20050160 (2).pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWyFjl N/AM /NAME OF 0 iINESS
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MAILING ADDRESS
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CITY ZIP IIELEPHONE
NAME v
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� ADDRESS
CITYZIP TF.LEPHO E
2�.
PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
.JOB SUITE/APT#
ADDRESS ��
PLAT NAME/SUBDIVISION NO. LOT NO, LID NO.
LID FEE $
OP
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PerApproved L1
RW mit Required Q
Street Use Permit Req'd
EXISTING PROPOSED Inspection Required E3
Sidewalk Required 0
REQUIRED DEDICATION_ FT __ Underground
wiring required CI
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED W
YES ❑ NO O =
Cc
REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE Z
ull
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CBL #
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ENGINEERING REVIEWED BY
FIRE REVIEWED BY DATE W
CITY ZIP TELEPHONE
jCM Ilk30 LL
STATE LICENSE NUMBER EXPIR TION DATE CHECK g VARIANCE OR CU SHORELINE OR ADB# �I0YESNSPEO'D ONO CTION BOND
/ % �L7 — 'lJ' ES POSTED
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCQ ACC
`NT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP /V `
❑ NEW ❑ RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMPLIANCE OR
❑ ADDITION COMMERCIALE3CHANGE OF USE N�' 5 �' •5/17 45 z
PARKING LOT AREA PLANNING REVIEWED BY DATE n
REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
GRADING FENCE M 4
❑ REPAIR ❑ CYDS ( X FT) REMARKS f 6
❑ DEMOLISH ❑ TANK ❑ OTHER
GARAGE RETAINING WALL FIRE SPRINKLER ldk
❑ CARPORT ❑ ROCKERY ❑ FIRE ALARM
(TYPE Of.USE,j BUSINESS OR ACTN EXPIN',,
CHECKED BY TYPE OF CONSTRUCTION 1CO OCCUPANT
GROUP f�-�
NUMBER NUMBER OF CRITIC / 1
OF DWELLING AREAS SPECIAL INSPECTION JAREA
OCCUPANT
STORIES UNITS NUMBER 3 — REQUIRED [:]YES ( LOAD
DESCRIBE WORK TO BE DONE
REMARKS _
a�/��/(�y���///� ///A/■. • .l. /� A /�►///� //�� PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REDID 9
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T Q ✓ VALUATION
Ijj-Nczjz�z 44A_ u)rcayDescription FEE Description FEE
u CG Plan Check State Surcharge ±0
HEAT S CE GLAZING % LOT SLOPE %
Building Permit t5 r City Surcharge
PLAN CHECK NODVESTED DATE Plumbing Base Fee
4040 l'
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
C BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Gradin
i DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
F SEPARATE PERMISSION.'
Engr. Review
PERMIT APPLICATION: 180 DAYS
W PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr, Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
"' 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Q EDMONDS, WASHINGTON• ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
= FROM THE ISSUANCE. OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landsca a Ins Total Amt. Due
S DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE p p
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt # r
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
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- CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VIO ON OF THE LA13 R CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided.
WOR NF COMPENSA lb INSURANCE AND RCW 18.27.
OFFICIALS NATURE:j
DATE
SI ATU7 DAT SI NE•D (425)
(J/) ✓ `� 771-0220 REI�EAfiEDgBY / DATE
A .. ENL2N � / EXT 1333 71 / Z.---
IT IS UNLATO USEOR OCSUPY A BUILDING OR STRUCTURE UNTIL l/ '/� 12A FINAL INTION HAS BEEN MADE AND APPROVAL OR A CERTIFI oRlcwL • FI YELLOW - wsPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK • R GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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Occupancy/Load established by this certificate:
A3 / 44
I.
Units: NA
No.
Stories: NA
Type of Construction: Concrete Patio
Basement: NA
Occupancy/Load established by this certificate:
A3 / 44
Dwelling
Units: NA
No.
Stories: NA
Type of Construction: Concrete Patio
Basement: NA
Owner of Building Restaurants Unlimited Address: 81;15 -Lake Ballinger'Way
The Scofts Bar and Grill Patio has been inepecfed and approved.as compiyingh'with".the requirements of the 1997 Edition
of the Uniform Building Code as adopted by the City for the 'gcoup'and division of occupancy and the use for which the proposed
F occupancy is classified.
I
Issued this 6th day of May 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.
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