20041084.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER EXPIRATION DATE I CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
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PLUMBING / MECH
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Pes�3eY-4141
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NUMBER
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DESCRIBE WORK TO BE DONE
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PLAN CHItCK 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: 160DAYS
PERMIT LIMIT, I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK 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 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 CONSTRLIC-
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 r,�ATION INSURANCE AND RCW 16,27.
DATE SIGNED
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PERMIT EXPIRES If
bSF PERMIT
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JOB SUITEJAPT#
ADDRESS Z I
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE S
I ESCP Approved 13
PUBLIC HIGIT OF WAY PER OFFICIAL STREET MAP RW Permit RAquiled 13
street use Permit Roq'd 0
EXISTING — PROPOSED inspection Requited [3
Sidewalk Required (3
REQUIRED DEDICATION— FT Underground
Wiring required 0
METER SIZE LINE NO� OF FIXTURES PRV REQUIRED
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YES 13 NO 13 1 iE
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REMARKS z
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE I a
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU HORELINE OR ADBI I INSPECTION I BOND
REO'D POSTED
OYES A NO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
V,.:iC) (2 4Ct._"Se_
EXP X
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT IJR SIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATI!
REO'D I PROVIDED
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REMARKS
CHECKED BY ITYPE OF C�N�FRUCTION C9DE OCCUPANT---.�----�
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED LOAD
[:] YES
REMARKS
PROGRESS INSPECTIONS PER UBC 108/IBC109/[RC109 FINALINSPECTION REO'D
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VALUATION
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Plan Check I
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE
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Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit �7 (D
Receipt #
Total Amt. Due
L2
Receipt #
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APPLICATION APPROVAL
I his application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided,
F IS SIG 1URF DATE
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jVAS_FjD BY bATE
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. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL/FILE YELLOW - INSPLICTC
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NOTICE: IF THE DOCUMENT IN THIS FRAME IS LESS CLEAR THAN THIS NOTICE
IT IS DUE TO THE QUALITY OF THE DOCUMENT.
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GARY HAAKENSON
CITY OF EDMONDS MAYOR
121 5TH AVENUE NORTH EDMONDS, WA 98020 (425) 771-0220 FAX (425) 771-0221
Website: www.dedmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning Building Engineering
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April 18, 2005
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Jeffrey Blossey
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1210 8"' Ave South
Edmonds, WA 98020
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Re:. Building Pen -nit: 2004-1084
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Site Address: 1210 8t" Ave. S.
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Expiration Date: 12/28/05
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Dear Mr. Blossey,
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The purpose of this letter is to inform You that the last remaining inspec tion on your
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project is a final inspection(s). The final inspection(s) detet -mines that there are no
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Outstan -ety issues and approval allows tile City to close your pen file.
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The City considers the Final inspection to be one of the most important inspections
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conducted oil a project. In order to grant Final approval tile following must be complete:
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smoke detectors, house numbers, guardrails, handrails, selr-close doors between garage
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and residence, egress from sleeping rooms, safety glazing, weather-stripping, any
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Engineering department requirements etc. Of Course not al I of these things may
specifically apply to Your project but it does give you an idea about the kinds of things
that must be complete as well as some items that do not need to be installed such as:
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paint, carpet, rrioldings, wallpaper, etc. Please be advised per its expir one y ar froi 1
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the date Of issuance. if you will need more time to complete tl e work, permits can be
renewed p im- to expiration ror one hal r fees. I f the pernlit expires without a final
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approval granted by the Building Inspector, full fees are rc quired in order to renew tile
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pen -nit. This can be very costly to You and we strongly encourage you to check Your
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perrnit expiration date and call for tile required final inspcction(s). Note: If more than
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one department is required to Final your Project, this is noted oil your Job Card.
Please feel free to contact me at 425-771-0220 i r You have any questions.
Sincere
IKY
�"ncerc Y'
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ali t
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Incorporated August 11, 1890
Sister Citv - Hekinan, Japan
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
1 "7 -10
Footing ......................
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Wall ..........................
Pier/Porch .................
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Retaining Wall ...........
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Slab Insulation ..........
PLUMBING:
underground .............
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Rough -in ...................
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-40
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Commercial Final ......
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HEATING:
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19 _!9 _e3_5
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Gas Test ....................
Gas Piping .................
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Equipment .................
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Commercial Final .......
4
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EXTERIOR SHEATHING
65
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NAILING ..........................
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fill Ir
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9 cn
FRAMING ........................
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FIRST FLOOR FRAMING ...
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INSULATION ...................
Floor Insulation .........
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Wall insulation ...........
Ceiling Insulation .......
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6,5
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
The fnitials MT are Milton
Thonll)son, a tcIllporary Contract
inspector for tile City.
1� - ( 3-1�� S_
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