20040808.pdfDATE RECEIVED <1' PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER —
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS-
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OWNER NAME/NAME OF BUSINESS
1�'IC141Q,b r, PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS LID FEE S
TESCP Approved E3
q, PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 13
0 1 Street Use Permit Rect'd E3
CITY ZIP TELEPHONE EXISTING PROPOSED- inspection Rertinrod 13
SidnWalk Required [3
71 Underground
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REQUIRED DEDICATION FT Wiring required 13
NA METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 0 NO 13
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE Z5
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CITY ZIP TELEPHONE
NAME CBL#
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10 0 IM EERING REVIEWED BY DATE
ADDRESS
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EWED BY 6ATE UJI
CITY zli3 TELEPHONE
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VAHIANCE OR Cu SHORELINE OR ADB# INSPECTION BOND
STAfE UbEN& NUMBER EXPIRATI)N DATE4 CHECKED []Y REOV10- POSTED
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SEPA REVIEW SIGN AREA HEIGHT
PROP�JITY TAX ACCOUNT PARCEL NO, COMPLETE , EKT ALLOWED PROPOSED ALLOWED PROPOSED
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EXP
RESIDENTIAL PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED, FRONT SIqE REAR 1` FROI�T Lp 9 E REAR
NEW COMPLIANCE OR
F�YADDITION El COMMERCIAL OCHANGE OF USE 3,;-'10' 15 aq it 7 �-_/l 6, ZE
PARKING LOT AREA ANNING REVIEAED By DATE
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED
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REPAIR GR2NG E] FENCE
Li CYDS X Fr) REMARKS
DEMOLISH T4 K E] OTHER
EiGARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUPS!P�ESS OR ACTIVITY) EXPLAIN:
CHECKED BY I TYPE OF CqWTRUCTION CQDE OCCUPANT
w NUMBER NUMBER OF CRITICAL
0 OF DWELLING AREA' SPECIAL INSPECTION JAREA OCCUPANT
M UNITS NUMES LOAD
ci STORIES /_:� I I REQUIRED
DESCRIBE WORK TO BE DONE
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PROGRESS INSPECTIONS PER LIBC 108/IBC109/[RC109 FINALINSPECTION REQ'D FS
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VALUATION
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % 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
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
- Engr. Review
ul PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
��M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
Ir ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
It
X FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERM11 SHALL NOT BE
'3 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQU Landscapelnsp. Total Amt. Due
j IREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
9 Recording Fee Receipt #
1 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 APPEICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Olficial or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LAC30R CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION ieceipt is acknowledged in space provided.
WORKMEN'S CQMPENSATION INSURANCE AND RCW 18.27.
OFFICIALS SIGNATURE DATE
SIG AT R (OWNE�ROFI At. NT) DATE SIGNED (425)
�A 771-0220
R L D Y DATE
ATTENTION EXT 1333 14,
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL e
INSPECTION HAS BEEN MADEAND APPROVALOR A CERTIFICATE OF OCCU- 7
ORIGINAL - FILE YELLOW - INSPrC R
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK -OWNER GOLD,ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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CITY (COPY 3 2 C! 04
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FINAL PROJECT APPK3VAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
ny-ASF SIGN
Z���6�GINEERING DIVISION DATE
PLANNING DIVISION DATE
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PROJECT
SITE ADDRESS
B# TED
PERMIT #4 —AD _________�DATE INSPEC
DESCRIPTION OF WORK TO BE INSPECTED
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:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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Date ------------- —
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
2-
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
GasTest ....................
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 ..................
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Tile initials NIT arc Milton
Thompson, a temporary contract
inspector for the City.
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