20040550.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
Hartford Con6.racting Inc.
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il* 5525 --jakeview i)r. 9te. 200
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CITY ZIP TELEPHONE
Kirkland, WA. 98033
NAME
Wangerin Associates
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ADDRESS
12408 106th Pl. N.E.
CITY ZIP TELEPHONE
KirklLnd, WA. 98034 1425-823-559:1-
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USE PERMIT
ZONE NUMBER
JOB SUI`rg�//A T#
ADDRESS
PLAT NAMEISUBDIVISION NO
1_04��O,
LID NO.
LID FEE $
TESCP Approved E3
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Requirod 13
Street use Permit Roq'd 13
EXISTING - PROPOSED
Inspection Required Q
sidewalk Required
1 13
REQUIRED DEDICATION- FT
I underground
I wiring requituct C3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES NO
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REMARKS
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OWNER/CONIRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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NAME
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Smith Fire Systems, Inc. C4 N
jj�, �;/ ENGINEERING REVIEWED BY BAT E
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ADDRESS
15 �813 168th St. N.E. Siiite 1
< FIRE REVIEWED BY DATE uj
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CITY ZIP TELEPHONE
0 Arlinaton. 1�!A. 98223 360-C31-770l D fl-0-
VARIANCE OR CLI HORELINE OR ADBI INSPECTION BOND
STATE LICENSE NUMBER EXPIRATI N DATE CHECKED By REO'D POSTED
1 04 OYES ONO
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SHITHF:3 13'.')L)T SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
UJI �104 �341` 12101600 .1
EXP
NEW ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
11 RESIDENTIAL El PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
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ADDITION COMMERCIAL COMPLIANCE OR 2
1:1 CHANGE OF USE z
PARKING LOT AREA 'PLANNING REVIEWED BY DATE
REMODEL 0 MULTIFAMILY SIGN REO'D PROVIDED
REPAIR GRADING E] FENCE I I I -
CYDS X FT) REMARKS
DEMOLISH TANK F-1 OTHER
GARAGE RETAINING WALL IRE SPRINKL R
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(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN! nommommom�
Fr Condo)n_',;-ti_,ni_, CHECKED BY
ITYPE OF CONSTRUCTION OCCUPANT
GROUP
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ul NUMBER NUMBER OF CRITICAL
0 OF DWELLING AREAS SPECIAL INSPECTION jAhtt% NT
to 4 LOAD
0 STORIES UNITS NUMBER REQUIRED DYES
DESCRIBE WORK TO BE DONE
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D Ei
Instal 1 Virg, Sprinkl.,-r cystein,
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VALUATION
$
Description FEE Description �EFEE
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= 13E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
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Lu PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT., 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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u) *APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
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_j IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS T14E CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt #
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECI LY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
93 -Y ORDINANCE Landscapelnsp. Total Amt. Due
_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CIT
0 NOR LIMIT IN ANY WAY THE CITYS ABIL11Y TO ENFORCE ANY ORDINANCE PROVISION'
I - Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS 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 WITH CITY AND STATE LAWS REGULATING CONSTRUC CALL I his application is not a perinit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building 011icial or his/her Deputy and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW IB 27
OFf ICIA1 S SIGNAI UR DATE
NATURE (OWNER ORAt* DATE SIGNED (425)
_41� 1� I . " C-),�
OV 771-0220 RELEASE( BY DATE
ATTENTIOW- E)ff 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
.IN PEC
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- (JVXIG��INAL ��LE Y 4 T
CATE OF OCCUPANCY FiAS BEEN GRANTED. UBC SECTION 109 Plr4 - OWNER GOLD - ASSESSOR
09,'03 PRESS HARD -YOU ARE MAKING 4 COPIES
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MEMO TO:
FROM:
FIN L PROJECT APPROVAL �)RM
TO:
DATE:
IG DIVISION
IRE DEPARTMENT DATE
__�-ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT C-et-t- 1 K7-0
SITE ADDRESS
PERMIT # -7:jtE), D STZ2) ADB# DATEINSPECTED
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
PERFORAIANCE 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
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to own er/con tractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fonns:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
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Retaining Wall ........... 11
0
Slab Insulation .......... M
PLUMBING:
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Underground ............. x
M
Rough -In ................... M 0
--1 0
0
Commercial Final ...... 0 C
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HEATING:
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Gas Test ....................
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Gas Piping .................
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Equipment ................. 0 -n
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Commercial Final ....... __4
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EXTERIOR SHEATHING M
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NAILING .......................... 0 r-
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FRAMING ........................ C 0)
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M 0
FIRST FLOOR FRAMING... Z
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INSULATION ...................
Floor Insulatir,() .........
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Wall Insulation ........... z
Ceiling Insulation ....... Cn
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SHEETROCK NAILING ... 0
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SPECIAL INSPECTION ... 0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
VIP 63
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