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CONSTRUCTION PERMIT APPLICATION ADDRESS i,-�
OWNER NAME/NAME OF BUSINESS � 4 PLAT NAMEISUBDIVISI7777 LOT NO. LID NO.
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MAILING ADDRESS TESCP Approved 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 13
Street use Permit Hoq'd C3
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CITY EXISTING — PROPOSED inspection Required 13
ZIP TELEPHONE Sidewalk Required
Underground
REQUIRED DEDICA11014— FT Wiring required E3
NAME METER SIZE LINE SIZE NO. OF FIXTURE; YEPRV REQUIRED
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VALUATION
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE "ING LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO —
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
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PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
(n 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Fire Review ��C--) PlanChk.Deposit
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 #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due :2
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1 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Recording Fee Receipt # Li
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM TIIE OWNER, OR THE DULY AUTHORIZED AGENT OF
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
THE OWNER. CALL Building Official or hisitier Deputy: and Fees are paid, and
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 FOR INSPECTION receipt is acknowle)dged in space provided.
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WORKMEN'S CFPEN)-ATION INSURANCE AND RCW 18.27. OFFI PA[1,IG)NA:rURE
SIGNATURE?(54, OR AGENT) DATE.SIPI)ED (425)
t,41 6, t, L 771-0220 1�( -A ED Y /DATE f
RF( -A ED BY
ATTENTION EXT 1333 -- -----
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBCjo9/IBC110/IRCll0. PINK -OWNER COLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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FUEL TANK INSTALLATION CO- INC- PO Box 46412
Seatfic, WA 98146
Ah—one 2-0--6--244-8020
Pax 206-243-3477
LETTER (3Fr CERTIFICATION
September 7, 2004
Leif Helleren Construction, Inc.
PO Box 1764
Edmonds, WA 98020
R.E.- 10 16 Grandview. Edmonds. WA
This is to certify that this company removed one 300 gallon underground residential heating oil
tank. from the above named property. The tank and the effluents were legally disposed of in the
City of Seattle. This residential tank removal was performed according to the guidelines set
forth by the Washington State Dept. of Ecology sod the International Fire Code Institute.
Fuel Tank Installation Co., Inc. shall not be held liable for sub -surface conditions either now
existing or whieb could develop in the future.
Aaftk A
incerely,
Dawnelle Anderson
Vice Pitsident
Wa. State Cont, License NFUELTIC08OB8
ICBO 41059581-U2
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D�)t.e Extracted: 09/02/04
Date An, ed: 09/03/04
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FOR TOTAL PETROLEUM HYDROCARBONS AS DIESEL
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: —FIRE DEPARTMENT DATE �t=
PLEASE SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT 3T
SITE ADDRESS /0 1(a 4(16-�AILULCW
PERMIT 9 ADB# DATE INSPECTED 1— 2
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
OC_
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
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
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2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1: temp:b Idg: forms: ocapry 13/25/04
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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 ....................
GasPiping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
"X
N FINAL APPROVAL FOR �Q�e7
OCCUPANCY ..................
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