20041009.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
1-74 2-1 L tj PC-10 vc=.
CITY ZIP ELEPHONE zorb-
51-40aer Lltjo '7811--2
10 64 0
NAME
ADDRESS
TELEPHONE
NAME
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ADDRESS
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER
EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
005 &`7
0000 1&0-+
NEW
�j�ESIDENTIAL
1
1:1 PLUMBING / MECH
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COMMERCIAL
COMPLIANCE OR
ADDITION
MIXED USE
E] CHANGE OF USE
REMODEL
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MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
( X FT.)
DEMOLISH
TANK
OTHER
GARAGE
r.ARPnRT
RETAINING WALL
ROCKERY
�FIR SPRINKL R11)
�9 FIREA
FTYPE OF USE, BUSINESS�ORA��TIVITN�6KPLAIN.
NUMBER NUMBER OF
OF DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
eF 5 160 111,,)
P-0-51 �
HEAT SOURCE
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LOT
PERMIT EXPIRES
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NUMBER
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SUITE/APT#
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PLAT NAME/SUBDIVISION NO
LOT NO
LID NO
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UD FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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TESCPApprov0d
R,tj Peraid Redulled
13
E3
Street Use Permit Requited
[3
EXISTING PROPOSED
E
inspei:ijon Required
0
S.de*aik Required
13
REQUIRED DEDICATION
FT
Unatitgiound
0
METER SIZE
LINE SIZE
OF FIXTURES
PRv REQUIRED
YES 13 No 0
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE
FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED BY
FIRE REVIEWED BY
VARIANCE OR CU
CAft
WAIVERO
STUDY 13
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D , PROVIDED
REMARKS
SPECIAL INSPECTION
REQUIRED 13YES
REMARKS
t-r L�L_, GEOTECH REPORT
BY:
STRUCTURAL DESIGN
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LIE P?,— VALUAT ON
rz) $ L
VESTED DATE
PLAN CHECK NO:
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
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 THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S 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 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 COMPEN�AyoNjt�U RANCE AND RCW 18:27.
DATE SIGNED
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
DATE
DATE Lu
5
LL
SHORELINE ORAD1111 I INSPECTION SEPA
REQ'D COMPLETED EXEMPT
OYES CI NO
ZONE SIGN AREA HEIGHT
ALLOWED . PROPOSED ALLOWED , PROPOSED
REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT UR SIDE REAR
z
2
z
LOT AREA I PLANNING REVIEWED BY DATE I �
OCCUPANT
GROUP
occu
LOAD
FEE
Description
817
State Surcharge
City Surcharge
Base Fee
/00_ Plan Chk. Deposit
2 /0 Receipt #
9
CALL
FOR INSPECTION
14251
FEE
Total Amt. Due
Receipt # I
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or hisither Deputy and Fees are paid. and
receipt is ac�nowledged in space provided
FICIAI.$ SIGNATI DATE
`7 y.
ISIGNA RE OW,NER ALi N 1 V )7�
E7z '0 _J 771-0220 srE sE
------- r___ EXT. 1333
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL E-2/4
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110-
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
BY DrE
ORIGINAL - FILE YELLOW - IN6PEC7f
PINK -OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE, DEPARTMENT DATE
I'LLASESIGN
ENGINEERING DIVISION DATE z
0
PLEASE SIGN
PLANNING DIVISION DATE M
PLEASE SIGN
PROJECT Q 1IL14 10V 3-- 0
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SITE ADDRESS �L� L 5L -I
PERMIT #R�C
�)— �-�(_�ADB# DATEINSPECTED
DESCRIPTION OF WORK TO BE INSPECTED C_" k.
A field inspection was condncted 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
1:1 Copy of CONDITIONS given to owner/contractor by inspector
2, 2-
C' /,/X
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
1.
2- 6 J,
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
I:tei-ni):bldg:fortils:ocapi-N,I 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
0
M
PLUMBING:
Underground .............
Rough -In ...................
M
C
M
Commercial Final ......
-4 0
0
0
C
HEATING:
-4
x M
Gas Test ....................
M z
g) --I
C
Gas Piping .................
>
Equipment .................
Cn
0 _Tl
Commercial Final .......
EXTERIOR SHEATHING
M M
NAILING ..........................
0 C—n
0 r-
FRAMING ........................
0 M
C Cn
FIRST FLOOR FRAMING ...
F. C0
M 0
Z
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
>
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Ceiling Insulation .......
Cn
SHEETROCK NAILING ...
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SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
M
OCCUPANCY ..................
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