20040897.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
J.
MAILING ADDRESS
L
CITY
J01.)
NAME
ADDRESS
CITY
NAME
ADDRESS
ZIP TELEPHONE
ZIP
R . 011 L_ k_ F,
TELEPHONE
CBL N
CITY ZIP TELEPHONE
I e,
t, () e-11 -0 - -,) (. ) e", � %� �: A L� I �-i _-,� �, - ') -) � -- C: "I -) �1
STATE LICENSE NUMBER EXPIRATION DATE r14ECKE
I c:, ;, YX e C
Lj
PROPERTY TAX ACCOUNT PARCEL NO.
CfO 0 Y
7 0 C7000 :706,1
NEW
ADDITION
/X�RESIDENTIAL
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
m
GARAGE
CARPORT
RETAININGWALL
ROCKERY
(TYPE OF USE, BUSINEZS OR ACTIVITY) EXPLAIN:
NUMBER NUMBER OF
OF DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
U Sl] 01N %� fAT E R S n, V 1 (3
rurnr W�IER9`WETAL
CRECKNOtl W 1-11., Lf X_ 06
G1r,*.'.0UNP.,,1NG PURPOSE
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( x FT)
OTHER
SPRINKLER
EFIRE
FIRE ALARM
USE
ZONE
JOB
ADDRESS
PLAT NAMEISUBDIVISION NO
PERMIT EXPIRES 71
PERMIT
NUMBER,-4��e//// -
LOT NO.
Z/xl el"K-2
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
REMARKS
OWNERIO
Ez
REVIEWED BY
FIRE REVIEWED BY
LID NO.
LID FEE $
ii��
AW permit Required
Street Use permit Rari'd
1,spection Rocillred
SIdewalkRequifed
Un(jerground
Wirmirtaquired
PRV REQUIRED
YES M NO 13
FOR EROSION CONIROL/DRAINAGE
��c
DATE
DATE
0
Z
cc
uj
z
z
E5
z
ul
LU
cc
i-L
VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
REO'D POSTED
ES 11N0jS
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
E IXP I
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT IJR SIDE REAR
z
2
z
PARKING LOT AREA I PLANNING REVIEWED BY DATE
REQ'D I PROVIDED
I SUA�T TO UPC 608
REMARKS
F F
CHECKED BY ITYPE cclo�e OCCUPANT
Zl, GROUP /
.,2
CRITICAL
AREAS R SPECIAL INSPECTIOINAREA OCCUPANT
NUMBE REQUIRED LOAD
IREMARKS
PROGRESS INSPECTIONS PER UBC 108 IBC109 if IRC109 FINAL INSPECTION REO'D -za
.Ap i2 C.� —4:' to
n1tOM!iilhC3
I I V;; : 'M - -
Tt-c-
IWI 7 r 4 ITf lip PrgAT R-11:
16VID NU - AURR I TA481'10VED
OAP IC/&-, oWYE IALf:jbrHISC�0A-+tfR
T
I I ' N.
IN 11 TEFIEST AGRAS TO INDEMNI .*bE0EW) N
ED NEE �4401N(�T.04. jqj'Or.PI11IALS3 E� - 'ff93, AND AGENTS FROM ANY AND
ALL LAIMS FOR 6AMAGES OF W11—AT"EVIE'R NAME, ARISING DIRECTLY OR INDIRECTLY
FRO a0l . hAll SLIAI 1 Nny
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANR
NOR LIMIF IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.q
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 AGRI�E 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 COMPENSATION INSURANCE AND RCW 18,27.
SIGNATURE (OWNER 012 GENT) DATE SIGNED
n / 4. /. :� �r
A_ _/ -Z Zi I I . -
VALUATION I SHALL BE INSTALLED ON THE
$ i T.Mtr% AS IT
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
..............
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Fz
Recording Fee
Receipt #
APPLICATION APP-ROVAL
CALL
I his application is not a permit until signed by the
FOR INSPECTION
Building 011icial or hisitier Deputy: and Fees are Paid, and
-'receipt is acknowledged in space provided.
(425)
0 V) S SIGNATU E I
FF I DATE
771-0220
__RfttAS?5
13Y bATE/'
ATTENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU-
PANCYHAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE -. YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
z
0
1
0
M
--i -n
U5 --I
3:
0 M
C
M 0
0
C-)
0 C
--j K
3: M
M Z
jo 11
C: _z
r: --A
3:
0 -n
n ;U
__j >
3:9
M M
0
0
0 M
C cf)
?. 0)
M C-)
Z
z
Cl)
z
0
11
0
M
FINAL PR03ECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASI: SIGN
RD n" ENGINEERING DIVISION DATE
PLrA.SESIGN
PLANNING DIVISION DATE
PI_r.,%Sr SIGN
PROJECT
SITE ADDRESS
PERMIT# ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED IAIL-
A field inspection was conducted to determine compliance with -approved plans. Final approval
partment to the release of
denotes that there are no objections from the above signed De
PERFORMANCE BONDS and the granting of
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
1 .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
1.
2.
a
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tenip:b1dg:romis:ocaprv1 3/25/04
z
0
M
=n-
o M
C
M
0
0
0 C::
--I K
= M
M Z
g) -4
C: —Z
C')
0 _n
n;u
_j >
= 9
M M
0
0
0 M
C rJ)
90)
M
Z
M
z
En
z
0
i
0
M
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
194
OCCUPANCY ..................
477
z
0
1
0
M
q5i