20050342.pdflvqltale
DATE RECEIVED "q
;L PERMIT EXPIRES
c
CITY OF EDMONDS NUMBER '31
JOB -.SUITE iA P
CONSTRUCTION PERMIT APPLICATION 1ADDRESS
OWNER NAME/NAME OF BUSINESS'
MAILING ADDRESS
LV/11'
CITY ZIP TELEPHONE -
ADDRESS
ZIP
NAME iv CBL#
ADDRESS _j
-7,1',12 (2 L5�7
CITY ZIP ELEPHONE
-7 75%
STATE LICENSE NUMBER CHECKEDE1
L 1�
1.16t_ 9(1 t N (�o
PROPtRTY TAX ACCOUNT PARCELJqO,
0040 10 1 bO 6
NEW RESIDENTIAL PLUMBING / MECH
ADDITION COMMERCIAL COMPLIANCE OR
MIXED USE CHANGE OF USE
REMODEL MULTIFAN11LY SIGN
GRADING Ei FENCE
REPAIR CYDS X FT.)
13 DEMOLISH TANK OTHER
IGARAGE Ei RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY El FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN�,
'A I A . L I -
NUMBER NUMBER OF
OF DWELLING
UNITS
STORIES
DESCRIBE WORK TO BE DONE
LOTSLOPE%
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 PUBIC
DONMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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 INFORMATION
6APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESSORS
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. -
PLAT NAMEiSUBDIVISION NO. LOT NO LID NO�
I LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved
RV4 Permit Reouired
'ttktl tTb'PVHW �equifed
EXISTING Q
(f 2 Insoodion Run irf I
IJP EDt0_t
in -ad 1811 e<
Lindatitiound
REQUIRED E E IV
F
OFT P V
ETFR
_ S12
MET _R S12 i FI�E�IZE :IIXRTVRTE PRV REC JIRED
fT 0
US expan n t0a n � x7sh a I �,, [3
4� S NOO
SIBLE FOR EROSION CONTROUDRAINAGE
PURSUANI'TO UPC 608
ENGINEERING REV#V%tMM REGULATO RIVALVEIPRV)
SHALLRELNSTALLED NEAR
1,
FIRE REVIEWED By DATE
VARIANCE OR CU SHORELINEORADB# I INSPECTION 1. SEPA
T007 OMPLETED I EXEMPT
GAS PIPE TES b ff- _
0
z
z
F3
z
w
uj
cc
X
CA# CAB
EM) 0
jjjItfjAjr#j)F- LIP
I I '10E I (_�H T
WAIVERO
rAFFIDAVOO"MORT
A�
OwE PROPOSED
STUDY 13
I
LOT COVERAGE
RECfl&
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FFMNT
REAR FRONT URSIDE REAR
I
!I
z
I
z
PARKING
LOT AR
PLANNING
REVIEWED BY DATE 1z
REQ'D , PROVIDED
IL
REMARKS
IMW WHERE METAL W*TM-- S'E.rtVIC
GEOTEIHIM,f
INC ALS (MUP
BY: ;' SHALL BE OF Lf !'*I,- M,-M,-* "�f
STRUC 4st) A STATE ELE-C71-P.11CAL F-11 rZ.%11T
BY: Q;Na Ch `1 ; I �
A'3 f) tv ft:EeT ftlk'
VALU 16
1 $ Z-OUN ING 1-9
Des ipto-n-7
J V:
P I a InelK, J V i
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recordina Fee
Ij- IL) 11� A I ) li L. U I- k I ;-�
LAff�D,rZ&,fl'WiiiAi L"L-E
TA7415-2��f�aWurcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
i
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 permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building official or his/her Deputy and Foes are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
�,,MC nC TUC -!TATE OF WASHINGTON RELATING TO 9: If`% P 1N4ZP1=rT1('1Kl receipt is acknowledged in space provided
IN VIOLATION OF ME I-ABOR
WORKMEN'S COMPENS714h�=NC� AND RCW 18:27. DATE S�IKED OFFICI
SIGNATUR 425)
(2 771-0220
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-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
: A"
I Ob
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
z
0
i
0
M
11 -n
M
C
M 0
0
0
0 C=
M
M Z
rt) -1
C _z
0 -n
n
MM
055
0 r-
0 M
C (n
M W
Q 0
.z
X
z
__4
M
(1)
z
0
__q
F5
M
I
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASESIGN
DIVISION DATE
ENGINEERING
z
PLEASP SIGN
0
PLANNING DIVISION DATE
0
M
PLFASI: SIGN
PROJECT
Fn
OM
M0
SITE ADDRESS
0
PERM �ADB# WSPECTED_i�/,L
IT it
0 C:.
M
___�DATE
M
M Z
DESCRIPTION OF WORK TO BE INSPECTED
z
A field inspection was conducted to determine compliance with approved plans. Final approval
th r
denotes that there are no, objections from the above signed Department to, e elease of
0 -n
-n;u
PERFORMANCE BONDS and the granting of:
M M
0 in
0
GRANT FINAL PROJECT APPROVAL
0 M
Cn
9 Cn
Q 0
Z r
X
M
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
z
0 Copy of CONDITIONS given to owner/contractor by inspector
z
0
FAILED FINAL INSPECTION - OUTSTANDING. ISSUES
0
M
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
.2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbrms:ocaprv1 3/25/04
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .......... ..............
Wall...........................
Pier/Porch. ...............
Retaining Wall .........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping ....... ..........
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
.......................
'WAM'ING.: ... . ....................
—FIRST FLOOR FRAMING,...
ISLLbA 10t)k ... of .... . . %.
Floor Ura)'! ...
Wall lns5l�tlon 4* ---
Ceiling Insulation
SHEETROCK NAILING
f
SPECIAL INSPECTION
7
MI§CLL4NE`O'U'-S ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
FIR
z
0
1
0
M