20040678.pdfDATE RECEIVED 11 . )t
PERMIT EXPIRES
U IF L PERMIT 4n
CITY OF EDMONDS I N NUMBER
.100 SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAME/NAME OF BUSINESS 7- �7
P0 r -.& t I -f PLAT NXkIE;SU13D;VISION NO LOT NO LID NO,
cr MAIL ING ADDRESS LID FEE S
ui
z
L"O I LSCP Aprilmed 0
'0
F
P
'I UBIIC RIGHT OF WAY PER OFFICIAL STREET MAP FjW Permit Required 13
20: 33C potlr,,�_cj tAlcry P St,001 Use Permit Hori'd E3
CITY ZIP EXISTING — PROPOSED inspechonRoquiled 13
Side%s.11k Fi0qLJ1r0d 0
Undeiground
,jTELEPHONE REQUIRED DEDICATION— F] Wiring requited 0
0-1ma n 7 7 41 OS-01
NAME MEIER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 0 NO
Lit
t ADDRESS REMARKS
E OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
U
Ir
CITY ZIP ITELEPHONE eg- b", 0�j St. �n -QD(F__
NAME ICBLm
IA4 �- C- e-T e- . "
FM ON
cc
0
ADDRESS
/30 '�L cp ee
CITY ZIP
TELEPHONE
0
E— a
Lla_f - �7 7? -0 F:7 7
STATE LICENSE NUMBER EXPIRATION DATE
""'ECK
z A /V 6 & Jo� �T a3 # /?7 V
PROPERTY TAX ACCOUNT PARCEL NO.
a 7,e3 'ZL,3 00,y o il7t�r
_j
NEW 13 RESIDENTIAL PLUMBING / MECH
ADDITION 1000, MERCIAL COMPLIANCE OR
uktom
CHANGE OF USE
REMODEL MULTIFAMILY SIGN
GRADING FENCE
REPAIR 5311"l. 6<yn CYDS ( x FT)
DEMOLISH 1:1 TANK OTHER
Ei GARAGE E3 RETAINING WALL FIRE SPRINKLER
ALARM
z CARPORT ROCKERY FIRE
r (rYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
L
'3
NUMBER
NUMBER OF
CRITICA
�5qe
M OF
DWELLING
AR
A_
0 STORIES 41�V
UNITS
NU
DESCRIBE WORK'TO BE DONE
�1\
e e 491j,
w Mr
ed
E
M
w
z
z
F3
z
uj
FIRE REVIEWED BY DATE Lu
M
VARIANCE OR CU
SHORELINE OR AD111
INSPECTION I
BOND
REO'D
I
I
POSTED
CRYES ONO
1$
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED
PROPOSED
prv�
I
EXP 9'/, � /Jj
AY_
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT
LJR SIDE REAR
AT&
z
z
PARKING
LOT AREA
PLANNING REVIEWED BY
DATE
REQ'D
PROVIDED
n
I Nt�
REMARKS /—AAA 4 A441 V 6�e jyic. br,41
h la/y
CHECKEDBY I TYPE OF CONSTRUCTION CODE OCCUPANT
GROUP -------
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED LOAD
REMARKS
z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
19,1 �A � �A A 1 A. A J,
S
1 `CY7 &I C7 e-- SO r'
VALUATION
z
Dg;Pe.-
$
Oz.'
L— W
Description
FEE
Description
FEE
4 C _11�- ee f /-0 C f r-'r t C; CT/,
Plan Check
QLIC
State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
45C7
City Surcharge
Plumbing
Base Fee
PLAN CHECK NO: VESTED DATE
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
t 13E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU13LIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
ui PERMIT APPLICATION: 180 DAYS
EL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review
Plan Chk. Deposit
U) *APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt 0
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREC FLY OR INDIRECTLY
Landscapelnsp.
Total Amt. Due
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFI� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
x 0 NOR LIMIT IN ANY WAY THE CITY's ABILITY 10 ENFORCE ANY ORDINANCE PROVISION."
Recording Fee
Receipt #
057
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 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 COMPENSATI RANCE AND RCW 18.27.
(425)
OFFICVLS SIGNA R DATE
Fly, _q
SIGNATURE (OWNER OR GENT)
DATE SIGNED
1_�
771-0220
�
R
I.E' D BY YATE
ATTENTION E)ff 1333
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
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
le
OF31GINAL - FILE YELLOW - INSPECTC
PINK - OWNER GOLD - ASSESSOR
z
0
i
0
M
--I -T1
M
M 0
0
0
0 C:
M
M Z
—Z
co
0 _n
n
M M
0
0
0 rn
C co
9 (n
Q 0
Z
X
z
z
0
1
0
M
A
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
&�I— PLANNING DIVISION DATE2�
L-1 PLrASESIGN
PROJECT C/Lj�'Zr4
SITE ADDRESS— 170
PERMIT # S ADB# DATE LNSPECTED-2i/ I
Oyl) -
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
El Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
El Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date SigiiatUre
1Aenip:b1dg:f6rms:ocaprv1 3/25/04
z
0
M
--i -n
0 M
C
M 0
0
0
0 C::
--i K
x M
M Z
ID
C:
0 -n
III ;U
>
M M
0
0
0 M
C cl)
K Cl)
M
Z
M
z
0)
z
0
1 1
0
M
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 ....................
GasPiping .................
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 ..................
,; /�P4�0; I - rl
1A1111
106.4ewll, .-
Sovilow e&7 IF woo"'
z
0
M
-4 -n
0M
C
ITIO
0
0 C:
3: M
M z
C _Z
Cn
o -n
n
M M
0
0 rr
C cl)
C 0)
Q 0
Z
z
C0
z
0
--I
M