20040798.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME)NAME OF 0 USINESS
L L
MAII. ING ADDRESS
CITY� �Ip ITELEPHONE
NAME
Lu
t ADDRESS
x
L)
I CITY
ZIP ITELEPHONE
USE
ZONE
JOB
ADDRESS *7
wwwnm____�
PLAT NAME"SUBDIVISION NO
NAME ICBL#
7-b
ADDREq
7
C L#
BA
CITY ZIP TELEPHONE
"Iec-1
STATE LICENSE NUMBER EEXPIRATION DATE CKED Y
r
TAX ACCOUNT PARCEL NO.
NEW
'RESIDENTIAL
ET,
PLUMBING I MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
FENCE x Fr,
GRADING
CYDS
DEMOLISH
TANK
OTHER
GARAGE
RETAININGWALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
CARPORT
MPE OF USE,
BUSINESS OR ACTIVITY) EXPLAIN:
NUMBE12
NUMBER OF
LLLIF
DWELLING
L
CRITICAL
AREAS L
OF
STORIE�
UNITS
UNITS
—A
NUMBE4RZ�A
DESCRIBE WORK TO BE DONE
.e-! e '_ ,
HEAT SOURCE
PLAN CHECK NO:
GLAZING %
LOT SLOPE %
VESTED DATE
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.
PERMIT APPLICATION: 180 DAYS
w
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
THIS
D
B
P
E
0
P
E
E
M
D
R
R
0
A
M
M
I
N
N
I
E
IT
A
I
C
L
D
in NS AND SUCCESORS
'APPLICANT . ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIG
S
IN INTERE�T. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
S ENTS FROM ANY AND
2 EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AG
cc LL CL IM I ATURE, ARISING DIRECnY 013 INDIRECILY
4
ALL CLAIMS FOR DAMAGES OF WHATEVER N
F tj
ROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF IHIS PERMIT SHALL NOI BE
k
DEEMED 10 MODIFY, WAIVE OR REDUCE ANY REQUIREMEN1 OF ANY CITY ORDINANCE
_j MIT I BILIIY TO ENFORCE ANY ORDINANCE PROVISION,*
0 NOR LIMIT IN ANY WAY THE CITYS A
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING _-I PROPOSED
REOUIRED DEDICATION� FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
PERMIT EXPIRES
PERMIT
NUMBER
SUITE/APT#
7 VIC AV
_TLOT NO LID NO
LID FEE $
7ESCP 'APPIO�Od
RW permit Hoquired
Street Use Permit R00
respect an Required
Sodnwa�k itaquired
Underground
wiring required
ErRV REQUIRED
YES 0 NO 13
REMARKS
OWNERICONTRACIOR RESPONSIBLE FOR E90SION CONTROI-JURAINAGE
ENGINEERING REVIEWED
I IIEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
GIVEN IS CORRECT, AND T14AT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
RUC
TIIE OWNER, I AGREE TO COMPLY Willi CITY AND STAIE LAWS REGUL-ATING CONST
11ON AND IN DOING TIIE WORK AUTIIORIZED TtIEREBY. NO PERSON WILL BE EMPLOYED
IN Vj6LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
wORKMEN'S COMPENSATION INSURANCE AND RCW 18 27
DATE SIGNED
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE I EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
DATE
DATE
SHOREILINE OR AD130 INSPECTION
R E O6'DD
OYES ONO S
SIGN AREA
ALLOWED .. PROPOSED ALLOWED
0
7-
Ir
W
W
w
cc
-7 BOND
POSTED
.HT
P Ro POSED]
REQUIRED SETBAC I PROPOSED SETBACKS (Fr.)
FRONT SIDE FRONT L/R SIDE REAR
z
z
z
. . .... . . ...... . DATE 5
PARKING LOT AREA PLANNING REVIEWED BY IL
REO'D I PROVIDED I
REMARKS .101 r
I �110VAL. OR CAP
7ANK FILL. RE
CHECKED BY TY E 0 CONST LICTION E OCCUPAN�
I
±��'G R 0 U P ('j
I I
OCCUPANT
I
S Lo
7 7 A PRE A
SPECIAL INSPECTION AREA LOAD
REQUIRED [] YES
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
In
VALUATION
Description
Plan Check
Building Permit
plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp
[Recording Fee
FEE Description FEE
State Surcharge
city Surcharge
Base Fee
CALL
F013 INSPECTION
(425)
nil
Plan Chk. Deposit
Receipt #
ToEtalAmt. #Due55
Receipt
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.
FjjCIAI/SYiG ATURF DATE
I —ur. L-I'RELEAS
E)CT 1333
ATTENTION OR STIIUCTURE UNTIL I:L
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING
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
1; / , .
ORIGINAL FILE YELLOW - INSPECTOR
PINK I OWNER COLD - ASSESSOR
z
0
4
0
M
--I -n
Y) --I
3:
OM
C
MO
0
—1 C.)
0 C:
4 C
X M
M z
X
0 -n
n X
>
M M
0
0
0 M
C: 0)
9 Cn
M 0
Z
X
z
C0
z
0
1
0
M
III
0
I
FINAL PROJECT APPROVAL FORM
SEP 27 TO:
DEVELONAEN1 SUI
DATE:
GIT',
MEMO TO: PE CO 0 BUILDING DIVISION
FIRE DEPARTMENT DATE sl (9.41
LPLEASE qSIGN
FROM:
ENGINEERING DIVISION DATE
z
0
?LZME SIGN
i
PLANNING DIVISION DATE
0
M
PLEASE SIGN
-n
PROJECT
0
M
C:
SITE ADDRESS cd
M0
0
0 -7 9 INSPECTED
0 C:
--i K
=
PERMIT ADB# DATE
M
M z
DESCRIPTION OF WORK TO BE INSPECTED U j5C L) &A t-A, k i
CE
>
A field inspection was conducted to de termine final compliance with approved plans. Final approval
o -n
denotes that there are no objections from the above signed Department to the release o f
-n;u
>
PERFORMANCE BONDS and the granting of
M M
0
0
0 M
GRANT FINAL PROJECT APPROVAL
0 1701
C: Cl)
F. U)
M 0
Z
X
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
z
--i
u Copy of CONDITIONS given to owner/contractor by inspector
X
Cn
z
0
0
M
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
ci Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
2.
3. 1 %
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
ocaprv1.doc.1:temp:b1dg:fbrms 10/0 1
..........
-C- r I
IN
RECORD OF INSPECTIONS
.INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .................
Wall ...................
Pier/Porch .................
z
Retaining Wall ...........
0
Stab Insulation ..........
0
M
PLUMBING:
Underground .............
C/)
0
M
Rough -In ...................
M 0
0
__10
Commercial Final ......
0 C
--A ic
HEATING:
X M
M Z
Gas Test ....................
C —Z
Gas Piping .................
Equipment .................
0 -n
Commercial Final .......
-n
EXTERIOR SHEATHING
M M
0
NAILING..........................
0
0 M
FRAMING ........................
Cl)
C/)
FIRST FLOOR FRAMING ...
Q 0
Z
INSULATION ...................
Floor Insulat/ .........
Wall Insulation ...........
z
--I
Ceiling Insulation .......
0)
SHEETROCK NAILING ...
z
0
SPECIAL INSPECTION ...
0
M
MISCELLANEOUS
FINAL APPROVAL 4t=
O=URANGY ..................
2wq aw
D =79 9