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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
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STATE LICENSE NUMBER EXPI
a PROPERTY TAX ACCOUNT PARCEL No.
❑ NEW RESIDENTIAL
ADDITION ❑ COMMERCIAL
® REMODEL ❑ MULTIFAMILY
❑ REPAIR ❑ GRADING CYDS
❑ DEMOLISH ❑ TANK
GARAGE RETAINING WALL
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OF DWELLING
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DESCRIBE WORK TO BE DONE
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DATE'T CHECKED BY
® LUMBIN MECH
COMPLIANCE OR
❑ CHANGE OF USE
❑ SIGN
❑FENCE
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❑FIRE SPRINKLER
FIRE ALARM
CRITICAL
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NUMBER / 7
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HEAT SOURCE, ING LOT SLOPE %
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PLAN CHECK N? `/ VESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE ORK NOTED. THIS PERMIT OVERS 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: 180 DAYS
PERMIT LIMIT. 1 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 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 TO ENFORCE ANY ORDINANCE PROVISION.'
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.6�i lISATION INSURANCE AND RCW 18.27.
DATE SIGNED
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USE
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PERMIT
NUMBER
JOB SUITE/APT#
ADDRESS 75^r70/ r✓ �E 1�.��a�� &
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO,
LID FEE $
TESCP Approved ❑
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required O
Street Use Permit Req'd 13
EXISTING PROPOSED Inspection q
Sidewalk Requireduued ❑
REQUIRED DEDICATION FT underground
W,nnp required ❑
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED O
YES ❑ NO X Z
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REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE Z
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ENGINEERING REVIEWED BY IDATE
FIRE REVIEWED BY DATE w
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VAR19NpCE OR CU SHORELINE OR ADBtf INSRPEC IION BOND
POSTED
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SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXE T ALLOWED PROPOSED ALLOWED/ PROPOSED
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EXP
LOT COVERAGE REQUIRORED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FNTr SIDEO,RIEAR FROIF L/gSID., REARS O
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PARKING LOT AREA P NING REVIEWE B DATE CL
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SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED YES / LOAD
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REMARKS z
PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION REQ'D FS
VALUATION
$ �O/_
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
FEE Description
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State Surcharge
Q City Surcharge
FEE
Fire Review jReceipt
Chk, Deposit
Fire Inspection b�ll Air
Landscape Insp. Amt. Due
Recording Fee ipt k
APPLICATION APPR VAL
CALL This application is not a permit until signed by the
Building Otticial or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
I I SS NATURE DATE
(425)
771 m0220 SED BYA DATE
ATTENTION
EAT 1333 �' �iY/ `7/11��i
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 PPF.qq HORn -vr)I I AMF MAKINr, S rC)PIFS
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CASCA[DETESTING LABORATORY, INC. i �^ n
TESTING & INSPECTION / ENGINEERS PF+Fvlous` U `-F
RFPORT No. No.
12919 N.E. 126TH PLACE
KIRKLAND.WASHINGTON 911034 (425) 823-9800
919' EVERETT (425) 259.01117.
FIELD REPORT
TO:
2004
{ENT 10111ICES L'T�.
ATTN:
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THE FOLLOWING WAS NOTED:
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TEST RESULTS APPLY ONLY TO THE ITEMS
HEREIN TESTED. THIS REPORT SHALL NOT INSPECTOR(S), NAMES PRINTED
BE REPRODUCED EXCEPT IN FULL WITH-
OUT THE WRITTEN APPROVAL OF CASCADE INSPECTOR SIGNATURE -
TESTING LABORATORY. INC.
SIGNED BY
REVISED 1102
COPIES TO:
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CONTR CTOR
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1 v D S GARY HAAKENSON
CITY OF EDMO MAYOR
121 5TH AVENUE NORTH • EDMONDS, WA 98020 • (425) 771-0220 • FAX (425) 771-0221
�,.,. Website: wwadedmonds.wa.us
DEVELOPMENT SERVICES DEPARTMENT
j� c 1$9p Planning •Building Engineering ,ll
June 16, 2004 -
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Scott & Tiffany Hansen MI
15615 75th Pl W
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Edmonds, WA 98026
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FAX: 425-743-2083 M r
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RE: Vesting current plan reviews#04409 under the current building codes --� n
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Dear Scott & Tiffany Hansen: m z
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We are writing to remind you of the City adoption of the International Building Codes effective a Z
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on July 1, 2004,
With the code change -over fast approaching full permit and plan check fees are required before
July 1, 20G�4 to vest your application under current codes. The amount to vest your application is m rn
$355,009 0 0)
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If the noted fees in the amount listed above are not received BEFORE July 1, 2004 your plans
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must be returned to you and any fees paid to date must be forfeited. z 0
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If you have any questions please don't hesitate to contact the permit coordinator assigned to your
project at 425-771-0220. _
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Sincerely; i
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Permit Coordinator
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• Incorporated August 11, 1890 •
Sister City - Hekinan, Japan '
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS
FOUNDATION:
Footing
Wall ...........
Pier/Porch .. ............
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Retaining Wall
Slab Insulation .......... m
PLUMBING:
Underground ............. _
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J Cl; ` Cv
Rough -In M
vessel!
Commercial Final ...... 0 C
Gemmel 9
HEATING: MZ
p -ill
Gas Test C Z
ressiss!
Gas Piping ................. — _
Equipment ................. 0 eelseen
Commercial Final .......
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EXTERIOR SHEATHING� . v �
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NAILING 0
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FRAMING ........................ (� Q r �
FIRST FLOOR FRAMING... 1 �1 r� ru Zveselr
71
INSULATION C �'I C� l � ;U
Floor Insulation 2
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Wall Insulation ........... Z
2
Ceiling Insulation .......
SHEETROCK NAILING ... l_s 0
SPECIAL INSPECTION sells0
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MISCELLANEOUS .......... j f
FINAL APPROVAL FOR
OCCUPANCY
'd&w ... I Ad%k. I .r. .�
The Initials MT are Milton
Thompson, a temporary contract
inspector for the Cityo
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