20040820A.pdfCITY
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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
1�4 NAME/NAME OF BUSINESS
ADDRESS
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CITY
PERMIT EXPIRES
USE PERMIT (�
ZONE NUMBER
JOB SUITE/APT#
ADDRESS y, /, ,
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PLAT NAME/SUBDIVISION NO. T 0. LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pe mit Required
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% 1 Street Use Permit Roq'd ❑
ZIP TELEPHONE EXISTING PROPOSED Inspection Required ❑
Sidewalk Required ❑
REQUIRED DEDICATION FT Underground
Wiring required ❑
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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YES ❑ NO ❑ z
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE a
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ZIP ITELEPHONE
NAME` CBL #
ADDRESS
CITY ZIP TELEPHONE
STATE LICENSE NUMBER
EXPIRATION DATE I CHECKED BY
PROPERTY TAX ACCOUNT PARCE N .
❑ NEW ❑ RESIDENTIAL PLUMBING I MECH
❑ ADDITION COMMERCIAL 7 ` COMPLIANCE OR
❑ CHANGE OF USE
1REMODEL ❑ MULTIFAMILY ❑ SIGN
GRADING FENCE
❑ REPAIR ❑ CYDS ❑ ( X FT)
❑ DEMOLISH ❑ TANK ❑ OTHER
GARAGE RETAINING FIRE
❑ CARPORT ❑ ROCKERY WALL ❑ FIRE ALARM SPRINKLER
�I (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER NUMBER OF CRITICAL
OF DWELLING �( AREAS
STORIES 1 UNITS ✓ ` NUMBER
DESCRIBE WORK TO BE DONE
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HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: VESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t_ BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
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SEPARATE PERMISSION.
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PERMIT APPLICATION: 180 DAYS
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a• PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
rn 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
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 DIRECLI.Y OR INDIRECIlY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHAI-L NOT BE
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
O NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION '
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I HEREBY ACKNOWLEDGE THAr I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR TIIE 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 5PM2kNSATION INSURANCE AND RCW 18.27.
SIGNATURE OWNEF&POR AGENT) I DATE SIGNED
ENGINEERING REVIEWED BY
DATE
FIRE REVIEWED BY DATE W
7 _-
/ VARIANCE OR CU SHORELINE OR ADB11 INSPECTION BOND
REO'D POSTED
OYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP I L
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING LOT AREA PLANNING REVIEWED BY DATE a
REQ'D I PROVIDED
REMARKS
CHECKED BY ITYPENSVUCTION CO OCCUPANT&
GROUP
SPECIAL INSPECTION AREA / OCCUPANT
REQUIRED ❑ YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REQ'D 9
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscape Insp.
Recording Fee
CALL
FOR INSPECTION
(425)
771 �OSSO qFl EASED BY I DATE I
ATTENTION Off 1333 I A I �l/ K � � � 14 I
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTII_AFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/ IBC110/ IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt H O (_
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.
OFFICIALS SIGNATURE DATE
M . en C Q
RIGINAL\QFILE •YYELLOW- INSPECTO
PINK - OW . GOLD -ASSESSOR
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FINAL PROJECT APPROVAL FO
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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FROM: FIRE DEPARTMENT DATE
PLEASESIGN
ENGINEERING DIVISION DATE
PROJECT,
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN _
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SITE ADDRESS
PERMIT #� �'� _ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine 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.
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
O Copy of CORRECTION NOTICE given to owner/contractor by inpector
I.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date Signature
l:temp:bidg:forms:ocaprvl 3/25/04
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GARY HAAKENSON
CITY OF EDMONDS ,
MAYOR
;SG> ;,t } a 121 STN AVENUE NORTH • EDMONDS, WA 98020 • (425) 771.0220 FAX (A25) 771.0221
Website: www dedmonds.wa.us
DEVELOPMENT SERVICES DEPARTMENT
jjl c ��p Planning • Building • Engineering
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October 6, 2004
Tolleffson's Markel z
7533 Olympic View Dr, Mimi
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Edmonds, WA 98026 n
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Re: 'Building Permit: 2004-0820 co
Site Address: 7533 Olympic View Di . v rn
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Expiration Date: October 4, 2005 rn O'
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Recording to Building Division records the subject project has recently received the sheetrock A
nailing inspection approval. The remaining inspections required are noted on the field job card
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and include final inspections by Fire, Engineering, Planning and lastly Building. Please be
advised, the subject building permit will expire on October , 2005, prior to this date you must p M
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have final project t renew the pe
approval from the above noted Departments or you musrnnit. If
you are certain that the work will not be complete prior to this date you must submit a new
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application and remit fees of $20 (one half the original building pen -nit fee) before November v co
1st. If the permit expires, full fees of $40 shall be required in order to complete the project, c crmn' j
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If you are certain the building will be complete before the pen -nit expires be sure that before Z
contacting` the Building Inspector for the final occupancy inspection all other City Departments X
have granted final project approval, -�
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If you have any questions please feel free to call our office at 425-771-0220. Z
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lily Readwin
rnnit Coordinator
L\Tempm)sT's\Master i etters\smoanil_trCom 10/27/00
• Incorporated August 11, 1890 •
Sister City - Hekinan. Janan
•
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 S+ L O •-per'' 1 S
OCCUPANCY ..................
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