20040680.pdfED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
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MAILING ADDRESS
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NAME
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STATE LICENSE NUMBER EXPIRATION DATE 14
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AS?f'NEW RESIDENTIAL
V
ADDITION
19
COMMERCIAL
REMODEL
11
MULTIFAMILY
REPAIR
0
GRADING CYDS
DEMOLISH
1:1
TANK
GARAGE
rARPORT
m
RETAINING WALL
ROCKERY
(TYPE OF US�, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER NUMBER OF
OF 44— 1 DWEL,LING &
STORIES UNITS y
DESCRIBE WORK TO BE DONE
�4%'/ 00 W-c- fl�4
(7
0 9 a i(!
HEAT SOURCE
GLAZING %
PLUMBING / MECH
COMPLIANCE OR
OF USE
CHANGE
SIGN
FENCE
( X FT)
OTHER
FIREePRIfift"r
FIRE ALARM
CRITICAL
AREAS
NUMBER
qu.M PR
A-Iti V'Le? 14 01JU.
LOT SLOPE %
PLAN CHECK 7N:.,/ VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COV(RS WORK TO
t 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
W
IL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
cn '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
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4 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF 1 HIS 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 DU& 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 AND RCW 18.27.
SIGNATURE (OWNER 11 DATE SIGNE�)
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PERMIT EXPIRES
7�
USE
PERMIT C
ZONE Cez
NUMBER L
Jo B -7
ADDRESS
SUITE/APT#
"4y P 1 9 �
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
IESCP APPIOVOd 0
mv Permit Required 13
[3
Street Use permit Rect'd
Q
EXISTING - PROPOF
,ED
inspection Required
Sidewalk Hortuired [3
REQUIRED DEDICATION-
F1
Underground d 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV R QUIRED
I
I
YES [3 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY
DATE
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Fl!;,a7WED BY(:., DATE us
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VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP I
LOT COVERAGE
ALLOWED PROPOSED
SHORELINE OR ADBN I INSPECTION BOND
REO'D POSTED
YES ONO S
SIGN AREA HEIGHT
ALLOWED . PROPOSED I ALLOWED , PROPOSED
REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
FRONT SIDE REAR FRONT LJR SIDE REAR 0
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PARKING LOT AREA I PLANNING REVIEWED BY DATE
IL
REO'D I PROVIDED
REMARKS
CHECKED BY
TYPE OF CONSTRUCTION
CODE
OCCUPANT
7
GROUP/
1 /25
SPECIAL INSPECTION
OCCUPANT
REQUIRED [] YEE
JAREA
LOAD
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/lBC109/IRC109
FINAL INSPECTION REO'D
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VALUATION
Description
Plan Check
Building Permit_
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
ATTENTION t:A I I jjj'--
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCLI-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110,
FEE Description FEE
State Surcharge
Fz) City Surcharge
Base Fee
Ef
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building 011icial or his/tier DOPuty: and Fees are paid, and
receipt is acknowledged in space provided.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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ORIGINAL - FILE YELLOW - (NSPECTL
PINK - OWNER GOLD - ASSESSOR
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(Certt"ft,vtatt of Oct antp
DEPARTMENT OF BUILDINGS
PER UNIFORM BUILDING CODE SECTION 109
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Occupancy established by this certificate: Dwelling Units: **N/A*** No. Stories: I
S3/B/S1 V-N SPRINK Basement: No
Maximum Occupant Load (Per UBC 1002)
Room capacity signs, w�en.!'Tqq_q!r-�qi-0ust remain posted at afl times.
Owner of Building Bruce Lingle'. Address:"7323,224fh'St. SW
The Collision Clinic has been'inspected and a 'ro%iied! , as -complying -with. the requi Edition
pp rements of the 1997
of the Uniform Building Code as adopted by ihei'.C.Ity for the-gr6up',and division.of occupancy and the use for which the proposed
occupancy is classified.
Issued this 13 day:of! October, 2004
CHIEF BUILDING OFFICIAL
BY:
This certificate shall be posted in a conspicuous public area and shall not be removed, mutilated or obscured and s Nible conclition at all times, Any change of occupancy or use requires a building permit and a new
Certificate of Occupancy Issued by the C41y of Edmonds Building Official.
10 -_ . .. .:-* U S .:A*. 4AU 10
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PI�I:ASII SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLrASESIGN
PROJECT CO L L( & / -" --
SITE ADDRESS 7-?
PERMIT # 2-00 C� — ADB# DATE INSPECTED �e 0
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
Copy of CORRECTION NOTICE given to owner/contractor by inpector
I .
2.
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RE -INSPECTED OUTSTANDING ISS . UES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tenip:b1dg:fonns:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
GasTest ....................
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 ..................
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