20040630.pdfECEIVL,
PERMIT EXPIRES
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USE PERMIT
CITY OF EDMONDS ZONE (4 NUMBER
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CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS,,)
OWNER NAME/NAME OF BUSINESS �?4'
, 4A.1A.1EL PLAT NAMEISUBDIVISION NO. L T NO., Llb NO�
LM MAILING ADDRESS
u LID FEE $
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B. OW i F-7t PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP JESGP Approved 0
0 Fivv Porrinit Required 13
(t t ti Speot Use Permit Roq'd 0
CITY ZIP TEIEPHONE EXISTING — PROPOSED inspection Acquired 13
Sidowalk Requited 13
=? REQUIRED DEDICATION— ET Undergrocind
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NAME METER SIZE LINE SIZE NO 01 FIXTURES PRV REQUIRED
A-1cc-14- YES NO 11
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ADDRESS REMARKS
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0 OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE E5
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CITY ZIP
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STATE LICENSE NUMBER EXPIRATION DATE VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
CHECKED TAY REO'D POSTED
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114 SEPA REVIEW SIGN AREA HEIGHT
PROPERTY PARCEL NO.)
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
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NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (171) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJRSIDE REAR
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ADDITION OMMERCIAL E
O—C CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE :5
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED a.
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El REPAIR GRADING CYDS ( X FT) REMARKS
E] DEMOLISH TANK OTHER
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o GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT E] ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
LZ;,7- CHECKED BY TYPE OF CONSTRUCTION COD OCCUPANT
U) GROUP
uj NUMBER NUMBER OF dRITICAL N27
a OF DWELLING AREAS S ECIALINSPECTION JAKEA OCCUPANT
to 211
to STORIES NITS NUMBER REQUIRED LOAD
DESCRIBE WORK TO BE DONE _] YES
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURqE GLAZING % LOT SLOPE %
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
In 111�/_ z2K�_:_
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
W PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Plan Chk. Deposit
U) Fire Review
W IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMI ESS THE Cl rY Or
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:E EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Receip
ALL CLAIMS FOR DAMAGES OF WHATEVER NAT URE, ARISING DIRECTLY 0 Fire Inspectio #
R INDIREC I IY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF 1111S PERMIT SHALL NO] LIF
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMEN r OF ANY CITY LandscapeInsp. Total Amt. Due
_j ORDINANCE
x 0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY 10 ENFORCE ANY ORDINANCE PROVISION
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION �W/71 .
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DU& AUT110FIlZED AGE-N1 OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
1:ON; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED CALL Building 011icial or his/tier Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATIiQ�� �URANC,E.AND RCW 18,27.
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/[IAI.S SIGNATURE DATE
OWNER 01 AIE I
SIGNATURE A E 11) DATE SIGNED (425)
y c � " Y I / /
/ - -_
__9 W 771-0220 'RFi EASED 13Y /DATE
ATTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY 'A' BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOIj
09,103 PRESS HARD -YOU ARE MAKING 4 COPIES
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FIN. PR03ECT APPROVAL. )RNI
TO:
DATE:
MEMO TO: PE 0 .0- ILDING DIVISION
FROM: 71LEMrSIGN #/ FIRE DEPARTMENT DATE
Pl.r.,%SUSIGN ENGINEERING DIVISION DATE
—PLANNING DIVISION DATE
PLEASESIGN
PROJECT
SITE ADDRESS
PERMIT # —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
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
11 Copy of CORRECTION NOTICE given to owner/contractor by inpector
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tei1ip:b1dg:forn1s:ocaprN,1 3/25/04
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FINi�w_ju PROJECT APPROVAL tORM
TO:
DATE:
MEMO TO: PERMIT COORDfNATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
-PLEA-SESIGN
ENGINEERING DIVISION DATE-
PLEASESIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT
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SITE ADDRESS- C(
PERMIT ADB# DATE INSPECTEDq---(3--o_S
DESCRIPTION OF WORK TO BE INSPECTED F
A field inspection was con i ducted 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
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
R-E-INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date SignatUre
1:teMp:b1dg'f6rn1s:ocaprv1 3/25/04
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DATE APPROVED
INSPECTOR
S ETBACKS .....................
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 ... ------- I
-------------
INSULATION ...................
Floor insulation .........
--------------
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
-------------
MISCELLANEOUS ..........
FINAL APPROVAL FOR 64
OCCUPANCY ..................
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