20050572.pdfIZILI IL�L
DATE RECEIVED [PERMIT EXPIRES
4
P
CITY OF EDMONDS N
CONSTRUCTION PERMIT APPLICATION JO
A
OWNER NAME/NAME OF BUSINESS
P
G61 �- d IV 0 J'N (�Aggj
e(-��,2A'TF C4,4 Ptol
'W�
z
MAILING ADDRESS
C9 / 700 Ile /v, P
0':
-
CITY ZIP
TELEPHONE E
do,'rlolik W o
5�- 3L1q-_;e�o1 R
NAME
U
LU
t'-
i
ADDRESS R
0
U
CITY ZIP —]TELEPHONE
NAME
caii__
Fic o (f 6).
E
M
R
U
ADDRESS
Rax 31' a e-
CITY ZIP
F
TELEPHONE
0
u
STATE LICENSE NUMBER EXPIRATION DATE
CHECK"BY
I
FIV6clto�-�PU A/ 6 k -5--
<Ni
-j
PROPERTY TAX Ar 9,yNT_PARCEI_
11k)
W
o600111,01
NEW UkRESIDENTIAL PLUMBING MECH
ElADDITION COMMERCIAL o COMPLIANCE OR
CHANGE
MIXED USE OF USE
REMODEL MULTIFAMILY SIGN
GRADING FENCE
REPAIR CYDS X FT.)
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z
CARPORT ROCKERY FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) E)WILAIN:
IL
A./ Z&V
uj
NUMBER
OF
NUM BER OF
DWELLING
0
STORIES It
UNITS
DESCRIBE WORK TO BE DONE
AJ2 dtJd'
V ?130. P eVaWAjd Apa
/9 1 Z4-Allf &,�Le - h-:?
HEAT SOURCE
LOTSLOPE%
TED DATE
PLAN CHECK NO:
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.
W
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.
U)
OAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE, H EIRS, ASSIGNS AND SUCCESSORS
_j
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
x 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 CONSTRUC-
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'S59ht!ZNSAT�PN,== AND RCW 18:27,
GWNER� AGENT'
-
DATE S)GNED
'711-5-16 5'
I
ERMIT
UMBER
B SUITE/APT#
DDRESS do')
:�� / �W �� — z)
LAT NAME/SUBDIVISION No. LOT NO. LID NO,
LID FEE S
UBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approwtia 0
RW Permit Required 0
Street Use Permit Requited [3
XISTING PROPOSED Inspection Required 13
Sklowalk Required 113
EQUIRED DEDICATION FT Underground cl
Woing required E3
METER SIZ E ZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO 13 z
EMARKS W
WNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDIRAINAGE z
7
W
NGINEERING
IRE REVIEWED BY
DATE w
VARIANCE OR CU SHORELINE ORADB,1 I INSPECTION SEPA
REO'D COMPLETED I EXEMPT
OYES ONO I
:A# ZONE SIGN AREA HEIGH
VAIVER13 ALLOWED , PROPOSED ALLOWED PROPOSED
;TUDY E3
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
z
PARKING LOTAREA PLANNING REVIEWED BY DATE
REQ'D . PROVIDED I I Q.
iEMARKS
SPECIAL INSPECTION
REQUIRE
CONSIJILTANT OCCUPANT
LOAD
REMARKS
:;EOTECH REPORT
3Y:
STRUCTURAL DESIGN
BY:
VALUATION
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
2L),
(2
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or hisiher Deputy: and Fees are paid. and
receipt is - acknowledged i� space provided
ICIALS SIGN TL E
(425)
771-0220 RELE DATE
ATTENTION 7% L 1JJJ
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. UBC1091 IBC110 / IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
0
z
I
z
0
4
0
M
-A -n
Ui -I
X
0 M
C
M 0
0
40
0 C::
M
rn z
C
o -n
n
M M
0 5
0 r- I . I
0 M
C Cn
C CD
M 0
Z
X
> k
z
__q
3:
z
0
0
In'll
FINAL 'OVAL FORM
TO:
-DATE:.
MEMO TO: PERM ORD 0 DING DIVISION
MU—ILD
FROM: —FIRE DEPARTMENT DAT
SIGN
—ENGINEERING DIVISION DATE
z
PLEASESIGN
0
-PLANNING DIVISION DATE,
M
PLEASE SIGN
PROJECT &�tl� r_l�
CD
SITE ADDRESS
C M
M 0
0
0 0
PERMIT # ATEINSPECTE
LL_Ai)B# I&r—
C:
M
—D
M Z
DESCRIPTION OF. WORK TO BE INSPECT
C 2
A field inspection was conducted to determine compliance with approved plans. Final approval denotes that
0 _n
there, are no objections from the above signed Department to the granting f
0
M
Fina, I approval of the described work
M
0
�gr-
0 M
Performance Bonds associated with the project may be released
C CD
go
MO
Z
X
GRANT FINAL PROJECT APPROVAL
x
>
GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
x
55
z
0
—FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0
M
2.
3.
—RE-INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
ocaprvl.doc.l:temp:bldg:fonns6/98
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall..........................
Pier/Porch .................
Z
Retaining Wall ...........
0
ITI
Slab Insulation .........
PLUMBING�
Cl)
M
Underground .......
M a
—40
Rough -in ........ ........
0 0
C
Commercial Final ...
M
171 z
HEATING:
C
>
r
Gas Test ....................
3:.
-Gas Piping ..................
0
Equipment ..................
M
Commercial Final .......
M
00)
EXTERIOR SHEATHING
0 M
NAILING ...........................
C co
0
FRAMING .....................
MO
z r
FIRST FLOOR FRAMING ...
X
INSULATION ...................
3:
>
Floor Insulation .........
Z.
W611 Insulation ...........
3:,
Ceiling Insulation .......
z
SHEETROCK NAILING ...
0
ITI
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................