20040902.pdfI
DAIE H
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
PAUL
MAILING ADDRESS
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CITY ZIP I TELEPHONE
E:D%,Vl I) Mty�l, q8026 1,20, 63Y 5`73-,5
ADDRESS
CITY
ZIP I TELEPHONE
NAME
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CBL#
ADDRESS
7-11 Anijuill=
CITY
Zip
L E P��O N;E
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96C,3,3
FTE
4 0
(L121)- J30*3-%:3032_
STATE LICENSE NUMBER EXPIRATION DATE
4,04"TA -S C. a 66 I>a
PROPERTY TAX ACCOUNT PARCEL 70.
(5r')' 000 a/ (0 oo
I-] NEW
9.<EI-IDENTIAL
E] PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
I X FT)
DEMOLISH
TANK
OTHER
E:]GARAGE
CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVI-M EXPLAW-�
NUMBER NUMBER OF CRITICAL
OF DWELLINfG AREAS
STORIES UNIT NUMBER
DESCRIBE WORK TO BE DONE
BK#�bflj - I M - A41-E— ( I
F
.6-4
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
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 160 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCr=SORS
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 DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF *THIS PERMIT. ISSUANCE OF 1 HIS PERMIl SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO 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 Willi 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 COMPENSAPC9;fMQANCE AND RCW 18.27.
DATE SIGNE
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4 ,
[PERMITEXPIRES —_
PERMIT /�C-- 7/� ) L4 7
NUMBER
JOB 7 - SUITE/APT#
ADDRESS
PLAT NAME/SLIBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
I ESCP Approved 13
RW Permit Required El
EXISTING
Street Use Permit Roq'd 13
� PROPOSED
inspection Required 13
Sidewalk Required E3
REQUIRED DEDICATION� FT
underground
Wiring required 13
METER SIZE LINE SIZE NO. OF FIXTURES
PRV REQUIRED
0
YES 13 NO 0
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING
FIRE REVIEWED BY
r-RE8EN*=f r6A
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...........
DATE
VARIANCE OR Cu HORELINE OR ADIIII I INSPECTION-F BOND
REQ'O I POSTED
OYES ONO IS
SEPA REVIEW SIGN AREA HEIGH
COMPLETE , EXEMPT ALLOWED I PROPOSED ALLOWED , PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
PARKING
REO'D I PROVIDED
REMARKS
CHECKED BY ITYPE
LOT AREA I PLANNING REVIEWED BY DATE
SPECIAL INSPECTION [AREA
REQUIRED [:
GROUP
OCCUPANT
LOAD
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REMARKS a
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
5
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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 Description FEE
State Surcharge
City Surcharge
Plan Chk. Deposit
LReceipt #
c 'pt
T t I
otal Amt. Due
To c ipt W I -7�qe�.5Z
Receipt
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Oflicial or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFELM[ S SIGiNUiRF E
PF1 F n
ATTENTION / I E)ff 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL L
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
GREEN - ACCOUNTING
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FINAL PROJECT APPROVAL FORM
(15 0
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE C)
4- Pdr.Asr.91GN
ENGINEERING DIVISION DATE
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PIXASUSIGN
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PLANNING DIVISION DATE
PLEASrSIGN
PROJECT)4A—,5/ ,V-1
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SITE ADDRESS. 2, 0
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PERMIT ADB# DATE INSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED
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A field inspection was conducted to determine compliance with -approved plans. Final approval
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denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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0 Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRE CTION NOTICE given to owner/contractor by inpector
2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signaftire
1: tenip: bidg: forms: ocaprvl 3/25/04
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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
OCCUPANCY ..................
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