20040523.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAM ESS
y- I n m
MAILING ADDRESS
CITY
NAME
ADDRESS
CITY
ZIP TELEPHONE
Nzb-771
ZIP I TELEPHONE
FERMIT EXPIRES
P
USE PERMIT
ZONE
NUMBER -10
JOB SUiTE/APT#
ADDRESS -7�4'1` Atl�
PLAT NAME/SUBDIVISION NO. LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
4
LID NO
LID FEE $
TESCP Approved
13
Rw Permit Required
E3
Street Use Permit Req'd
E3
Inspection Required
13
SidewalX Required
[3
Underground
Wiringrequired
0
PRV REQUIRED
YES 13 NO IJ
UREMARKS
WNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROODRAINAGE
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STATE LICENSE NUMBER EXPIRATIOV D)TE Y REO'D POSTED
Ll SEPA REVIEW SIGN AREA DYES ONO I S HEIGHT
dx PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE I EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
NEW RESIDENTIAL PLUMBING MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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ADDITION COMMERCIAL CHANGE OF USE z
ED BY DATE 5
PARKING LOT AREA PLANNING REVIEW IL
REMODEL MULTIFAMILY E] SIGN REO'D_ I PROVIDED
GRADING FENCE I 't - 11 �7
REPAIR CYDS X FT) RKS ' " .1 - Z!�- --� () M�
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GARAGE RETAINING WALL FIRE SPRINKLER
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: CHECKED BY jTyeg PCNt�IrOkN C� OCCUPANT./�*
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to NUMBER AREAS SPECIAL INSPECTION JAREA OCCUPANT
0 OF DWELLING LOAD
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0 STORIES UNITS
DESCRIBE WORK TO BE DONE
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/IBC109/lRC109 FINAL INSPECTION REQ'D a
LUATION
$
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
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU13LIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
cc PERMIT APPLICATION: 180DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Fire Review PlanChk.Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS 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 THIS PERMIT SHALL NOT BE
a DEEMED TO MODIFY, WAIVE OR REDUCE ANY REOUIREMEN r OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
xi Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application is not a permit until signed by the
THE OWNER. I AGREE 70 COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CqDE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORK�� OFFIC17ALYIGN IITU�E
ENSA!��AANCE AND RCW 18-27. ATE
NAT IN 0 G�Nfi DATE Sl D (425) 7/
/pId" 4 R/I - V/ — — —
LL;ln� 1 7 D�TE
771-0220 RELEASED BY
AtTENTION EXT 1333 ------------------
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC1 09 / IBC1 10 / IRC1 10. PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM.
TO:
DATE:
MEMO TO: PE , IT - 0 ATOR, BUILDING DIVISION
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FROM: FIRE DEPARTMENT DATE 12-1,_1101
_T PLCAICSr ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT L-L) A49 51
SITE ADDRESS— 164 () 1 -7 It- 19-V LIJ
PERMIT# t) 4 - _Z- 5 ADB# DATE INSPECTED I z_
DESCRIPTION OF WORK TO BE INSPECTED I'; 4:�—_ --0&)JV6C7-Z &A-)
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 the release of
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
D Copy of CORRECTION NOTICE given to owner/contractor by inpector
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2. RECEIVED
3. DEC 2 2 200t:
PERMIT COUN-0—
RE-fNSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:ten1p:b1dg:fonns:ocaprv1 3/25/04
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: M CQ�.� FIRE DEPARTMENT DATE
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ENGINEERING DIVISION DATE
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PROJECT -
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SITEADDRESS /U'76// /6-111-1 /-' dzL 1-r -, & t,-,z -4
PERMIT ADB#_________PATE INSPECTED
PLANNING DIVISION DATE
DESCRIPTION OF WORK TO BE INSPECTE (/,6w
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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 the release of
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
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3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fomis:ocaprv1 3/25/04
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE- DEPARTMENT DATE
PLEASESIGN z
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ENGINEERING DIVISION DATE —1
PLEASESIGN 0
PLANNING DIVISION DATE
PIXASE SIGN
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PERMIT ADB#_DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED 411 fjit 0&o�6M__AKLP_
A field inspection was conducted to determine compliance with -approved plans. Final approval
above signed Department to the release of
denotes that there are no objections from the
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
n Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tenip:b1dg:fonns:ocapn,1 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 ...
YMI S �C �EL OUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
2001Dq 0,w06ZS
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