20041073.pdfDATE RECEIVED
C1W OF EDMONDS
'C"'ONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
CITY ZIP TELEPHONE
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NAME
PERMIT EXPIRES 4-L�
- UbE PERMIT `7
ZONE NUMBER
JOB SUITE/APT#
ADDRESS ZL2 --7..
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PLAT NAMEISUBDIVISION NO, LOT NO. LID NO.
LID FEE S
TESCP Approved 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Roquifed 0
Street Use Permit Raq'd 13
EXISTING - PROPOSED Inspection Required E3
Sidewalk Haquirod E3
REQUIRED DEDICATION— FT Underground
— Wiring required
METER SIZE LINE SIZE NO. 9F, FIXTURES PRV REQUIRE 1)
I I , --I YES E NO 13
t: ADDRESS REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP TELEP HONE
NAME CB�#
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CCI 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.
NEW
RESIDENTIAL
��PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
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REPAIR
GRADING
El CYDS
1:1
FENCE
( X FT,
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL
El ROCKERY
1:1
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN-.,
iM NUMBER NUMBER OF CRITICAL
0 OF /If DWELLI AREAS
M UNITS NUMBERCA--Ct4-_jq
0 STORIES
DESCRIBE WORK TO BE DONE
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HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 111110 DAYS
PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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 CITYS ABIL11Y TO ENFORCE ANY ORDINANCE PROVISION."
FIRE REVIEWED BY DATE
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SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/R Sl )E REAR
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REQ'D ifIDED
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REMARKS
CHECKED BY ITYPE OF CONSTRUCTION CODE OCCUPANT
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SPECIAL INSPECTION AREA OCCUPANT
REQUIRED [] YES 1 5� 1� LOAD
REMARKS ZO
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINALINSPECTION REEQ"D
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VALUATION I
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Description FEE Description
Plan Check 4�4!A I state surcharge
FEE
Building Permit
City Surcharge
Plumbing
(CC) _�
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp-
Total Amt. Due
Recording Fee
--TReceipt
#
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTIIORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITIf CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by the
TION; AND I ClOLING11THE "M UTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid. and
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IN VIOLATION T E Lr,�13QR C )DE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided,
WORKMEN'S COMPENSAIPN'INSU ANCE AND RCW 18.27.
4su�E OFFICIALS SIGNATURE DATE
SIGNA E (OWNER 011,kTl�� DATE SIGNED (425)
7 771-0220
ATTENTION EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBCl09/IBC110/IRCI10.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
RIGINAL - FILE/ YELLOW - INSPECTC
PIW EA GOLD -ASSESSOR
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OTTO ROSENA U & ASSOCIATES, INC
CONSTRUCTION INSPECTION REPORT
Job Number:
Permit Number:
WWWAIROW, RV-11MAK" ISAR,
Project:
—'-M "12421-4-MR., �411"�"t.'V�"�-�l
Client:
Address: 77-1.
Address:
Date: Inspector: /t7r— f�"/
--C,071 YA
Reinforcing Steel
Installation of Holdown System
Structural Steel Fabrication
Anchor Bolt Installation
Seismic Tie Installation
Structural Steel Erection
Epoxy-Gro,uted. Anchor Bolts
Lateral Wood
Steel Decking
Epoxy Grouting (Rebar) Spray-Appl.led Fireproofing Other (specify)
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Is this a re -inspection? y s
Original inspection date:
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Inspected by. -------Review-qo by: . . ...
Start Time: Finish Time:
This report applies only to the items tested or reported and is the exclusive property of Otto Rosenau & Associates, Inc. Reproduction of this report,
except in full, without written permission from our firm is strictly prohibited.
Page of
6747 M.L. King Way S., Seattle, Washington 98118 — Phone (206) 725-4600 or 1-888-OTTO-4-US — Fax (206) 723-2221
Form No.: INSP-63-02 (Rev 05104)
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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
M7-
3 -1
OCCUPANCY ..................
Zoo qow 10 73 l000"'
Tile Initials Ware Milton
Thontipson, a temporary contract
inspector for tile City.
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