20050293.pdfDATE RECEIVED PERMIT EXPIRES
PItRMIt
CITY OF EDMONDS NUMBER �17�
CONSTRUCTION PERMIT APPLICATION JOB SUITEiAPT#
ADDRESS
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OWNER NAMEjNAME OF BUSINESS
PLAT NAMEiSUBDIVISION NO. LOT NO LID NO
MAILING ADDRESS I LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPAPP(0�ed
All e, RW Permit Required -d [3
Street Use Perreet Requirtu [3
CITY ZIP TELEPHONE EXISTING '0'0' PROPOSED Inspeciton Required
SgiaAalk Required A;f
'7 FT unaergi,aund E3
4[-(; IV 4:1 REQUIRED DEDICATION — Wring required
NAME METER SIZE LINE SIZE NO OF FIXTURES PRV REQUIRED
YES 13 No C3
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ADDRESS REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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CITY ZIP TELEPHONE
NAME CBL9
ENGINEERING REVIEWED BY DATE
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ADDRESS
-5 2-1 7 Ae, ldi,4
71RE REVIEWED BY DATE LU
CITY ZIP TELEPHONE o:
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VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
STATE` LICENSE NUMBER EXPIRATION DATE CHECKED By REQ'D COMPLETED I EXEMPT
IV Al /I C T___ r 9& 5P 2- 017 1 MYES 13NO
CA# ZONE SIGN AREA HEIGHT
PROPERTY ACCOLINT PARCEL NO. I
WAIVERO ALLOWED , PROPOSED ALLOWED , PROPOSED
tii? nel r 7 6 7 /) r) 0 1 STUDY [3 1
NEW %;)�ESIDENTIAL PLUMBING I MECH LOTCOVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT)
dli% ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR C)
[7 COMMERCIAL COMPLIANCE OR z
E] ADDITION z
1:1 MIXED USE CHANGE OF USE I z
PARKING LOTAREA LANNING REVIEWED BY DATE
El REMODEL 1:1 MULTIFAMILY SIGN REQ'D I PROVIDED P
GRADING FENCE
REPAIR 1:1 CYDS x FT.) REMARKS
E] DEMOLISH 1:1 TANK
_�OTHD a (lov,
GARAGE Ei RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIREALARM
(TYPE OF USE, BUSINESS OR IVITY) EXPLAIN:
�M CWTr U C T I OCCUPANT
IT IC-11le I GROUP
41 11 1
NUMBER NUMBER OF
OF eZ_ DWELLING SPECIAL INSFIECTION CONSULTANT 6CCUPMT
STORIES UNITS 2, REQUIRED 13YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOTSLOPE% VESTED DATE
L Building Permit City Surcharge EL
PLAN CHECK NO: Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
E DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Engr. Review
u
L PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
A D SUCCESSORS Fire Review Plan Chk. Deposit
n 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 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
Landscapelnsp. Total Amt. Due
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.'
Recording Fee Receipt
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 This application is not a pornet until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his1her Deputy: and Fees are paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY , NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSAT!PU4,NSURANCE AND RCW 18:27. OFFICIA�S SIGNATURE DATE/
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SIGNATURE (0 NE DATE SIGNED (425)
W __ I x",
RELEASED BY DAfE
771-0220
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE - YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. uBC109 / IBC110 / IRC110. PINK -OWNER GOLD - ASSESSOR
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
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FINAIL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
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ENGINEERING DIVISION DATE— 0
PLEASESIGN 0
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT 0M
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SITE ADDRESS 0
PERMIT 4 1 -- . ADB# DATE INSPECTED 2-
DESCRIPTION OF WORK TO BE INSPECTED\
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 tile release of
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 4: * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * *
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpcctor
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date SignatUre
1:tei11p:b1dg:rbrtw:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATIO�:
Footing ......................
Wall..........................
Pier/Porch .................
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Retaining Wall ...........
0
Slab Insulation ..........
0
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PLUMBING:
Underground .............
Rough -in ...................
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Commercial Final ......
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0
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HEATING:
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Gas Test ....................
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Piping
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Gas .................
Equipment .................
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Commercial Final .......
EXTERIOR SHEATHING
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NAILING..........................
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FRAMING ........................
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FIRST FLOOR FRAMING ...
Q 0
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INSULATION ...................
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Floor Insulation .........
Wall Insulation ...........
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Gelling Insulation .......
SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................