20040581.pdfN
DATE RECEIVED
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USE
CITY OF EDMONDS ZONE
JOB
CONSTRUCTION PERMIT APPLICATION JAD DR E S S
OWNER NAMENAME OF BUSINESS
P P T
_e� . . - � ��, . I - — LAT NAME/SUBDIVISION NO.
PERMIT EXPIRES
PERMIT
NUMBER
LOT NO.
MAILING ADDRESS I -
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
CITY ZIP 1 TELEPHONE EXISTING — PROPOSED
4S& REQUIRED DEDICATION— FT
NAME METER SIZE I LINE SIZE NO. OF FIXTURES
ADDRESS
SUITE/APT#
LID NO.
LID FEE $
TESCP Approved
RW Permit Required
Street Use Permit Roq*d
Inspection Required
Sidewalk Required
Underground
Wiring required
PRV REQUIRED
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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STATE LICENSE NUMBER EXPIRATIO1 DATE C 13Y REO'D POSTED
-I (f) M 6 L t I SEPA REVIEW OYES ONO S
r-k Eill (P� I SIGN AREA HEIGHT
-j PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
-7
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LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
NEW 0131�SIDENTIAL PLUMBING MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR 0
COMPLIANCE OR
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PARKING AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY E] SIGN REO'D I PROV
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CYDS ( X FT) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z El CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTWI EVi.AIN:
CHECKED BY TYPE7ffO I OCCUPANT
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ul NUMBER NUMBER OF CRITICAL
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DESCRIBE WORK TO BE DONE
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N PROGRESS INSPECTIONS PER UBC 108/IBC109/lRC109 FINAL INSPECTION REO'D
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit j\� City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
E DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
j SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
A
CL PERMIT LIMIT:11 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V) 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
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
ALI. CLAIMS FOR DAMAGES OF WHATEVER NAVURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF 1 HIS PERMIT SHALL NOT HE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due
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0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION
X1 Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION PROVAL
GIVEN IS CORRECT, AND THAT I AM LE OWNER, OR THE DU& AUTHORIZED AGENT OF APPLICATION AP
THE OWNER. I AGREE TO COMPLY.MeTTF1 I CITY AND STATE LAWS REGULATING CONSTRUC- This application is note permit until signed by the
TION; AND I IN4TI1,E WORK ITEHORIZED THEREBY. NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
N Do' LE LA D receipt is acknowledged in space provided.
IN VIOLATION OF OF THE STATE OF WASIJINGTON RELATING TO FOR INSPECTION
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WORKMEN'S COMP SA N URANCE AND RCW 18.27. OFFICIALS )SIGNATURE D E
VN� RIF IN" DATE SIGN
SIGNATURE ED (425)
�9A k 771-0220 4, tE=,, s, E /DATV
ATTENflOW/�_" EXT 1333
ITISUNLAWFUL SE OR��CUP DING OR STRUCTURE UNTILAFINAL
INSPECTION HATBEEN MADE AN APPROVALOR ACERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/]BC110/IRC110. PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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FUEL TANK INSTALLATION CO. INC.
PO Box 46412
Seattle, WA 98146
206-244-8020/ FAX 206-243-3477
Underground Storage Tank
Cleaning Certificate
Date: � C" 'I
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Owner: P V-L
Job site: bvi
City:
Tank size: 3L5C�� gallons
This letter is to certify that the underground heating oil tank being
decommissioned has been pumped and rinsed and all effluents legally and
properly disposed of in the city of Seattle. The above referenced tank is now
ready to be excavated and removed or decommissioned in place with inert
material.
Thomas H. Anderson
<1.6BO 059581-U2
WA St. Cont. license FUELTIC08OB8
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FINAL PaWEQ1 AkDROVAL FORM
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JUL 27 21010"
[)EVELOPMEN't r
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cJTY OF EM4�:*�*'�;�)'-'�
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
_a7-, FIRE DEPARTMENT DATE4&��/O �f
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ENGINEERING DIVISION DATE
PLEASESIGN
FROM:
PROJECT
SITE ADDRESS—
PERMIT#_s2-224�
-PLANNING DIVISION DATE
PLEASESIGN
,57
f 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
PERF ORMANCE BONDS and the granting of:
,11--k 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 inpector
1 .
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbrms:ocaprv1 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 ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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