20050863.pdf(q?01
DATE RECEIVED q I [PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER n7� 03
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APTP
N R ANJEINA OE OF BUSINESS ADDRESS *;6 4 V6 �51- —
PLAT NAME/SLIBDIVISION NO. LOT NO. LID No.
MAILNG ADDRESS LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved E3
o �2?(�' 7 RW Permit Required
57 5W Street Use Permit Requited 13
tITY z ZIP TELEPHONE EXISTING PROPOSED inspection Required 0
Sidewalk Required 0
underground 0
REQUIRED DEDICATIA FT,., Winnq requited E3
NAME METER SIZE 0 LINgqlZ "ORV REQUIRED
NO. OF FIXTUFI�S`
NOO g
1EAN_v Ytw;� W
Lu L4 WEu
ADDRESS REMARKS z
OWNERICONTRACTOR R&04�lje R' �ANAI;Nfk&O�Mgb
U Arr a
ff
CITY ZIP TELEPHONE WATER mpz,,,
1110SE� B113 W -"' 4" '11H REA40VED p,
I ITH AVB INSZI; 0
')UA4P ' �tzu
NAME BL# AT APPROvED rjrlh4p
IC D-Af P ONLY
do 69M 64 ENGINEERING REVIE"WiR DeNIOLITI
0: ADDRESS 0 CHECKLIST ON ON INSPEMON
2 BAr
U EQR Qra Iftle-0
FIRE REVIEWED BY 1LARD
CITY ZI TELEP HONE
z
P
a I
U 77& ZZI
VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
STATE LICENSE NUMBER EXFr1RATION DATE BY REO'D 01 COMPLETED I EXEMPT
1 10 YES CI N
041 CQ,<-- 6 CAN ZONE SIGN A EA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
4 WAIVER ALLOWED PROPOSED ALLOWED ., PROPOSED
:1
)Y
W STUDY
"I"JO 02 (X�)41 2J000 I I i
RESIDENTIAL PLUMBING I MECH LOT COVERAGE REQ IRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
NEW 11 ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR 0
COMMERCIAL COMPLIANCE OR z
ElADDITION z
MIXED USE El CHANGE OF USE z
5
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL SIGN REO'D I PROVIDED
MULTIFAMILY 11
RE GRADING FENCE
PAIR CYDS ( X FT.) REMARKS
OTHER
DEMOLISH El TANK
GARAGE o RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIREALARM
04
(TYPE OF USE, BUSINESS OR ACTIVITYjkEXPLAqN:
TYPE 0 TRUCTION T OCCUPANT9 -,jr—
P
0: a�� GROU
NUMBER IUMBER OF --- - 1
OF )WELLING SPECIAL 1ASPECTION CONSULTANT OCCUPANT
]NITS LOAD
0 STORIES TCL
DESCRIBE WORK TO BE DONE REQUIRED 13,
REMARKS
z
47 Uo0a
GEOTECH REPORT
BY: L
STRUCTURAL DESIGN
by:
VALUATION
Description FEE. Description FEE
Plan Check State Surcharge
VESTED DATE BuilAINr it City Surcharge
HEAT SOURCF____T LOTSLOPE%
PLAN CHECK NO: Mill Base Fee
(00
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
1: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
2— DONMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
j -
I= SEPARATE PERMISSION. Engr. Review
Ix PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
1U
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Do *APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
uj
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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
E Landscapeinsp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANC
0 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 APP ION 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 Fees are paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided.
IN VIOL;A;T!I4 OF THE LABOR CODE QETHE TATE OF WASHINGTON RELATING TO FOR INSPECTIO .1 j
WORKM S OMPENSATpyk9?A1rCE No RCW 18:27. roF E DATE
J0
S1rGU DATE SIG D (425)
1�271_000 -0220 DATE
It' .01 771 RELEA'3
AtfE TION EXT. 1333
IT IS FUL 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
z
0
M
—n
M
C
M
0
—40
0 C
—4 K
3: M
M Z
C
3:
Coll
0 —n
F1
-4
mc
MM
0 6)
0 171
0 M
C CD
9 Cn
M 0
Z
;0
X
z
0)
z
0
1
0
M
a
FINALPROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMII'COORDINA,roiz,'BUT.fD,ING DIVISION
FROM: F[RE'DEPARTMENT DATE
PLEASI: SIGN
2
JNG DIVISION bATE'l
�A.SE SITM---
z
0
PLANNING DIVISION DATE
rLEASE SIGN
PROJECT
=n
2
OM
C
SITE ADDRESS
M 0
PERMIT 42-0 (2-53-- 6k; (,,:9_dADB1/ DATE INSPECT*ED,:,.
0
C:
K
MM
MZ
DESCRIPTION OF wo,RKTO BE INSPECTED (?:),rl
C Z
r
A Field inspection was conducted to determine compliance with -approved plans. Final ap&oval
55
denotes that there are. no objections from the -above signed Department to :the release of
0 -n
n
PERFORMANCE BONDS and the granting of:
M M
0
GRANT FINAL PROJECT APPROVAL
0 M
C C/)
9 W
Q 0
Z r
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED.
>
z
0 Copy of CONDITIONS given to owner/contra6tor by -inspector.
Cn
z
0
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
M
El Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GIZANT FINALTROJECT APPROVAL
Date Signature
1:temp:b1dg:fonns:ocaprv1 3/25/04
RECORD OF INSPECTIONS