20050725.pdf9
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
Al 4R< OL—Fe —1c— c Ili
MAILING ADDRESS
(-� (v �� Ave 5iiw( t-Te—
CITY ZIP TELEPHONE
E-D ln�l D rJD_S 9�z)_o f
NAME
14A
ADDRESS
NAME
�/ 1i
ADDRESi
CITY
STATE LICENSE NUMBER
CBL#
DATE I CHECKED BY
PERMIT EXPIRES
'PERMIT
NUMBER C,,
`7
JOB
SUITE/APT#
ADDRESS
PLAT NAMEISUBDIVISION NO.
P
LOT NO,
LID NO
I
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApp(aved
RW Permit Required
E3
a
street use Permit Required
13
EXISTING PROPOSED
Inspection Required
13
0
Sidowalk Required
C3
REQUIRED DEDICATION FT
_FNE
_rPRV
undergiound
witina required
C3
METER SIZE
SIZE
NO. OF FIXTURES
REQUIRED
I
YES [3 NO13
z
-W
R
REMARKS
OWNER)CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
W
z
0
z
Lu
PROPERTY TAX ACCOUNT PARCEIL NO.
El NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
0_�C, OMMERCIAL
COMPLIANCE OR
MIXED USE
CHANGE OF USE
REMCDEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
( X FT.)
1:1 DEMOLISH
El
TANK
OTHER
GARAGE
RETAINING WALL
FIRE SPRINKLER
ALARM
CARPORT
ROCKERY
FIRE
(TYPE OF USE, BUSINES RACTIVITY) PLAIN:
AO
Moo 1,
NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS
BCS"rj,;:-&5 3,c�L10
2,, "2,5. Viiiiiii! a �A g!"A 6.-(\J
HEAT SOURCE I LOTSLOPE%
PLAN CHECK NO:
An, <:- I - -
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 i9.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
OAPPLICANT. 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. -
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 F.DGE4)t THE STATE OF WASHINGTON RELATING TO
WORKMEN is POMPEN SA
JJWSURANCYAND RCW 18:27.
DATE SIGNE
?, I i 0 1
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
VARIANCE OR CU
CA# I
WAIVER
STUDY
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D PROVIDED
REMARKS
TYPE OF
SPECIAL INSPECTIO]
REQUIRED 13YES
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
LandscapeInsp.
Recording Fee
DATE
DATE Uj
Ir
SHORELINEORADB#
INSPECTION
I SEPA
pfcItmi,rl
"F
REQ'D
I OYES 0 NOI
COMPLETED EXEMPT
I x
ZONE
SIGN AREA I
HE IGHT
E5C,
ALLOWED I PROPOSED
17,10
ALLOWED PROPOSED
I:V1015 1<1101aball
REQUIRED
SETBACKS (FT.)
PROPOSED
SETBACKS (FT.)
FRONT SIDE REAR
FRONT L/R SIDE REAR
CD
NIA—
w /A-
z
LOTAREA
PLANNING REVIEWED BY
DATE
."�
I 1A4,4nX,4xM .
02rl I & /
CONSULTANT
CALL
FOR INSPECTION
(425)
771-0220
OCCUPANT
GROUP 0—
OCCUPANT
LOAD
FEE
Description
,0
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
12
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his1her Deputy and Fees are paid. and
receipt is acknowledged in space provided
Fic[ALS SIGNATLAE DATE
ATTENTION ' / / I t: A L '11 .5,5 .5
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
I
E YELLOW - INSPECTC
'R GOLD - ASSESSOR
C4
0
z
z
0
4
0
M
0 M
C
M
0
40
0 C
-4 K
M M
M Z
jr) 11
C —Z
o -n
n
M
0
0
M
0
Z
.-IT
X
z
z
0
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DAT E z
PLEASESIGN 0
PLANNING DIVISION DATE 0
(fi-VVVK I - M
U PiIASESIaN
PROJECT A2_1L- TgCV1V1 0 9!A �!3 yj P e, rrei 05-
M
C 0
SITE ADDRESS— (o I Q �5 1-H A-4 6 iel 13� M 0
-10
0 C:
PERMIT# I-005—D-i7-5 ADB# DATE INSPECTED 0 K
M
M z
(o'D" nGq'1-NiLAMi n eite JO --i
DESCRIPTION OF WORK TO BE INSPECTED WrAll (2 d) C -Z
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 the release of
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GIANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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:bldg: forms: ocaprvl 3/25/04
cl)
0 _n
n X
__q >
x 9 !1�
M M
0 &5
0
5 'M
C U)
9 Cn
M 0
Z
z
U)
z
0
M
RECORD OF INSPECTIONS
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
NAILING..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Coiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
z
0
A
0
ITI
-4 -n
M
ITI 0
0
0 C:
M
ITI z
K) 4
C
Cn
0 71
n
M M
0
0
0 M
C Cn
90)
M 0
Z
z
--I
:E
(1)
z
0
1
0
ITI