20040541.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME /NAME OF BUSINES
V
MAILING ADDRESS
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CITY ZIP TELEPHONE
-3
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NAME
t: ADDRESS
CITY ZIP
NAME
F01919111*&I
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CITY I ZIP
STATE LICENSE NUMBER
TELEPHONE
CBL #
TELEPHONE
EXPIRATION DATE I CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
('D% C > (f) 0 Ck 0
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
EGARAGE
]
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
OF 2,
DWELLING
I
STORIES
UNITS
DESCRIBE WORK TO BE DONE
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
El SIGN
FENCE
( X Fn
OTHER
FIRE SPRINKLER
FIRE ALARM
USE
ZONE
PERMIT EXPIRES,
PERMIT
NUMBER
JOB
ADDRESS
PIAT NAMEISUBDIVISION NO LOT NO
PUBLIC RIGHT OF WAY FIER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE I LINE SIZE NO. OF FIXTURES
,I
SUITE/APT#
LID NO
LID FEE $
T_E;�S;CV �APPMV
nVj polMit 8nquand
Sl,,01 U50 pefrilit Hort'd
In5pection Requitod
SIdOW31k Requifed
Undergrolind
W,,,grequirad
PRV REQUIRED
YES [3 NO 13
REMARKS
OWNER/CON TRACTOR RESPONSIBLE FOR EROSION CONIHOIJDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU SHORELINE OR ADO# INSPECTION BOND
REO'D POSTED
U0, ��
(YES 0 N—OLS — — — _i�
SEPA REVIEW SIEN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP I X [� A�o e—
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACIZS (Fr.)
ALLOWED PROPOSED FRO
,,WT SIDE Wl� FRQt4T �R SIDE REAR/�
It it-7
No 411 el a5 t,76'- 1IL:k5 t )11�� z
PARKING 5
LOT AREA I P NING KBY DATE
VIDED 7/0
REMARKS e'X,,d_
T-j A
Ad (I -ce/N I
CHECKED BY ITYPE OF COI�
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CRITICAL V%J.4
AREAS SPECIAL INSPECT]
NUMBER 0 Lk 21 REQUIREDE] YE
OCCUPANT
LOAD
IREMARKS a
z
PROGRE55 INSPECTIONS PER LIBC 1081FINAL INSPECTION REO'D 3
63_c�_
HEAT SOURCE GLAZING % LOT SLOPE %
q -
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PLk1N CHECK NO: VESTED E
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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 BEHAt F OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OTWHATEVER NAIURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY 10 ENFORCE ANY ORDINANCE PROVISION *
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
H
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS HEGULAIING CONSTRUC-
TION. AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
LINVIOLATION OF_:rHE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMENS CPMPENSATION INSURANCE AND RCW 18,27.
4
NATURE N R R AGENT) DATE SIGNED
................... ............... C�
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
FEE Description
State Surcharge
7" City Surcharge
Base Fee
r
FEE
Plan Chk. Deposit .11)
Receipt #
Total Amt. Due 161, r
Receipt H
APPLICATION APPROVAL_�
This application is not a perinit until signed by the
Building Official or his/her Deputy. and Fees are Paid, and
receipt is acknowledged in space Provided.
OFFICIALS SIGNATURE DATE
ro (—)
RE(EASED BY'
A17ENTION EXT 1333 1,_". f,9
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
091;03 PRESS HARD -YOU ARE MAKING 4 COPIES
a
ORIGINAL FILE YELLOW INSPECTC
PINK - OWNER GOLD - ASSESSOR
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B UI'LD INS
JUN 2 9 2004
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kPPROVEDBY PLANNING
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5-A-0
Zone Cornerye, Flag IVO
Setback Required Actual
Front
Sides C -7' L - / q
Rear 76
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FINAL PROJECT APPROVAL FORM
TO:
DATE: —
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: -FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
PLEASKS1 14 K
PLANNING DIVISION DATE q11
C
PLEASCSIGN
PROJECT_��Al
PC S'
SITE ADDRESS —
PERMIT# ADB# DATE INSPECTED
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 the release of
PEPW ORMANCE 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
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
[I Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE-WSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tenip:b1dg:f6rtns:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
79 -64-
S,ETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
GasTest ....................
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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