20040987.pdf - LEGACYI
DATE RECEIVED
C1W OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
I-16LLPR 19 A)
MAILING ADDRESS
1551 /0 0) RAcjs NOR7H
CITY ZIP TELEPHONE
EDwivvbs 92-0 - 2 5<? 7
NAME
ADDRESS
CITY ZIP
NAME
AAA -i-wl( S-e-zo(c Cvi, /I
ADDRESS
73/ kIR16,Aiii PVCOAF�-
CITY ZIP
16wi.AKYrD 9803 ;,2)]
STATE LICENSE NUMBER
h 4 4 T 6 G C,01",6 6 -D L0
PROPERTY TAX ACCOUNT PARCEL
1.,2,Z_7
TELEPHONE
TELEPHONE
112.5
EXPIRATION DATE
6118106
NEW
�q�ESIDENTIAIL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAININGWALL
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN
CBL
1:1
PLUMBING / MECH
oCOMPLIANCE
OR
CHANGE OF USE
SIGN
FENCE
( X Fr)
OTHER
FIRE SPRINKLER
FIRE ALARM
Q NUMBER NUMBER OF CRITICAL
0 DWELLING AREAS
1111 OF UNI NUMBER uz
o STORIES I I
DESCRIBE WORK TO BE DONE
1) 'Soo 6fit-mi
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I PERMIT EXPIRES _LY_LfL�1_2
USE
ZONE
PERMIT
NUMBER
JOB
ADDRESS
SUITEIAPT#
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
7ESCP Approved 0
Rw Permit Required 0
Street Use Permit Roq'd 0
EXISTING — PROPOSED
inspection Required 13
Sidewalk Required [3
REQUIRED DEDICATION-
Fr
undergro,und
0
wiring required
METER SIZE
LINE SIZE
I
IXTURES
PRV REQUIRED
YES 1:1 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING REVI
FIRE REVIEWED BY
BY DATE
DATE
VARIANCE OR CU
HORELINE OR ADBIJ
NSPECTION
BOND
A E. to
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POSTED
SEPA REVIEW o
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LOT COVERAGE
REQUIRED SETBACKS
(Fr.)
PROPOSED SETBACKS (Fr.)
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ALLOWED PROPOSED
FRONT SIDE
REAR
FRONT
UR SIDE REAR
PARKING
REO'D I PROVIDED
REMARKS
CHECKED BY
SPECIAL INSPECTION
REQUIRED [—] YES
LOT AREA I PLANNING REVIEWED BY DATE
OCCUPANT
GROUP
OCCUPANT
LOAD
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PROGRESS INSPECTIONS PER UBC 108/ IBC1091IRC109 FINAL INSPECTION REO'D
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
45
City Surcharge
4
PLAN CHECK NO:
VESTED DATE
Plumbing
Base Fee
Mechanical
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.
Grading
Engr. Review
2
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PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFX DEFEND AND HOLD HARMLESS THE CITY OF
Fire Review
Plan Chk. Deposit
2
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0
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 THIS PERMIT 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.,
Fire Inspection
Receipt #
Landscape Insp.
Total Amt. Due
Recording Fee
Receipt #
1 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
APPLICATION APPROVAL
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
CALL
This application is not a permit until signed by the
Building Official or his/lier Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOVMGPE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATP� INSURI�CE AND RCW 18.27.
FOR INSPECTION
receipt is acknowledged in space provided.
GN [URE
OFFICIALS SI DATE
(425)
SIGNATURE (OWNER OR/AG��,
DATLES GNED j
DATE,
Iii;;;ii
771-0220
A17ENTION Diff 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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FINAL PROJEC"'T APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE-4.),
PLEASESIGN
ENGINEERING DIVISION DATE
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PI.EASESIGN
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PLANNING DIVISION DATE
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DESCRIPTION OF WORK TO BE INSPECTED t_),Y7_ 1_Z-rtA1QV12-L—
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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
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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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FAILED FINAL INSPE 11U1N-UU'31.,AN'J"'NU100 -E-0
[:1 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:foni1s:ocaprv1 3/25/04
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
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0
Retaining Wall ...........
0
Slab Insulation ..........
M
PLUMBING:
Underground .............
M
C
Rough -in ...................
M
0
__10
0
Commercial Final ......
C
HEATING:
M
M Z
Gas Test ....................
C
Gas Piping .................
x
Equipment .................
0 -n
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Commercial Final .......
x
M M
EXTERIOR SHEATHING
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NAILING ..........................
0
0 M
FRAMING ........................
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9 Cf)
ITI 0
FIRST FLOOR FRAMING ...
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INSULATION ...................
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Floor Insulation .........
3:
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Wall Insulation ...........
Ceiling Insulation .......
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SHEETROCK NAILING ...
0
SPECIAL INSPECTION
ITI
MISCELLANEOUS ..........
FINAL APPROVAL FOR
/27/
12&1
OCCUPANCY ..................