20040804.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
Ail _-
MAILING ADDRESS
7,14
CITY ZIP
W,
NAME
ADDRESS
CITY ZIP
NAME
PERMIT EXPIRES
USE PERMIT
ZONE N U M B E R
JOB
ADDRESS
-72
PLAT NAME/SUBDIVISION NO. I LOT NO
V-) PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TELEPHONE EXISTING — PROPOSED
REQUIRED DEDICATION— FT
I METER SIZE I LINE SIZE I NO. OF FIXTURES
TELEPHONE
0
"Ar C
" � �T_�ftA 1 �4 �
ADDRESS
(rio '5�7'
LUVL'tt 7
CITY
ZIP
TE LEPHONE
STATE LICENSE NUMBER
EXPIRATION DATE
filgPeKSR BY
11
1 t 0 V_ 'Ll
i I
I I I
[) L-1 I
( W
PROPERTY TAX ACCOUNT PARCEL NO.
nO 6ecl
I 1 -7
Cn 075 ol
NEW
RESIDENTIAL
1:1 PLUMBING / MECH
ADDITION
iC3-1r_oMMERCIAI_
)1P -
COMPLIANCE OR
M CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
L GRADING FENCE X
CYDS ( FT)
DEMOLISH
TANK
OTUM
GARAGE
CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
)1�
- (TYPE OF USE. BRSIT* &q"9TkV" EXPJ.Alf�., , A o"?
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS I NUMBER
1 DESCRI13E WORK TO 13E DONE
rq-A
45��
WE
HEAT SOURCE I GLAZING % I LOT SLOPE %
_O�N CHECK NO: ir 2,& VESTED DATE
I ( ))v 2
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
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
En *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
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.4
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 THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATI9W,11L�SU.RANP.E AND RCW 18.27.
SIGN61URE (OWNER OPjA9I!N1yj j/ / i DATE NED
4
4'� M /C
SUITEIAPT#
LID NO.
LID FEE $
TESCP Approved
13
RW Permit Required
[3
Street Use Permit Roq'd
13
Inspection Required
13
Sidewalk Required
E3
Underground
Wiring required
13
PAV REQUIRED
YES 11 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY
DATE
0
Z
M
Uj
z
z
F3
z
W
FIRE REVIEWED BY DATE WrL
-.00� - 6 — C7 y W*
VARIANCE OR CU SHORELINE OR ADB# INSPECTION -BOND
REO'D POSTED
OYES ONO IS
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
EXP I I
LOT COVERAGE REQUIRED SETBACKS tFT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
MNNI�REVIEWED BY DATE
PARKING LOT AREA Ti�A 9L
REO'D I PROVIDED I
REMARKS
CHECKED BY JTYPE�F CONSTDWCTION CQUIE, OCCUPANT —
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED F] YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 10811SC109/[RC109 FINALINSPECTION REO'D Ej
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE LDescription FEE
7 t r
'!2 State Surcharge
A z__1 City SurEcharge
Base Fee
Plan Chk. Deposit
Receipt N
Total Amt. Due
Receipt # 14-1
T
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy. and Fees are paid, and
receipt is acknowledged in space provided.
FFIC1,L&L&-6f@+4ATURE D�TE
Arr-ENT1014 r. L
IT IS UNLAWFULTO USE OR OCCU PYA BU I LDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OFOCCU-
FANCY HAS BEEN GRANTED. UBC109/IBCi10/IRC110.
09103 PRESS HARD -YOU ARE MAKING 4 COPIES
9 MV/_
12 IL
(Y/,70�/V !� /_' 7
ORIGINAL �QLE YELLOW INSPEC TOR
PINK - OWNER GOLD - ASSESSOR
z
0
1
0
M
--i -n
C0
0 M
C
M 0
0
C-)
0 C:
M
Mz
n, -4
C -Z
CD
o -n
n
--A
3:9
M M
0 —C/)
0 r-
0 M
C Cn
9 Cn
M 0
Z 17-
X
z
--I
3:
(1)
z
0
M
FINAL PROJECT. APPROVAL FORM
TO:
DATE:
MEMO TO: P C07 AT BUILDING DIVISION
FROM: , , , . I FIRE DEPARTMENT DATE 2
n2ASE SIGNI
ENGINEERING DIVISION DATE
PLEM13SION
z
0
PLANNING DIVISION DATE
nZASE SIGN
PROJECT
:n
SITE ADDRESS 71400 -7 k_J
M
0
M 0
AD --I C)
PERMIT# BIL-DATE INSPECTED 0 C:
M
DESCRIPTION OF WORK TO BE INSPECTED MZ
C
A field inspection was conducted to determine final 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 q -n
n X
M M
0 U5
GRANT FINAL PROJECT APPROVAL 0
0 M
C: C/)
9 U)
M 0
Z r- i
--I M
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED 3:
u Copy of CONDITIONS given to owner/contractor by inspector z
(n
z
0
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
M
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
1 .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_
ocaprvl.doc.l:temp:bldg:formsIO/O1
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ...................... .
Wall..........................
Pier/Porch .................
Retaining Wall ...........
z
0
Slab Insulation ..........
0
M
PLUMBING,
Underground .............
—i
Rough -In ...................
M
C
M
Commercial Final ......
0
0
0
HEATING:
--I
X M
M Z
Gas Test ....................
g) --I
C
Gas Piping .................
>
Equipment .................
0
Commercial Final .......
n
--I
EXTERIOR SHEATHING
M M
NAILING ..........................
0 U5
0 r-
FRAMING ........................
0 M
C: (/)
FIRST FLOOR FRAMING ...
9 Cn
M 0
Z
INSULATION ...................
Floor Insulation .........
_q
x
Wall Insulation ...........
>
z
Ceiling Insulation .......
SHEETROCK NAILING ...
z
0
SPECIAL INSPECTION ...
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................