20040743.pdfDATE RECEIVED
ILI /07/
[PERMIT
EXPIRES
CITY
OF EDMONDS
USE PERMIT
ZONE NUMBER C 7
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS -/67/6
a-e- hx,
OWNER NAMEINAME OF 13USINESS
3c/ 1) 1-�
PLAT NAM EISU BDIVI SION NO LOT NO.
LID NO.
LID FEE $
-!� —9s —go V-�, e -n4
cc
w
z
MAILIN AD RE S
`7(v
ra, vt III S: U 17E /040
0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
1 ESCP Approved
Bw Permit Required
0
0
CITY
ZIP TELEPHONE
EXISTING — PROPOSED
Street We Ponmit Roq'd
inspection Required
C3
0
M
E?,
gz;k(a JJ,�,5- -L7 -7:j:- 4 07 q �L
REQUIRED DEDICATION� FT
Sidewalk Required
Underground
Wiring required
E3
NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES NO 13
t:
ADDRESS
REMARKS
OWN ER/CON TRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY
ZIP
[TELEPHONE
NAME FCBL ft
ADDRESS
eQ o (0 )1:4 t/F—
C,
CITY
ZIP
TELEPHONE
SMoV4omjsL4
P3 G O-S: &9 - 3 S
STATE LICENSE NUMBER
EXPIRATION DATE
CHECKED BY
\/0 5
PROPERTY TAX ACCOUNT PARCEL NO.
L4
o,*)
NEW
RESIDENTIAL
�z --7�.
(ZL� �ING WECH
ADDITION
OMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING FENCE
CYDS x FT)
DEMOLISH
TANK
OTHER
GARAGE
RETAINING WALL FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINESS
OR ACTIVITY) EXPLAIN:
v u, T—
o r-- -F i c E-
NUMBER
NUMBER OF
CRITICAL
CR'T"
OF
DWELLING
7AREAS
STORIES
UNITS
UMB
NUMBER
DESCRIBE WORK TO BE DONE
I Aj S -7-)4 1� L- *b
C-3-Ac,- cz \j C: -r ir m
"i,
HEAT SOURCE I GLAZING % I - LOT SLOPE %
PLAN CHIEC K NO: OLL 3 V �/ I VESTED DAT
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Lu PERMIT APPLICATION: 180DAYS
a. PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
U)
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
-j DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS 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 DULY 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 THEA�QDE OF THE STATE OF WASHINGTON RELATING TO
ONIN
WORKMEN'S C( ON IN RANCE AND RCW 18,27.
ISIGNA E (9WN P LN DATE SIGNED
- ME V ;FTK 1 1
DATE
W
z
z
Z5
z
Lu
FIRE REVIEWED BY DATE W
if
VARIANCE OR CU SHORELINE OR ADBI INSPECT107N BOND
POSTED
N No S
0
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (1`7) PROPOSED SETBACKS (FF.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
PARKING
REO'D I PROVIDED
LiDILVuMal
CHECKED BY ITYPE
LOT AREA I PLANNING REVIEWED BY DATE
SPECIAL INSPECTION JAREA
REQUIRED XYES
CODE
OCCUPANT
GROUP —4
OCCUPANT
LOAD
(3
z
2
z
5
CL
REMARKS C5
z
PROGRESS INSPECTIONS PER UBC 108/IBC1091IRC109 FINALINSPECTION REO'D
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
A17ENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
I his application is not a permit until signed by the
Building Official or histtier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
!FICI LS SIGNATURE DATE
4
-LEAbrD 13Y DATT—
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPVtTC
PINK - OWNEFJ/ GOLD - ASSESSOR
z
0
i
0
M
=i ii
M
C
M 0
0
0
0 C:
M
M Z
x
Fn
o -n
n
11
af
M M
0 —C/)
0 r-
0 M
C Cl)
?1 (1)
M 0
Z
71
r
z
--i
z
0
1
0
M
FINAt, PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT 7-0 ATIOR, BUILDING DIVISION
FIRE DEPARTMENT DATE.
FROM. ()o I
PLEAS13 S1136,1 z
0
ENGINEERING DIVISION DATE
PLCASrSIGN
PLANNING DIVISION DATE
PLFASESIGN
PROJECT Lu W�E
SITE ADDRESS- 1 -7 6, 714 4-Y
PERMIT# 0 ADB# DATE INSPECTED 1 2- /Z, 1 0
DESCRIPTION OF WORK TO BE INSPECTED (4Li!5�Q 6,13,
1-approved plans. Final approval
A field inspection was conducted to determine compliance witl
denotes that there are no objections from the above signed Department to tile 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
I ,
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRE CTION NOTICE given to owner/contractor by inpector
1. RECEIVED
2. DEC 2 2 2004
3.
PERMIT COUNTr"'
RE -INSPECTED OUTSTANDING ISS UES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:ten1p:b1dg:f6rn1s:ocaprv1 3/25/04
=1 =n-
M
C
M
0
--1 0
0 C
-A K
r M
M Z
o -n
n m
>
M M
0
0
0 M
C co
M 0
Z
z
z
0
i
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 ....................
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 ..................
7115;oq to 67q3
mom
-1
z
0
1
0
M
—i -n
0 M
C
M
0
0 C:
M
M Z
ID
C _z
o -n
-n
M M
0
0
0 M
C (1) i
9 Cn
M 0
Z
>
z
0)
z
0
M