES
I PERMIT
USE 0 'z\
ZONE
CITY OF EDMONDS f (0 NUMBER CIU100
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS Ll Vq
OWNER NAME/NAME OF BUSINESS 12 3 �L (11
DC PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LCC MAILING ADDRESS LID FEE $
U
z 7ESCP Approved 0
3: PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 0
0 s-D Street use Permit Roq'd [3
CITY EXISTING — PROPOSED inspection Required
Z �IP TELEPHONE Sidewalk Required
Underground
4-1 REQUIRED DEDICATION— Fr
- Wiring required E3
_717,20
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES13 NO 13
W
us z
1: ADDRESS REMARKS z
x OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROODRAINAGE a
0 z
0: W
99
CITY ZIP TELEPH ONE f��V 6C
kml
NAME ]CBL Al
C—./ !�/ W, d e- / ;I ( c I ENGINEERING REVIEW11D BY E
0C ADDRESS
0
Ave_ I'V'
FIRE REVIEWED BY DhE W
CITY zi7 TELEPHONE
0 y(,'jq_j
VARIANCE OR CU SHORELINE OR ADB" INSPECTION BOND
STATE LICENSE NUMBER EXI)RATION DATE CHOPKED BY REO'D POSTED
Kri %A"/ I OYES ONO S
F_ SEPA REVIEW SIGN AREA HEIGHT
OWED , PROPOS
PR PERTY T ACCOUNT PARCEL NO. -.1 COMPLETE , EXEMPT ALLOWED PROPOSED ALL ED
W
EXP
NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
COMPLIANCE OR z
ADDITION COMMERCIAL z
CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE 5
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED CL
REPAIR GRADING FENCE
CYDS 2� X FT) REMARKS
DEMOLISH TANK 1:1 OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY 13 FIRE ALARM
(TYPE OF USE-4USINESS OR TIVITY) EXPLAIN:
i-x , i . - CHECKED BY ITYPE-41ELIONSTRLICTION rQPE OCCUPANT
0 a 0 I\k /9 1/ Fr j -1 GROUP
in fl�'j ZIL
w NUMBER NUMBER OF CRITICAL V V Gil- I I U-1aL -0 1 1 � 1-_
0 ING SPECIAL INSPECTION JAREA OCCUPANT
M OF DWELL AREAS
0 STORIES UNITS _4V YES LOAD
NUMBER REQUIRED
DESCRIBE WORK TO BE DONE
REMARKS
z
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINALINSPECTION REO'D a
OQ
CIO' ('0 aV -4-�,n, �,
1�11aek Cl_hauh UyuK_ VALUATION
$ F_
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % City Surcharge
I Building Permit C)
HECK NO: VESTED DATE Plumbing Base Fee
ry
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
i DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
OAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPI OYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING Dinccrty OR INDIREC1LY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp. Total Amt. Due �2
DEEMED 1`0 MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
MI Recording Fee Receipt 0 '91 41�kl
I HEREBY ACKNOWLEDGE THAT I HAVE READ TfIIS 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 WITI I CITY AND STATE LAWS REGULATING CONSTRUC- CALL I his application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTIIORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHING1 ON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
O�FIYI[A).S SIGNATUPE
0/ A
SIGNATURE (�O �NER A AGENT) DATE SIGNED (425)
'RV ED
771-0220 D E
tV
ATTENTION Off 133 '2
7;
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILA FINAL /1( 12.-
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL -FILE YELLOW- 41PECT61`11
_R
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 CO S
z
0
M
--i -n
0 M
c::
M 0
0
C-)
0 C:
M
M Z
0 —11
C: _z
x
cn
0 _n
n
M M
0
0
0 M
C (n
K cn
M 0
Z
z
z
0
1
0
171
I
4-
V,
copy
WA U T
AppfioVL:D AS NOTED 7
NGINEERMG N -9
p jr
Date: rr
to a—V
+ los - + 12.
& CLZ K
40
D
LOT COVE RACrE
pow-
C% schvg r.
2 63 &/ :5&, FT
Lo-r 4REA GQ FT s 114
9400 SQ-,P7., - S, FLOOP,
Lo-r 5LOPe 5 0/6 �CAC-Q— 5517 SGkr-T 1p
-rA Y PCgl� 0.00
:6t�Rhc-F-
702
A Pr
. ... 1. �,, -:75
lij
rr-
+10%.93,.
�c �Clljs
Lij
K-tn, 1,�J
+
-M
C-C-
Wl -
cr
—CURB
A LN Wr s jcn.HEET FILE
OATOM 100,
(t,l� cr R
z
0
A
0
rn
--I -n
rn
c
rn 0
0
--lo
0 C:
--4 K
2: rn
rn z
cn
o -n
m M
0
0
0 rn
C cn
9 cn
M 0
Z
>
z
--I
:c
cn
z
0
1
0
rn
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLWESIGN
myvv� ENGINEERING DIVISION DATE
PLANNING DIVISION DATE
I'LLASE SIGN
PROJECT 0'6s� -
SITE ADDRESS U� � U
PERMIT 4 %t6A' ��O
�ADB#_________DATE INSPECTEDON�&4
DESCRIPTION OF WORK TO BE INSPECTED h 0 ct
A field inspection was conducted to determine final 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
u Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
I .
2.
0
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
ocaprv1.doc.1:temp:b1dg:fbn-ns 10/0 1
z
0
A
0
M
Zi =55
M
M
0
0
0 C:
--I K
M M
M Z
0 -n
n x
>
M M
0
0
M
Cl)
U)
Q 0
Z r-
7-1 M
z
M
Cn
z
0
M
0
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 L
OCCUPANCY .................. M'S
20* 0SV9
z
0
i
0
M
--i -n
j
:c
M
M
0
--I C) i
0 C
M
M Z
r') —i
C
cn
0 -n
n
M M
055
0 r-
0 M
C Cn
9 Cl)
Q 0
Z
>
z
0)
z
0
0
ITI