20041067.pdfDATE RECEIVED/" PERMIT EXPIR
ES
Ln 6 44AL
USE PERMIT
ZONE IER
CITY OF EDMONDS C
JOB 'A SUITE/AF`f;�-
CONSTRUCTION PERMIT APPLICATION ADDRESS 11
OWNER NAMEINAME OP BUSINESS
PLAT NAME/SUBDIVISION NO LOT NO. LID NO.
Pya, fiy� LID FEE $
LCc MAILING ADDRESS
U TESCP Approved 13
3: PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Rw permit Required
/1/// �- ( Street Use Permit Roq'd
z
inspection Required
CITY ZIP TELEPHONE4--"' EXISTING - PROPOSED Sidewalk Required E3
underground
REQUIRED DEDICATION� FT Wiring required
�d _: 4
NAME METER SIZE INE SIZE NO. OF FIXTURES PRV REQUIRED 0
z
YES 0 NO 0 rr
LU
z
z
Lu REMARKS a
ADDRESS OWNER/CONTRACTOR RESPON I E FOR EROSION CONTROL/DRAINAGE z
Ul
cc
1. )A
CITY ZIP TELEPHONE
NAME
REVIE D/DATE
j/ ENGINEERING
ccl ADDRESS
0
rj DATE Lu
FIRrE to B Cr
CITY ZIP TELEPHONE 3
VSHORELINE OR ADB# INSPECTION BOND
XPIRATION DATE CHECKED BY ANCE OR REq'D POSTED
STATE LICENSE NUMBER E [3YES 0
SEPA REVIEW 'SIGN AREA HE HT
PROPOSED ALLOWED R POSED
-j PROPERTY TAX ACCOUNT PARCEL NO., COMPLETE , EXEM13T ALLOWED
4*
Uj
_j EXP LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS
FRONT SIDE REAR FRONT URSIDE REA
14EW RESIDENTIAL PLUMBING MECH ALLOWED PROPOSED z
COMMERCIAL COMPLIANCE OR /V�l
ADDITION CHANGE OF USE
PARKING LOT AREA PLANNING REVIEWECAY DATE
REMODEL APARTMENT SIGN REO'D PROVIDED
------------------ mo 4( .3
REPAIR GRADING CYDS E] FENCE
( X FT) REMARKS
DEMOLISH TANK OTHER
- 4 "t
GARAGE RETAINING WALL
z CARPORT 0 ROCKERY RENEWA . L A
(TYPE OF USE, BUSINESS OR A.CTIVITY) EXPLAIN: OCCUPANT
CHECKED 13Y ITYPE OF CONSTRUCTION GOD GROUP
NUMBER �UMBER OF CRITICAL CTOR JAREA OCCUPANT
DWELLING A REQUIRED LOAD
OF ;7LP
N YES
0 STORIES UNITS
DESCRIBE WORK TO BE DONE 3,w
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
D-v P,
Ar,11-1,1V?0w Ica -
VALUATION $ Description FEE
Description FEE
__ T
+ lnug:��li &r7il I
E %
HEAT SOURCE GLAZING % LOT SLOP
PLAN CHECK NO: V S DATE e
�E TF D I�L
t111hIZ- J,)
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 1BO DAYS
PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
§ IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M 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
9 DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.0
2:1 NOR LIMIT_
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 COMPENSATION INSURANCE AND RCW 18.27.
DATE SIGNED/
S GNAT`61V OR AGENT)
.1 ". - - -
�jBuilding
bi n
Plumbing
u g
Mechanical
Grading
Recordiing Fee
X.
C
Engr. Review
City Surcharge
Engr. Inspection
State Surcharge
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
10/01
Traffic Mitigation
Fire Review
Fire Inspection
Landscapeinsp.
CALL
FOR INSPECTION
(425)
771-0220
EXT 1333
771-0221
FAX
Plan Chk Deposit tu t/
Receipt #
Total Amount Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by Ilia
Building official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFI�ICI�LS SIG �RE DATE
L
RELEASED BY DAT9
U Ild".'ri
ORIGINAL - FI YELLOW - ASPEdTOR
PINK��ZNER GOLD -ASSESSOR
z
0
i
0
M
-n
X
M
M 0
0
10
0 C
--j K
M M
M Z
C) --I
C _z
0 -n
n;u
>
M M
0
0
0 M
Cn
Cn
M C)
Z 17-
4
z
Cn
z
0
i
0
ITI
I
im
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PUASE SIGN
—ENGINEERING DIVISION DATE /03—
PLEXSdSIGtZ-_
PLANNING DIVISION DATE
PLWE SIGN
PROJECT
2� �-W -7 69 tz
SITE ADDRESS —
PERMIT# 4 —(c4, ADB# DATE INSPECTED I-e 1�e tle S-
DESCRIPTION OF WORK TO BE INSPECTED Ke -IW'g
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
El Copy of CONDITIONS given to owner/contractor by inspector
1 1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 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:forms:ocaprv1 3/25/04
z
0
M
--i -n
0 M
C
M 0
0
-10
0 C
x M
M Z
J0
C
Cn
o -n
-n ;d
-4 >
a: 9
M M
0 _Cn
0 r-
0 M
C Cn
9 Cn
M 0
Z
M
z
Cn
z
0
1
0
M
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
7
FROM: FIRE DEPARTMENT DATE_1� —3 —6-0—Y
lo, Lrrl:A.sr MGM-
z
0
ENGINEERING DIVISION DATE i
PLCASE SIGN 0
M
PLANNING DIVISION DATE—
PLEASI! SIGN
Fn
PROJECT /'-/L[ZC, /�X( CIL14- OM
co
M0
SITE ADDRESS'V� —7 C.)
00 1 0 C
M
PERMIT# 12.,o o DB# DATE INSPECTED M Z
�A g) --i
C
DESCRIPTION OF WORK TO BE INSPECTED7
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
PERF ORMANCE 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 - OUTSTA114DING ISSUES
0 Copy of CORRE CTION NOTICE given to owner/contractor by inpector
I .
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:teti113:b1dg:forms:oca13rv1 3/25/04
Cn
0 -n
_n
M M
0
0
0 M
C U)
9 Cn
Q 0
Z
z
z
0
I I
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:
GasTest ....................
Gas Piping .................
Equipment ..................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
d,j
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
z
0
11
0
M
q