20040936.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
MAILING ADDRESS
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CITY
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NAME
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NAME
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ADDRESS
CITY
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ZIP
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STATE LICENSE NUMBER
TELEPHONE
425 "137-23
ZIP TELEPHONE
r275 4?5 74- 65
CBL #
ZIP I TELEPHONE
EXPIRATION DATE I CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
005-97-0002.wooi
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
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CYDS
DEMOLISH
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TANK
GARAGE o
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
9
PLUMBING / MECH
1:1
COMPLIANCE OR
CHANGE OF USE
1:1
SIG14
IFENCE
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( X FT,
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OTHER.
FIRE SPRINKLER
FIRE ALARM
Un
w NUMBER NUMBER OF CRITICAL L "VI
OF DWELLING AREAS
UNITS NUMBER CA'03
0 STORIES
DESCRIBE WORK TO BE DONE
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HEAT SOURCE GLAZING % LOT SLOPE %
GAS I JO
PLAN CHECK Nql� /1 -1 -1-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
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
uAl PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF I HIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
21 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 AGR�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.
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SIGNA=TUREAER�R DATE SIGNED
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PERMIT EXPIRES
USE PERMIT
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NUMBER
JOB SUITE/APT#
ADDRESS
3rd AV e.
PLAT NAME/SUBDIVISION NO
LOT NO.
LID NO,
,90W'1141)�RK
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 0
WN Permit Required 13
EXISTING PROPOSED
Street Use Permit Roq d 13
Inspection Required 31
Sidewalk Requited 13
REQUIRED DEDICATION— FT
Underground
wiring required 0
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 1:3 NO 0
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REMARKS
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OWNERICONTRAcrOR RESPONSIBLE FOR EROSION CONTROLYDRAINAGE
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NG REVIEWED SY DATE
E REVIEWED BY DATE
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_bARI��'NCE OR CU HORELINEORADB# I INSPECTION I ' BOND
ENO I POSTED
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SEPA REVIEW SIGN AREA HEIGHT
COMPLETE I EKT ALLOWED PROPOSED ALLOWEDr PROJEOSPD
EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FROPT SIDE FRONT L1RS DE JREAR
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PARKING LOT AREi I Fit AA)NINGvREVIEWED BY DATE 0.
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REMARKS
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SPECIAL INSPECTION
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ-D F3
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VALUATION
$ 1,6'-7
Descri�tion
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
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Mechanical
Grading
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Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
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Fire Inspection
Receipt #
Landscapeinsp.
Total Amt. Due
Recording Fee
Receipt #
APPLICATION APPROVAL
CALL
This application is not a permit until signed by the
Buildingolficial or his/her Deputy: and Fees are paid. and
FOR INSPECTION
receipt is acknowledged in space provided.
OFFICIAUS S!GNA' DATE
(425)
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77/� zy-
771-0220
-RELEAS BY DATF�
_�ED
ATTENTION 7 EX 1 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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
NGINAL 'f ILE `YELLOW - (NSPEICTO
PINK.WWNIER - GOLD -ASSESSOR
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GARY HAAKENSON
CITY OF EDMONDS MAYOR
121 5TH AVENUE NORTH EDMONDS. WA 98020 (125) 771-0220 FAX (425) 771-0221
Website: www.d.edmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
9'�' Planning Building Engineering
October 25, 2004
Mel Scott
1165 3'(1 Avenue S
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Edmonds, WA 98020
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tion:
Re: Building Permit Applica 04-235
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Site Address: 1165 3 Avenue S
Expiration Date: November 4, 2004
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Dear Mr. Scott:
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The purpose of this letter is to info rin you that the above referenced permit application
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will expire on November 4, 2004. According to Edmonds Community Development
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Code Chapter 19.00.005(A)(5), applications are only valid ror a period of 180 days unless
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a written request for extension is submitted to the Building Official. If an application
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extension is granted it may only be extended for an additional 190 days for a total period
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of one year. If you need an extension on the subject permit application you must submit
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a request in writing to the Building Official prior to plan review expiration.
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Please be advised, once the pet -n-iit application expires, the application materials and plans
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will be destroyed within ten working days. Also, if the roject is pursued in the future a
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new pen -nit application and new fees will be required.
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-eel free to call our offices at 425-771-0220.
If you have any questions, please f
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Sincerely,
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Marie anrriso�
Permit Coordinator
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LV1*en1p\DST'svv1 aster Lctters\App Due to expire 1012 1 /00
Incorporated August 11 1890
Sister Citv - Hekinan, Japan
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
P . ASI: SIGN
C::1ENGINEERING DIVISION DATE— p/s/0 15
PLFASESIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT 1��L Se_0-rr_ X4)L)1--776-'1__e
SITE ADDRESS
PERMIT# 20os - 0' '=)3 (z, 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
0 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE-INSPECT,ED OUTSTANDING ISSUES - QERA�� _FINAL' C APPROVAL
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Date Signature
1:temp:b1dg:fornis: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 -In ...................
Commercial Final ......
HEATING:
GasTest ....................
Gas Piping .................
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Equipment .................
Commercial Final .......
EXTERIOR SHEATHING Let — 0
NAILING ..........................
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FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
�\L�_A� Ceiling Insulation .......
'S' fvj
,7,(2,-0 SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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Amout, Paid $ P-C-CCIP
Sid
Date Issued
WaterMeterSjkze__,__
Amount Paid d. PZ t 0
Date Purd,25cd
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The Initials Ml'ai-c Milton /)
A mount P6d rce-.OPV�, 4-
Thompson, a tempoi,u), conti*act
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inspectot - the City.
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FINAL PROJECT APPROVAL FORM
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DATE:
MEMO TO: PEt C OP., BUILDING DIVISION
FROM: V t�T FIRE DEPARTMENT DATE
M-EASEIr F_
ENGINEERING DIVISION DATE
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PLYASE SIGN
PLANNING DIVISION DATE —
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PROJECT
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PERMIT ADB# DATE INSPECTED 17-
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DESCRIPTION OF WORK TO BE INSPECTED O�-T �X/-/"OVOk�
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A field inspection was conducted to determine final 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
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PERFORMLANCE BONDS and the granting of
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GRANT FINAL PROM CT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
13 Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
c3 Copy of CORRECTION NOTICE given to owner/contractor by inspector
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3. PERMIT cOUNT'"'
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_,
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