20040669.pdfi
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DATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS 11
MAILING ADDRESS
CITY ZIP TELEPHONE
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NAME
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CITY ZIP I TELEPHONE
NAME ICBLq
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ADDRES
ZIP/
ZIP I Tct counntc
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I STATE LICENSE NUMBER iPIRATION DATE CHECKED BY
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HOPERTY TAX ACCOUNT PARCEL NO. _
❑ NEW ❑ RESIDENTIAL PLUMBING I MECH
❑ ADDITION COMMERCIAL COMPLIANCE OR
❑ CHANGE OF USE
❑ REMODEL MULTIFAMILY SIGN
❑ REPAIR ❑ GRADING ❑ l FENCE X FT,
CYDS
❑ DEMOLISH ❑ TANK ❑ OTHER
❑ GARAGE CARPORT ❑ ROCKIERY NING WALL FIRE ALARM FIRE SPRINKLER
(TYPE OF USE, BUSINI51SS OR ACTIVITY) EXPLAIN:
NUMBER NUMBER OF
OF DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE t .i
HEAT SOURCE
PLAN CHECK I
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CRITICAL
AREAS
NUMBER
USE
ZONE
JOB
ADDRESS �+ +
PIAT NAME/SUBDIVISION NO
PERMIT EXPIRES
PERMIT
NUMBER 7fv-
LOT
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
REQUIRED DEDICATION FT
METER SIZE I LINE SIZE NO. OF FIXTURES
TE/APT#
L-
LID NO,
LID FEE $
TESCP Approved
❑
HW Permit Required
❑
Street Use Permit Ro.jd
❑
Inspection Required
❑
Sidewalk Required
❑
Underground
Wrong required
❑
PRV REQUIRED
YES ❑ NO ❑
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONIROL/DRAINAGE
ENGINEERING
FIRE REVIEWED BY
VARIANCE OR CU
BY
DATE
SHORELINE OR ADBq INSPECTION BOND
REO'D POSTED
OYES ONO 5
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SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING LOT AREA PLANNING REVIEWED BY DATE :5
REO'D PROVIDED
REMARKS
CHECKED BY TYPE OF CONSTRUCTION CO OCCUPANT
G76.5 ��PF � GROUPIn
SPECIAL INSPECTION AREA OCCUPANT
REQUIRED YES LOAD
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 9
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Description FEE
Plan Check
Building Permit
Plumbing,77 i
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
J SEPARATE PERMISSION.
I-
� Engr. Review
PERMIT APPLICATION: 100 DAYS
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a PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
GLAZING %
LOT SLOPE %
VESTED DATE
Description FEE
State Surcharge
City Surcharge
Base Fee
*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
i EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt M
ALI. Cl-AIMS FOR DAMAGES OF WHATEVER NAT URE, ARISING DIRECTLY OR INDIRECT LY
= FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landsca a Ins Total Amt. Due r
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE p p
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION' p tf ^ G
Recording Fee Recei t C;?
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
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 CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Official or his/her 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 COMPENSATION INSURANCE AND RCW 111.27. DATE
OFFICIALS SIGNATURE
SIGNATURE (OWNER OR AGENT) DATE SIGNED (425) 1 ^ / y0�
/ 771-0220 HEL[ S IY l CJ' Al'E
ATTENTION EXT 1333 �CJ� C
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL M/A
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLOW - INSPECT R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COP S
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CITY OF EDMONDS
DEVELOPMENT SERVICES DEPARTMENT
121 5th Avenue North, Edmonds, WA 98020
(425) 771-0220
GIRDER TO C01URECT VIOLATION
Location of Violation (Address and Tax Account Parcel No): Tollefson Market cr 7533 Olym z
View Drive Edmonds WA 98026 Tax Account Parcel No. 004346-000-105-00 0�1
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Issued To: Tony S. Do & Stacy M. Tran Business Owners =i rn
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Address Of Person This Order Is Issued To: 7533 Olympic View Drive Edmonds WA 98026 � O
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Code Section Violated.. Uniform Mechanical Code Sections 112 & 115 & 116 & 11 T m z
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Description of Violation: Failure to remit fees and obtain permit for gas piping to a deep fry broiler, a—i
wok and stove. In
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Corrective Action Required: On 2/4/04 Tollefson Market submitted an application for a Qas piping p
permit This permit has never been issued and the work is complete. The corrective action required is to C �
remit fees of $270 00 obtain Den -nit and call for gas piping test m Cl)
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Correction is Required no later than: 5:00pm (time) July 27, 2004 (date)
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If correction is not made by the date and time specified in the Order, a Notice of cn
Civil Violation shall be issued. The Notice of Civil Violation shall assess fines of o
$100.00 per day, or portion of a day, during which the violation continues. rn
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Date Posted: Date Mailed: July 12, 2004 Date Served
Issuing Party Jeannine L. Graf Title Building Official
Signature6?4!!i
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ...............:.....
FOUNDATION:
Footing ......................
Wall
Pier/Porch 1*1101,
Retaining Wall
Slab Insulation
PLUMBING:
Underground
Rough -In
Commercial Final ......
HEATING:
ct
Gas Test CI C14
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
iLo V01000
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