20040999.pdfDATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEiNAME OF BUSINESS
MAILING ADDRESS
I 1 �
CITY ZIP TELEPHONE
2
NAME
PHONE
fit
PERMIT EXPIRES &!Zest.
PERMIT r
NUMBER
JOB I SUITEIAPTr+/1
ADDRESS /.,(�)� � t
(�LN
0 L
PLAT NAME/SUBDIVISION NO. JOT NO LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESL" Apprnnee
RW Prom Hequnetl
;tree) Use Petrmt Ra;uaed
EXISTING,.______PROPOSED InsGeclwn RegwrnJ
Sioewall, Renwree
REQUIRED DEDICATION FT uneurpuund
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES ❑ NO ❑
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
C 1-4
/3 `' ENGINEERING REVIEWED BY
Nvvntaa
G JBY
E REVIEWED BY
CITY zip TELEPI-1014E -A;!eg
STATELICENSE NUMBER EXPIRATION DATE CHECVARIANCE OR CU
Q PROPERTY TAX ACCOUNT PARCEL NO
tu
fog
. ipE
EW ❑ RESIDENTIAL ❑ PLUMBING / MECH
COMMERCIAL ❑ COMPLIANCE OR
❑ ADDITION CHANGE OF USE
MIXED USE
❑ REMODEL ❑ MULTIFILY SIGN
GRADING FENCE
❑ REPAIR ❑ GCYDS ❑ ( X FT.)
❑ DEMOLISH ❑ TANK ❑ OTHER
z ❑GARAGE IRE
CARPORT ❑ RETAROCKINING ERY WALL ❑ FIREALARM SPRINKLER
DATE
DATE
SHORELINE OR ADB# INSPECTION SEPA
17>� REO'D COMPLETED ESEr.+PT
CAP ZONE SIGN AREA HEIGHT
WAIVER ❑ ALLOWED PROPOSED ALLOWED PROPOSED
STUDY ❑ (� I G
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
_ z
Iz
PARKINGIL
LOT AREA PLANNING REVIEWED BY DATE g
REQ'D I PROVIDED
0
z
w
Lu
z
E5
z
w
ul
LL
S
r
a (TYPE OF USE, BUSINESS QRIAC�TIVITY) EXPLAI -� )
V Sd
% �J�� TYP mF CONSi RI1CTtON DZj GROUP
ANT�
in NUMBER NUMBER OF f
I DWELLING (�) SPECIAL INSPECTION CONSULTANT OCCUPANT
OF
n ` UNITS 1 v LOAD
❑ YES
DESCRIBE WORK TO BE DONE
REMARKS
tize S lid GEOTECH REPORT
BY:
) ,
Z' 171/�1 %l!!� e L lieSTRUCTURALDESIGN
/ , BY:
VALUATION
r111111111111110
Description
Plan Check
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit
PLAN CHECK NO: ,,, q Plumbing
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 19.00.005(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
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection
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 Landscape Insp.
NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee
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 WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL 8E EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
SIGNATURE_( NER RAGENT): fr j .1I' 'jrt (' DATE SIGNED (425)
771-0220
FEE Description FEE
State Surcharge
City Surcharge �J
Base Fee
Plan Chk. Deposit >( J
r+2�Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a punnet until signed by the
Budding 0t11cial or hislher Deputy and Fees are paid, and
receipt is acknowledged in space provided
FICiALS SIGNATURE DATE
ATTENTION t:)k 1333 y
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 I IRC110.
10104 PRESS HARD = YOU ARE MAKING 4 COPIES
/Z J
D BY DATE
rz/ Ile'¢
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
O
rn
_I91
vM
m 0
�O
OC
"j
=rn
mZ
A�
C Z
r— --I
T1
MM
O�
nr
m
�Cn
mn
Z r-
-1 m
DX
Z
2
Cn
Z
O
--I
n
M
1
FINAL l
OJECT APPROVAL FORM
TO:
O(
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
PLEASESIGN
� =r Q. �_ _ Y"''� � e PLANNING DIVISION DATE 1 :2— 2 a o W
.. PLLE,ASE SIGN PIPLde,
PROJECT tMMMox/� /� GcGr c
SITE ADDRESS I / WMIM-6 LQ/l.v
PERMIT # 2OU l'I ' O q q' ADB# DATE INSPECTED z �' O y
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
❑ Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
❑ Copy of CORRECTION NOTICE given to owner/contractor by inpector
I.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:forms:oca1)rv1 3/25/04
z
0
M
vm
m
0
�0
0C
M
_
m
Z
A"MM-1
Dz
r
-1
0M
m�
_�
mm
0
nr
�Cn
m
Z r
' D
z
Cn
0
-4
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
OCCUPANCY .................. ' V t