20040565.pdf0
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS I
CITY ZIP TELEPHONE
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NAME
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ADDRESS
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CITY IP IT�1LEPI!?NE
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NAME
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ADDRESS
CITY
STATE LICENSE NUMBER
ZIP I TELEPHONE
EXPIRATION DATE I CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
OMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR GRADING CYDS
i��FENCE
X Fr)
DEMOLISH TANK
.. J. Pr
GARAGE RETAINING WALL
CARPORT ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USErBIJSINE�_S OR ACTIVITY) EXPLAIN:
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NUMBER
OF
NUMBER OF
DWELLIN G
CRITICAL
AREAS
NUMBER,��/_5-2
STORIES
UNITS
DESCRIBE WORK TO BE DONE
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ADDRESS
PLAT NAME/SUBDIVISION NO
PERMIT EXPIRES �:�
PERMIT
NUMBER
SUITEiAPT#
�X- I.
7 LOT NO. LID NO.
LID FEE S
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Requiled 13
Street use Permit Roq'd C3
EXISTING — PROPOSED inspection Requited 113
sidewalk Requited 13
Underground
REQUIRED DEDICATION— FT I Wiring requited E3
METER SIZE LINE SIZE NO. OF FIXTURES I PRY REQUIRED
I I I YES C3 NO IJ
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLJDRAINAGE
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ENGINEERING REVIEWED BY DPrTE
FIRE REVIEWED BY
DATE
VARIANCE OR CU SHORELINEORADB# I INSPECTION BOND
REO'D POSTED
C"p-a3-197- 1A-03-03,19110YES KNOis
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE I EXEMPT ALLOWED , PROPOSED ALLOWED 4"" PROPOSED
�V4 3:000�
-10'
EXP V
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
PARKING LOT AREA PLANNING REVIEWED BY DATE
REO'D I PROVIDED
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REMARKS
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CHECKED BY
SPECIAL INSPECTIU
REQUIRED [:] YES
OF CONSTRUCTION
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IAREA
OCCUPANT
GROUP
OCCUPANT
LOAD
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
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VALUATION
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Description
FEE
Description
FEE
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Plan Check
State Surcharge
AA701,Ai- �(�X&,.7irc- ,t,
SOURCE
GLAZING
LOT SLOPE %
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Building Permit
City Surcharge
Plumbing
PLAN CHETO: VESTED DATE
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Engr. Review
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SEPARATE PERMISSION.
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PERMIT APPLICATION: 160DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR PADRE INFORMATION
Fire Review
Plan Chk. Deposit
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
2
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp.
Total Amt. Due
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Receipt #
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NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.4
Recording Fee
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
1 his application is not a permit until signed by the
Foes are and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building official or his/her Deputy: and paid,
receipt is acknowledged in Space provided,
OFF IALS SIGNATURE DATE
WORKMEN'S C9MNSATION IN URANCE AND RCW 18.27.
(425)
SIGNAT RE WNEA OR AGENT)
DATE SIGL/N D
771-0220
RELEASED BY 6ATE
I
ATTENTION LA I 1JjJ
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
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
ORIGINAL -FILE YELLOW- INSPECTOR
PINK -OWNER GOLD,ASSESSOR
GREEN - ACCOUNTING
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GARY HAA KENSON
tit �4% MAYOR
ARL V CITY OF EDMONDS
121 5TH AVENUE NORTH EDMONDS, WA 98020 (425) 771 .0220 FAX (425) 771-0221
Website: www.ci.edmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning Bu ilding Engineering
October 14, 2004
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All City Credit Union
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Branch Supervisor
19725 40'h Avenue W Ste A
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Lynnwood, WA 98036
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Re: P erformance Frozen Fun d # 1462180-SIO for Thomas G. McGraw at 20120
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76"' Avenue W, Edmond s, WA 98026
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Dear Sir or Madam:
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The City of Edmonds hereby authorizes the release $20,865.00 from the above referenced
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Performance Frozen Fund. The Performance Bond has been replaced with a
the release of the
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Maintenance Bond. All intereste d City departments have approved
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Performance Frozen Fund
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Sincerely,
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Marie Harrison
Senior Permit Coordinator
Cc: Applicant
File
1ITclilp/DST's/M,,isterLetters/Itele,isePerforiii-,IliceO2/01
Incorporated August 11, 1890
GARY HAAKENSOIN
CITY OF EDMONDS
MAYOR
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 FAX (425) 771-0221
Website: www.dedmondsmams
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building Engineering
October 14, 2004
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Branch Supervisor
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Lynnwood, WA 98036
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Re: Performance Frozen Fund # 1462180-Sl I for Thomas G. McGraw at 20120
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7 61" Avenue W, Edmonds, WA 98026
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The City of Edmonds hereby authorizes the release $34,787.00 from the above referenced
Performance Frozen Fund. The Performance Bond has been replaced with a
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Maintenance Bond. All interested City departments have approved the release of the
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Performance Frozen Fund
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Sincerely,
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Senior Permit Coordinator
Cc: Applicant
File
LITeiiil)/DST's/Mastcrl-ctters/ReleasePerforiiiaticeO2/01
Incorporated August 11, 1890
FINAI A)ROJECT APPROVAL F0__,q
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLLASE SMIGN
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PLWE SIGN
PLANNING DIVISION DATE
FL&%Se SM
PROJECT
SITE ADDRESS -2(722 _'0 �76
L_AD]3#_______IPATE INSPECTED /0// //0 --7-
PERMIT t
DESCRIPTION OF WORK TO BE INSPECTED
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
Copy of CONDITIONS given to owner/contractor by inspector
1
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign
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FINAL PROJECT APPROVAL FORM
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DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASUSIGN
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denotes that there are no objections from the above signed Department to the release of >
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:ten1p:b1dg:rorms:ocaprv1 3/25/04
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ............... ......
Wall ..........................
Pier/Porch .................
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Retaining Wall ...........
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Slab Insulation ..........
PLUMBING:
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Underground .............
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Rough -In ...................
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Commercial Final ......
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HEATING:
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Gas Test ....................
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Gas Piping .................
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Equipment .................
Commercial Final .......
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EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ........................
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FIRST FLOOR FRAMING ...
INSULATION ...................
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Floor Insulation .........
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Wall Insulation ...........
Ceiling Insulation .......
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SHEETROCK NAILING
SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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