20041056.pdfDATE RECEIVED I
PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER,'
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
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OWNER NAM ME OFJUSINES� , 2L z
/7 PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
MAILING D
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LID FEE $
TESCP Apptoved 13
0 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Potmil Requited 0
CITY INA V Stroot tise Parrind Roq'd [3
ZIP TELEPHONE EXISTING - PROPOSED Inspection Required 0
Sidawalk Required 0
REOUIHED DEDICATION. Fr Undotground
Winng toquired 13
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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YES 1:1 NO 0 K
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REMARKS z
OWNER/CON`IRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE z
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STATE LICENSE NUMBER EXPIRATION TE CKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
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OYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
;fl PROPERTY�RX ACCO NT PARCEL NO.
0 COMPLETE I EXEMPT ALLOWED POSED ALLOWED I PROPOSED
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NEW M'_<ESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
r_1 ALLOWED PROPOSED FRONT SIDE REAR FRONT L/P1 SIDE REAR
ADDITION COMMERCIAL COMPLIANCE OR z
CHANGE OF USE
I PLANNING REVIEW ED BY
PARKING LOT AREA DATE
REMODEL MULTIFAMILY SIGN REO'D PROVIDED IL
F� GRADING FENCE
REPAIR CYDS I X FT) REMARKS
TTHER
DEMOLISH U'-TANK El 0
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE Ol� USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY TIPE P'F CONST U::T ON OCCUPANT,
0 GROUP
U1 NUMBER NUMBER OF CRITICAL
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M OF DWELLING AREAS SPECIAL INSPECTION JAREA
0 STORIES UNITS NUMBER OCCUPANT
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DESCRIBE WORK TO BE DONE
REMARKS
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SS INSPECTIONS PER U BC 108 It IBC11 09 IRC1 09 FINAL INSPECTIO N REQ'D
PROGRE
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`/ �JOI/74 -k /I 1"Igse 7/- lwh-
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % Lor SLOPE % Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVER - S - WORKTO Mechanical
It BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
:3
10- SEPARATE PERMISSION.
Ir Engr. Review
W PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT., 1 YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS Engr, Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
"APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Plan Chk. Deposit
Fire Review
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTlY
_j ___1 5 '
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE or THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due
01 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt #
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 APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATI9N-6_F'Yt(E LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WO RXMEUf,_C 0 M P E N �AT 10 N IN .1 —
�J�AND RCW ILI.27. 1
0 11 I�I_S DATE
V16 A R E
-=N LrUR OV6:10 LOAGI DATE S NED _ /j
0'
(425) /, T11
771-0220 *AT/
V RELEASED BY E
ATTENTION EXT 1333 -------- ---------
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU-
0141GINAL-FILE YELLOW -INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/[BC110/IRC110. PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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Filco Company Inc.
PO Box 31228
Seattle WA 98103
206-547-8347
Lic.#FILCOCIO80RUEXP. QAO/6,�
IFCI License # At
City License4--45-4z,Z;—
SITE PLAN
Heating Oil Tank Decommissioning
PHONE: J�
ACTIVITY:
�(Pump Clean and Cap)
�`—Cpl�4ump & clean (triple rinse) oneat)—gallon underground oil tank, Cut off or remove
vent and filler pipes and cap them permanently below grade
0 (Pump Clean and Fill)
Pump& clean one gallon underground oil tank. Fill with Structural Polyurethane
Foam. Cut off or remove vent and filler pipes and cap them permanently below grade.
rl (Removal)
Pump out one gallon underground oil tank. Excavate and remove the oil tank
then back fill the hole and dispose of tank in proper manner.
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MEMO TO:
FROM:
FINAL PROJECT APPROVAL FORM
TO:
DATE:
)IVISION
DEPARTMENTDATE
12D TXTI�_ 7-%" 7TQ1 TnXT 7-% A IM
?LEASE SIGN
PLANNING DIVISION DATE
PILL&SE SIGN
PROJECT-L) 1- 86C 6-
SITE ADDRESS
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PERMIT # Q z'l - 10 E;� -ADB# DATE INSPECTED , -z ( -zo / 0 #
DESCRIPTION OF WORK TO BE INSPECTED U�'T-
A fleld inspection was conducted to determine final 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
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GRANT PROJECT APPROVAL WrIH CONDITIONS NOTED
c3 Copy of CONDITIONS given to owner/contractor by inspector
I .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
1 .
2.
0
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
ocaprv1.doc.1:temp:b1dg:fbrms 10/0 1
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
GasTest ....................
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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