20040948.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
KJOSPE�)C, C,14Lj1AA)C7
MAILING ADDRESS
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CITY ZIP TELEPHONE
NAME
ADDRESS
/Mo ol/ I I PERMIT EXPIRES
PE'�MIT
NUMBER
JOB SUITEiAPT#
ADDRESS 7y-/c/ koA13
F714j �yi t-, -Y) rlc->', tVA _-2e 6'
PLAT NAME�SUBDIVISION NO LOT NO LID NO
I LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP I ESCP Approved
RVY Porma Required
Street use Peraw Rewied
EXISTING PROPOSED Inspection Required
S.CW*411, Rliqu'rea
REQUIRED DEDICATION FT Uncerqrouna
VMV14 , fl-qu'rea
METER SIZE LINE SIZE NO OF FIXTURES PRV REQUIRED
YESO 140 Cl
REMARKS
OWNFRICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP TELEPHONE At'!', i I JILLI I I 'Lon ?.
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U�_"'_D T1qVir`.r'0*ERSEPM(1vE Pf111N1GPR0VM
NAMEO CBL# THAT WFIERE METAL WATER SERVICE
GIMPIT'AGE35Y Vt; 14 Fie) I, FILECTRYCAL
ADDRESS RMT
/ ) 1/ 11 G A"MID10 PtIRF.-OSr-.S,REPI,s;,CErytr��NT
CITY ZIP
STATE LICENSE NUMBER
PROPERTY TAX ACCOUNT PARCEL NO
TELEPHONE
EXPIRATION DATE I CHECKED BY
F-1
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
El
MIXED USE
REMODEL
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MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE. BUSINESS OR ACTIVIT/rEXI?�:",
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PLUMBING i FAECH
COMPLIANCE OR
OF USE
CHANGE
SIGN
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OTHER
FIRE SPRINKLER
FIREALARM
604.8) A STAT7:3 EL7nC-,T&,_fCAL PEP.3.11'r AND
CTL\.OU DIJNG IS AUTE: NO
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SETBACKS(FT) I PROPOSED SETBACKS
PARKING I LOTAREA I PLANNING REVIEWED BY DATE
REO'D I PROVIDED
REMARKS
NUMBER NUMBER OF - I ii� 11 � - __Lj�
OF DWELLING .,SPECIAL INSPECTION
STORIES UNITS REQUIRED 13YES
DESCRIBE WORK 10 BE DONE
10 — Zl_ 11 - / I /" 'P"-. "I REMARKS
GEOTECH REPORT
BY
STRUCTURAL DESIGN
BY:
VALUATION
CONSULTANT
OCCUPANT
GROUP
OCCUPANT
LOAD
Description FEE Description FEE
HEAT�� LOT SLOPE% VESTED DATE Plan Check State Surcharge
Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION. Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 119.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt ft
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE Landscape Insp. Total Anit. Due 4
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE I 16-S
NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' cc
Rec
Recording Foe Feipt
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF Trijs application is not a penilit until signed by Me
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building off cial or li,s:huf Deputy and Feesaie paid and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED rc.eipt isacknowledged in space piuvided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION I
WORKMEN'S C Vts�ATION INSURANCE AND RCW 18:27. OFFICIALS -IGN URE - A E�
SIGNATURET WNER RAGENT): DATE SIGNED (425)
D
7-
-02 LEASE 'Ely AIL I
771 20
ATTE NTIO C:A 1. 1%3%)%)
IT IS UNLAW_ _1 USE OR OCCUP)A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI.
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 f IRC110.
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL -FILE YELLOW � INSPI-CIOR
PINK -OWNER GOLD � ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PIXASE SIGN
ENGINEERING DfVISION DATE
A-LLXsr SIGN
PLANNING DIVISION DATE
PI.F,%SE SIGN
PROJECT
SITE ADDRESS —
PERMIT # 17j)1)4 _6qe ADB# DATE INSPECTED
VV
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/coiltractor by hispector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owiierkwitractoi- by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sigilature
1:temp:b1dg:rorn1s:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing........... ..........
Wall..........................
Pier/Porch .................
77
Retaining Wall ...........
Slab Insulation ..........
^PLUMBI�G:
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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