20040612.pdf4
DATE REC
CITY'OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINE S�,
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MAILING ADDRESS
CITY ZIP TELEPHONE
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ADDRESS
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CITY ZIP TELEPHONE
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NAME
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STATE LICENSE NUMBER
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PROPERTY TAX ACCOUNT PARCTEL NO.
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RESIDENTIAL
ADDITION
COMMERCIAL
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MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIV" EXPLAIN
NUMBER NUMBER OF
M OF DWELLING A,/
0 STORIES UNITS
DESCRIBE WORK TO BE DONE
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HEAT SOURCE I GLAZING %
PLAN CHECK
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CBL #
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
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FIRE SPRINKLER
FIRE ALARM
PERMIT EXPIRES 7
USE PERMIT
ZONE NUMBER
JOB SUITE/APT#
ADDRESS ELA q q
PLAT NAME/SUBDIVISION NO. Lotr NO.
LID FEE $
TESCP Approved [3
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Requited 13
Street Use Patten Roq'd C3
EXISTING - PROPOSED inspection Requilod 11
Sidewalk Required E3
REQUIRED DEDICATION- FT Undefgtound
Wiring required 13
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I I YES 1:1 NO 11
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL.1DRAINAGE
ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE 1-�jfe_rr,
VARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND
RE(We' POSTED
OYES YkO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEIPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP I N,
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
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PARKING LOT AREA NING 131�,VIEW[o PY DATE 5
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RFO'D I PROVIDED wj� / 71V
REMARKS
CHECKED BY TYPE F CON§TRUCTION E OCCUPAN1,>
GROUP
CRITICAL T U/1 C1*7
AREAS SPECIAL INSPECTION JAREA OCCUPANT
LOAD
NUMBER REQUIRED [:] YES
REMARKS
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]PROGRESS INSPECTIONS PER UBC 108/ IBC109 if IRC109 FINAL INSPECTION REQ'D EI
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LOT SLOPE %
VESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
M PERMIT APPLICATION: 180DAYS
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CL PERMIT LIMIT' I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
W 'APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
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�j IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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< ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS 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 COMPENSATION INSURANCE AiND RCW 101n,
SIGN�ATURE (�O�WNE14 ORAC ENT) ATE SIGNED
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FEE Description FEE
State Surcharge ?
C ty
ity Surcharge
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-, IJ7Bta e Fee
Plan Chk. Deposit
Receipt 0
Total Amt. Due
Receipt 0
APPLICATION APPROVAL
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This application is riot a permit unin s gno y o
CALL Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
OEFICI IGNAT DATE
(42
5)
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771-0220 R'ELEAS`ED BY _i�(TE
ATTENTION E)ff 1333 'T h�' " x 1,
ITIS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL /Rff/,_ 71�7
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINA�- FI YELL61W - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK GOLD -ASSESSOR
09M PRESS HARD -YOU ARE MAKING 4 COPIES
VALUATION
$ CA LD
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
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MEMORANDUM
Date: 7/27/04
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To: Debbie Karber, Accounting Assistant
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From: Marie Harrison
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Subject: REFUND
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Debbie, please prepare a refund check in the amount of $91.50. Please mail the check to M z
Northwest Tea Station at 22315 Highway 99 #A, Edmonds, WA 98026. The bid came in under
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the estimate. Please deduct from the building permit fund. I have enclosed a copy of our receipt >
-924478 for your records. Thank you.
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Sincerely, 0
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Marie/
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Development Services Division Director's Signature
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City of Edmonds cza Coninitinity Services
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I& '�46rtupant &A
%L'elarAtt"ft" rate of AV
DEPARTMENT OF BUILDINGS
PER UNIFORM BUILDING CODE SECTION 109
At: 22315 Highway 99 # Building Permit # ZOU4-Ufjl 2
Occupancy established by this certificate: Dwelling Units: **N/A*** No. Stories: 1
B Type of Construction: III-N Basement: No
Maximum Occupant Load ***26*** (Per UBC 1002)
Room capacity signs, when required, must remain posted at all times.
Owner of Building Ted Yamamura Address: 22315 Highway 99 #A
The Tapioca Express has been inspected and approv as complying with the requirements of the 1997 Edition
of the Uniform Building Code as adopted by the City for the group and division of occupancy and the use for which the proposed
occupancy is classified.
Issued this 30 day of September, 2004 _
CHIEF BUILDING OFFICIAL
BY:
cy or use requires a building permit and 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 occupan
Certificate of Occupancy issued by the City of Edmonds Building Official.
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: ukAz_, PRETRLATMENT DATE
MASE SFeT
ENGINEERING DrVISION DATE,
PLWE SIGN
PLANNING DIVISION DATE
PVASE SIGN
PROJECT Zn_ '
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SITE ADDRES
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PERMIT # 200 0 6 / 2- ADB#_________PATE INSPECTED 2-
DESCRIPTION OF WORK TO BE INSPECTED -InSLIIINLOD 4 22�am !�ro_xp_ Ln-ap
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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
PERFORMANCE BONDS and the granting of
X GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
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2.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fomis:ocaprv1 3/25/04
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERNMnITA009 BUILDING DIVISION
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FROM: FIRE DEPARTNMNT DATE
nzmiism/ ENGINEERING DIVISION DATE
PUMESICM
PLANNING DMSION DATE-
PLPASE SIGN
PROJECT -T_-PV)_0c-4
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PERmrr;� 04- - 0 (9 ADB#_____--PATE INSPECTED
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
PEPW ORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
c3 Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
cl Copy of CORRECTION NOTICE given to owner/contractor by inspector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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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 ..................
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
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