20040757.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS?'
MAILING ADDRESS
CITY
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NAME
I CITY
ZIP TELEPHONE
01P 0A I q:25 02
ZIP TELEPHONE
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ADDRESS
12-3,1 fp AV E, IJ t E,
CITY ZIP TELEPHONE
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I
ST TE LICENSE NUMBER
GJ JA 10100�1
[41
3,F40ERTY TAX 4C�UNT
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PARCEL NO.
1:1 NEW
P-IRESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
ROCKERY
[TYPE OF USE, BUSINESS OR-,P*TIVLjYJ EXPLAIN:
NUMBER
OF
STORIES
QESCIRIBE WORkTO BE
HEAT SOURCE
PLAN CHECK NO:
NUMBER OF
DWELLING
UNITS
T5
PERMIT EXPIRES
9Y/ 6 AL I I
USE PERMIT
ZONE NUMBER
JO ' JilTE/ PT#
ADDRESS OC::j �)- :;lr;�o �h
I _�, / — �5� �_ I .........
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
144P TESCP �APPfOvod 0
PLUMBING MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
X FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
62�
CRITICAL
AREAS
.M511i UP W Aj
.44E F.AJ,46 4
(V (2.0y 4:4y 0
GLAZING %
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Required 13
street Use Permit "oq'd
EXISTING PROPOSED
inspection Required
Sidewalk Required 0
REQUIRED DEDICAHON FT
Unduroround
±uing taqurod 0
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 NO
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP 1
LOT COVERAGE
ALLOWED PROPOSED
DATE
SHORELINE ORADBIJ INSPECTION BOND
REO'D POSTED
E]YES ONO S
SIGN AREA D-1— HEIGHT
FALLOWED . PROPOSE ALLOWED , PROPOSED
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REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR FRONT LJR SIDE REAR
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PARKING LOT AREA PLANNING REVIEWED BY DATE
REQ'D I PROVIDED
REMARKS
CHECKED BY
TYPE F C(IINSTR
..VLICTION
13 1
CID DE
0
OCCUPANT,
GROUP
N
SPECIAL INSPECTION
EQUIRED YES
1
—
JAHEA
OCCUPANT
LOAD
LOT SLOPE %
VESTED DATE
�4 REMARKS
PROGRESS INSPECTIONS PER UBC 108/ ISC109/ IRC109 FINAL INSPECTION REO'D 'F3
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
u, PERMIT APPLICATION: 180DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
(n 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
M 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 1 HIS PERMIT SHALL NOT BE
_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
2 NOR LIMIT IN ANY WAY THE CITYS ABILITY 10 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 VIOLAjiON OF THE LABOR CODE OF TIIE STATE OF WASHINGTON RELATING TO
WORKMn'S COMPENSATION INSURANCE AND RCW 18.27.
ATURE (OWNER DATE SIGNED
6") ____.OR AGENT)
/7r 7
VALUATION
6?141
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
FEE
35)'7
C;
CALL
FOR INSPECTION
(425)
-
Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt H
Total Amt. Due
7 �,5
Receipt ifif
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APPLICATION APPROVAL
This application is not a permit until signed by the
Building 011icial or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFFICIALS SIGNIXTURE DAT
A
�y
77
1-0220
n 1 -1 AS
ATTENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTU RE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OFOCCU-
FANCY HAS BEEN GRANTED. UBC109/IBC110/lRC110.
09/03 S
PRESS HARD -YOU ARE MAKING 4 C'9,01ES
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YELLC-14
ORIGINAL FILE M - W ECT
PINK -OWNER GOLD-ASSF.qqnn
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING D'M10N
FM DEPARTMENT DATE ---------
.FROM:. ""now
ENGINEERING DIVISION DATE
PLANNING DIVISION DATEL—__�__
MAAW9W
PROJECT
SITE ADDRES
--zoo I
PERMIT —0 ADB# DATE.INSPECTED
DESCRIPTION OF WORK TO -BE INSPECrED—J�,!
A fleld inspection was condiicted to determine flual 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 MALPROJECT APPROVAL
GRANT PROJECT APPROVAL wrrH coNDITIONS NOTED
0 Copy of CONDMONS given to. owner/contractor by inspector
r.,CTION - OUTSTANDING ISSUES
FAIILM FINAL INSPE given to owner/contractor by inspector.
C) COPY of-CORR.ECTION NOTICE
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
—T- �,Iwk
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
j�4 EXTERIOR SHEATHING
NAILING..........................
13
FRAMING........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR M
OCCUPANCY ..................
aw
757/
The initials MT are Milton
Thompson, a temporary contract
inspcetor for the City.
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