20041031.pdf1 '1 DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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NAME
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NAME
ADDRESS
ZIP I TELEPHONE
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ADDRESS
PLAT NAME/SUBDIVISION NO.
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PERMIT EXPIRES
NUMBER V- M
SUITE/APT#
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION� FT
METER SIZE LINE SIZE NO. OF FIXTURES
LID NO.
LID FEE S
TESCP Approved
0
RW permit Rocitirtrid
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Street Use Permit Roq 'd
0
Inspection Required
0
Sidewatk Hequired
0
Uncitirg(ound
0
Wiring required
PRV REQUIRED
YES 0 NO 0
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DFAINAGE
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0 ENGINEERING REVIEWED BY DATE
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CITY
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STATE LICENSE NUMBER
EXPIRATION,DATE.
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CHECKED BY
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PROPERTY TAX ACCOUNT PARCEL NO.
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DEMOLISH
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GARAGE
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FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE. BUSfjESS OR ACTIVITY) EXPLAIN
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NUMBER
NUMBER OF
CRITICAL
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DWELLING
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UNITS
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DESCRIBE WORK TO BE DONE
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ItfYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (F-T)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR 0
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REMARKS
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PROGRESS INSPECTIONS PER UBC 108/IBC109/IRClD9 FINAL INSPECTION REQD
VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
T GLAZING %
LOT SLOPE % Building Permit
City Surcharge
Base Fee
PLAN CHE K VESTED DATE Plumbing
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NY: /.O;�
--- Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, FTC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
4
Plan Chk. Deposit
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESO RS Fire Review
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS -THE CITY OF
EDMONDS, WASHINGTON. ITS 0 FFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECILY
FROM THE ISSUANCE OF [HIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY C11Y ORDINANCE Landscapelnsp.
_>2�)
Receipt it
Total Amt. Due
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NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION' Recording Fee
Receipt #
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION
'� AUTHORIZED AGENT OF
GIVEN IS CORRECT; AND THAI' I AM THE OWNER, Oil THE out.
APPLICATION
APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTAUG CALL I his application s no, a Parini unh, s gried Dy the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building 011icial or his/tier Deptity: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged III space provided.
WORKMEN'S COMPENSAT19N
,0&�RANCE AND RCW 10 27.
OFFICII SIG TURF. DATE
SIGNATURE (OWNER OR(GE" DATE SIGNED (425)
4/
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mmonalwanomenum RFI FAS
ATTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCU PYA BUILDI NIS OR STRUCTURE U NTI LA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI FICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
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09/03 PRESS HARD -YOU A MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASESIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASUSIGN
PROJECT
SITE ADDRESS-
PERMIT#'�2n6!�_ _ADB# DATEINSPECTED
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
11 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by hipector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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Date Signattire
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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ENGINEERING DIVISION DATE
PLEASC SIGN
PLANNING DIVISION DATE
PLEASE SIGN
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SITE ADDRESS S3"
PERMIT # ADB#--------PATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED_7_/11��
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 tile 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
El Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANTFINAL PROJECT APPROVAL
Date Signature
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DEPARTMENT OF BUILDINGS
A11101111111, Fie r
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PER International Building Code Section 110
ilding Permit#:
Occupancy established by this certificate: I Dwelling Units: **N/A**
A3
031
No. Stories: 1
Construction: V-N Sprink I Basement: No
Maximum Occupant Load **49** (Per IBC 1004)
Room capacity signs, when required, must remain posted at all times.
Owner of Building: ESC Associates —Address: 3226 Cascadia Avenue S, Seattle, WA 98144
THE Terivaki 123 HAS BEEN INSPECTED AND APPROVED AS %COMPLYING WITH THE REQUIREMENTS OF THE 2003 EDITION OF THE
INTERNATIONAL BUILDING CODE AS ADOPTED BY THE CITY FOR THE GROUP AND DIVISION OF OCCUPANCY AND THE USE FOR WHICH THE
PROPOSED OCCUPANCY IS CLASSIFIED.
Issued this 7th - day of March , 2005 .
CHIEF BUILDING OFFICIAL
BY:
This certificate shall be posted in a conspicuous public area and shall not be removed, mutilated or obscured and shall be maintained in legible condition at all times. Any change of occupancy or use requires a building permit and a new
Certificate of Occupancy issued by the City of Edmonds Building Official.
(1) (-T) (b (1) (T) (1) 4) (T)
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 ..................
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