20050241.pdfFOATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
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CITY
NAME
ADDRESS
CITY
PROPERTY
NEW
ADDITION
REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
(TYPE OF USE, E
OF
STORIES
PERMIT
NUMBER
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ADDRESS
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PERMIT EXPIRES
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PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO,
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LID FEE C,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
0
[3
RW Permit Required
Street Use Permit Required
(3
EXISTING PROPOSED
Inspection Roquifird
[3
Sidewalk Required
0
REQUIRED DEDICATION FT
Underground
(3
C3
Wale"? required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YESE3 N 0
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED BY
DATE
FIRE REVIEWED BY
DATE W
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VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
SEPA
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COMPLETED
EXEMPT
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CA# ZONE SIGN AREA HEIGHT
WAIVER 13 ALLOWED ROPOSED ALLOWED PROPOSED
STUDY 13 1 1 1 1 1
LOT COVERAGE REQUIRED SETBACKS (FT.) ED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR L/R SIDE REAR
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PARKING I LOT AREA= REVIEWED BY DATE :3
_13 MULTIFAMILY SIGN REO'D I PROVIDED
1:1 GRADING FENCE
CYDS 0( X FT.) REMARKS
TANK
OTHER
RETAINING WALL
FIRE SPRINKLER
ROCKERY
FIRE ALARM
TYPE OF CONSTRUCTION
NUMBERbF
DWELLING SPECIAL INSPECTION
UNITS 14,04.1 REQUIRED 13YES
BE DONE I
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Description
Plan Check
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building Permit
PLAN CHECK NO:
Plumbing'
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC `19.00,005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATIO14
Engi Inspection
'APPLICANT, ON BE14ALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD 14ARMLESS 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 ANYWAY T14E CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISIO
Fire Review
Fire Inspection
Landscfapo Insp
4 Recording Foe
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
CODE.. OCCUPANT
GROUP
40M
CONSULTANT OCCUPANT
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FEE
Description
FEE
State Surcharge
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City Surcharge
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Base Fee
W Plan Chk. Deposit
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THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- I
TION: AND IN DOING T14E WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CAL L
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING To FOR INSPECTION
WORKMEN'S COMFIENSAVOVMSURANCE AND RCW 16 21 n,
SIGNAT E (OWNER OR N' DATE IGNIED (425)
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RESIDENTIAL
COMMERCIAL COMPLIANCE OR
MIXED USE CHANGE OF USE
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APPLICATION APPROVAL
This dpplication is nola poutut rifild signod by tire
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IFICLAI NATUNII DATE
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ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL /4.,1 )k;
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAc" fii.F - Y[11t.ow . A'SPICTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 / IBC110 I IRC110. PINK - OWNER - GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM
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DEVELOPMENT SERVICES CTR- DATE:
CITY OF EDMONDS
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE Q
MEASE SIGN
ENGINEERING DIVISION DATE
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PLEASE SIGN
PLANNING DIVISION DATE
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PLEASE SIGN
PROJECT
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PERMIT LQ DATEINSPECTED x—
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DESCRIPTION OF WORK TO BE INSPE C TED
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A field inspection was conducted to determine compliance with -approved plans. Final approval
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denotes that there are no 'objections from the above signed Department' to the 'release of
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PERFORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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0 Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
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RE -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date Signature
1:teMp:b1dg:romis:ocaj)rv1 3/25/04
------ - ----- ------
assesses
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DEPARTMENT OF BUILDINGS
tell,
PER International Building Code Section 110
At: 22828 1 00th Ave W Building Permit#: 2005-0241A
Occupancy established by this certificate: Dwelling Units: IN/A** No. Stories: I
B Type Construction: VB Sprink Basement: No
Maximum Occupant Load **48** (Per IBC 1004)
Room capacity signs, when required, must remain posted at all times.
Owner of Building QFC (Starbucks) Address: 22828 1601h Ave W
THE Starbucks HAS BEEN INSPECTED AND APPROVED AS COMPLYING WITH THE REQUIREMENTS OF THE 2003 EDITION OF THE
INTERNATIONAL BUILDING CODE AS ADOPTED BY THE CITY FOR THE GROUP AND DIVISION OF OCCUPANCY AND THE USE FOR WHICH THE
PROPOSED OCCUPANCY IS CLASSIFIED.
Issued this 6 th day of April 2005
CHIEF BUILDING OFFICIAL
BY:
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This certificate shall be posted In a conspicuous public area and shall not be removed, mutilated o obscured and sha� egible 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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