20040568.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
A&D Y�CIAA,_)
MAILING ADDRESS
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CITY ZIP TELEPHONE
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CITY ZIP I.TELEPHONE
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NAME ICBLN
ADDRESS
CITY ZIP
STATE LICENSE NUMBER
TELEPHONE
ON DATE I CHECKED BY
ROPERTY TAX ACCOUNT PARCEL NO.
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NEW RESIDENTIAL PLUMBING/MECH
ADDITION COMMERCIAL
rHANGE OF USE)
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REMODEL 11 MULTIFAMILY SIGN
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REPAIR
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GRADING
CYDS
FENCE
0 ( X Fr)
DEMOLISH
TANK
OTHr 126 f J�',
CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
EiGARAGE
PERMIT EXPIRES
USE PERMIT
ZONE NUM__
JOB SUITE/APT
ADDRESS,.�,;f 'm / j-I J, 7 Z //"
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET AAP
TESCP ApFD—vod (3
RW Permit Hequired E3
Street Use permit Req'd . [3
Required
EXISTING PROPO
Inspection
Sidewalk Hequired
REQUIRED DEDICATION FT
Underground
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 NO
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REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/ORAINAGE Z5
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ENGINEERING REVIEWED BY DATE I
FIRE REVIEWED BY
DATE
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INSPECTION
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POSTED
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SIGN AREA
HEIGHT
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ALLOWED PROPOSED
ALLOWED PROPOSED
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LOT COVERAGE
REQUIRED SETBACKS (Fr.)
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PROPOSED SETBACKS (IT)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LJR SIDE REAR
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PARKING
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PLANNING REVIEWED BY DATE V
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REO'D PROVIDED
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100
REMARKS
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER6
DESCRIBE WORK TO BE DONE
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HEAT SOURCE GLAZING % LOT SLOPE %
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PLAN CHEC11% 110: VESTED DATE
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: 180DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF 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 OF WHATEVER NATURE, ARISING DIRECTLY On 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 CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,'
PE 0 CODE OCCUPANT
.r ,QTRUCTION T7 GROUP f3.
SPECIAL INSPECTION AREA OCCUPANT
I — —7,3 LOAD
REQUIRED 0 YES
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 5
19 A A 03
-1 f-VALUATION
Des4cri'Dtion
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
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
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
SIGnTURE ANER'61`1 AGEN-n DATE'SIGNED
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
LandscapeInsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
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FEE Description FEE
State Surcharge
City Surcharge
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building 011icial or his1her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFFICIALS SIGNATURE DAT E
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RF)t;TfffD7
ATTENTION
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
04102 PRESS HARD -YOU ARE MAKING 5 COPIES
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ORIGINAL - FILE YELLOW - fNSPE(7rC
PINK - OWNER GOLD - ASSESSOR
GREEN - ACCOUNTING
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PARKING SPACES REQR .,'ETBACKS: RECEIVED
Lrt JAN 2 6 2004
APPROVED BY PLANN11' PARKING SPACES PROPOSEM.2 SIDE .-L
REAR
B B I PERMIT COUNTER
ARRIER FREE PARKING SPACES: OT HER -&A-, LAC
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EXIST. SITE PLAN* Nrw siTE PLAN
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DEPARTMENT OF BUILDINGS
PER UNIFORM BUILDING CODE SECTION 169
�2�004-0568
At: 20120 76" Ave W. Building -��erjt #
Occupancy established by this certificate: Dwel No. Stories: I
jTyjpe of d ��-'jls,'jjuctlon: V-N Basement: No
B
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Maximum occupant Load (Per UBC 1002)
Room capacity signs, wh'"''-'. ust remain posted at a// times.
of
5 73' AVe'W'
Ad �63h-
owner of Building Dr. Thomas and Yvonne, Mc, r1n, 1997 Edition
The McGraw Doctor's Office has ',frippetted and a-pproved,as..compl�irig-With�,the requirements of the
of the Unifor ilding Code as adopted by'th w.ql , t . y for the §rou I di y and the use for which the proposed
Vision o occupanc
occupancy is classified.
Issued this 13 �,:Oay,bf - October, 2004
CHI BUILDING OFFICIAL
BY:
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nd a new
This certificate shall be posted in a conspicuous public area and shall not be removed, mutilated or obscured and shall be maintained in legible condition at all times. Any change of occupancy or use requires a building permit a
Certificate of Occupancy issued by the City of Edmonds Building Official.
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FINA PROJECT APPROVAL FC M
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASESIGN
—ENGINEERING DIVISION DATE—L!
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PROJECT
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SITE ADDRESS 12,012-0
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PERMIT # 1004 -0 S- U e5 DATE INSPECTED lzeyi
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DESCRIPTION OF WORK TO BE INSPECTED Q7 oflqc'e
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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
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PERFORMANCE BONDS and the granting of
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GRANT FINAL PROJECT APPROVAL
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign___________—
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OCT 13 2004
DEVELOPMENT SERVIceS GTR* DATE:
CITY OF EDMONDS
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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FROM: I
PLEASE SIGN
ENGINEERING DIVISION DATE—
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DESCRIPTION OF WORK TO BE INSPE CTED
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denotes that there are no objections from the above signed Departmen t to the release of
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PERFORMANCE BONDS and the granting of:
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FAIILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
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2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:teMP:b1dg:fbnns: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 ...........
0
Slab Insulation .......... M
PLUMBING:
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Underground .............
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Rough -in ................... M 0
0
0
commercial Final ...... 0
C:
HEATING: X M
M Z
Gas Test .................... I[)
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Gas Piping .................
Equipment ................. 0)
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Commercial Final .......
EXTERIOR SHEATHING M M
NAILING..........................
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nos 0 M
FRAMING ........................ c:: C#)
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FIRST FLOOR FRAMING ... Q 0
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INSULATION ...................
Floor insulation .........
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Wall Insulation ........... z
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Ceiling Insulation ....... 0)
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r,—�V�HEETROCK NAILING ...
SPECIAL INSPECTION ... 0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................