20040873.pdfDATE RECEIVED
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CONSTRUCTION PERMIT APPLICATION
OWNER N6ME/NAME OF BUSINESS
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MAILING ADDRESS
CITY ZIP TELEPHONE
6 rm 7 71,
NAME
ADDRESS
CITY ZIP I TELEPHONE
NAME
CBL#
ADDRESS
-16&- ILI
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CITY
ZIP
'70271
rELEPHONE
C V1vA)aee,0
STATE LICENSE NUMBER
EXPIRATION DATE
CH C BY
C BY
bm Hii�le4
(4 6) i
2/4)
PROPERTY TAX ACCOUNT PARCEL NO.
e14,L5-09"
qd0a cyO 72A
O'NEW
RESIDENTIAL
PLUMBING MECH
F� ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING Ei FENCE
CYDS x FT)
DEMOLISH
TANK
OTHER
oGARAGE
CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINR88) OR ACT[Vr.M EXPL�114: t I
w NUMBER NUMBER OF CRITICAL
0 OF DWELLING AREAS
la
0 STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE vl 1
JOB
ADDRESS
PLAT NAME/SUBDIVISION NO
PERMIT EXPIRES 1'4 11 1
PERMIT 6
NUMBER
SUITE/APT#
LOT NO, LID NO.
LID FEE $
TESCP Approved 13
PUBLIC RIGH1 OF WAY PER OFFICIAL STREET MAP
RW Permit Hammed 13
Street Use Permit P0q'd [3
EXISTING - PROPOSED
I
Imiriection Hequired 13
Sidewalk Required E3
REQUIRED DEDICATION- FT
underground
Witing required E3
METER SIZE
LINE SIZE
NO. OF FIXTURES
I
PRV REQUIRED
I
YES 1:1 NO 0
REMARKS
OWN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
EN
T11AT WIIER-E METAL WATER SEERVICI!
GYROLWD-1140 PURPOSES, R-EPLACENffiNT
604.19) A
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SEPA
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EIV'L�- �\4 kT425-20,,0-1309
REQ�D I PROVIDED
REMARKS
CHECKED BY ITYPE OCCUPANr
GROUP
SPECIAL INSPECTION OCCUPANT
REQUIRED [] YES LOAD
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/ IBC109 / IRC109 FINAL INSPECTION REQrD
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HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
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
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
uj
CL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) @APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
R
EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS F OM ANY AND
Ir ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
4
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
C1 DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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01 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 VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENS=SURANCE AND RCW 18.27.
SIGNATTf (OWNER OR DATE SIGNE - D _04
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
WIM
FOR INSPECTION
(425)
771-0220
�TTENTION tAI lijul
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk- Deposit
Receipt III
Total Amt. Due
Receipt # I Z'r
-1 1 21� - �d � �)
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.
-F1 'i' I PIGNATu E PAT��
/bx )'a
ILEASED BY I DATI!
ITIS UNLAWFULTO USEOR OCCUPYABUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/[BC110/IRC110. PINK - OWNER GOLD - ASSESSOR
09103 PRESS HARD -YOU ARE MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM
_...: I I
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEA.St: SIGN
Om h, ENGINEERING DIVISION DATE— ?11'Y /,2
Pk._dESIdN_
PLANNING DIVISION DATE
PLEASESIGN
PROJECT
SITE ADDRESS— act
PERMIT
ADB# DATEINSPECTED
DESCRIPTION OF WORK TO BE INSPECTED W5L_
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
1:1 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
1:1 Copy of CORRECTION NOTICE given to owner/contractor by inpector
I .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:teinp:b1dg:fbrms:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .... ........
Rough-!h.�,, ..................
Commercialfinal ......
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 ..........
-7—
FINAL APPROVAL FOR
OCCUPANCY ..................
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