20051140 (2).pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME)NAME OF BUSINESS
MAILING ADDRESS
1 2 E
CITY ZIP I TELEPHIZINE
NAME
ADDRESS
t 17 - I—
P E R M IT
N U_ I MC _B E R
JOI
A 0 _Ss
D R- S
PERMIT EXPIRES
Z�_ ZXI�e t—did-tc-1
PLAT NAME!SUBDIVISION NO. I LOT NO
PUBLIC RIGI IT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
7 7Y
�-�i
"3_3
REQUIRED DEDICATION FT
METER SIZE
LINE SIZE
NO OF FIXTURES
PHONE
CBLP
ADDRESS
'ITY
ZIP TELEPHONF
ATC I W&ffh1Q17 kii UAPPQ EIPIRIT/IN C
ell
I
Mai E&� 7
nROPERTY TAX ACCOUNT PARCEL NO.
A-3
,c-./ 7o
--2z�3 L, &
10 - Uz
NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
XCOMMERCIAL
COMPLIANCE OR
CHANGE OF USE
E]
MIXED USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
E]
GRADING
CYDS
13
FENCE
( X FT.)
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL
ROCKERY
Aig-SPRINKLER
FIREALARM
z
0
P:1 (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN
U
NUMBER NUMBER OF
DWELLING
OF
STORIES UNITS
DESCRIBE WORK TO BE DONE
_94E
HEAT SOURCE I LOTSLOPE%
VESTED DATE
PLAN CHECK NO: llb4r��4
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
'APPLICANT. 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. -
II 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 AUT14ORIZED THEREBY, NO PERSON WILL BE EMPLOYED
OF THE��
IN VIOLATION _r OF THE STATE OF WASHINGTON RELATING TO
'S COMPENP WX CE/
WORKMEN N RCW 18:27.
DATE SIGNED
SIGNA71p,/ NEX
SUITEIAPT#
L�D N
L D ( ELW
T E SCP Appro�vd
13
RW Permit RequiteJ
[3
Street Use Permit Reqwied
C3
lospection Requiled
0
Sidewalk R(quirerl
E3
Unoergiound
El
ftilriq r(iqu,red
0
PRV REQUIRED
YES 13 NO
z
Uj
REMARKS W
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
C)
1 v6l
A) amell&l
ENGINEERING REVIEWED BY DATE
114, q
FIR V ED BY DATE W
it
P.Z 1 1 t1c A9_1 M
fARIANCE OR CU
RELINE OR AD1111
INSPECTION
SEPA
REQ D
Cot. EXEMPT
13YES 13 NO1
CAP ZONE SIGN AREA HEIGHT
WAIVER 13 ALLOWED PROPOSED ALLOWED PIIOPOSFD
1 1
STUDY 13 , I
LOT COVERAGE REQUIRED SETBACKS (FT) SED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR L/R SIDE REAR
z
E
z
PARKING
LOT AREA
PLANNING REVIEWED By DATE
IL
REQ*D I PROVIDED
I
REMARKS
TYPE OF CONSTRUQTION CODE OCCUPANT
GROUP A>1
SPECIAL INSPECTION
CONSULTANT
OCCUPANT
LOAD
REQUIRED MYES
z
R E 1��j/ toi
-0 my).
GE07 ft
BY
STRUCTIIAITVN 4'
1/1 `4_ -7
BY: XrAl tvt
VALUATION 1
$ <z__--
Description FEE Description FEE
State Surcharge
Plan Check
Building Permit City Surcharge
Plumbing BaseFee
Mechanical
Grading
Engr, Review
Engr. Inspection
Fire Review Plan Chk. Deposit
Fire Inspection Receipt #
Landscapelnsp. Total Amt. Due
Recording Fee Receipt #
APPLICATION APPROVAL
This application is not a permil until signed by the
CALL Building Official or his/her Deputy and Feesare paid, -and
recLlpt is acknowledqed in space provided
FOR INSPECTION
OFFICIAl Sl NATURE D /AAT
(425) -�2 1 _'2
771-0220 RELEASED By DATJ(
ATTEN;rIO�O us Al. Ij%3j
OCCUPY A BUILDING OR STRUCTURE UNTIL L
IT IS UNLAWF VC
A FINAY INSPULTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC11110 / IRC110-
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER GOLD - ASSESSOR
z
0
1
0
M
11 -n
X
M
M
0
--I (-)
0 C:
--i K
X M
M Z
0 —1
0 -n
n
M M
0
0
0 M
C cl)
9 (n
M 0
Z
r
z
C/)
z
0
M
MEMO TO:
FROM:
PROJECT
FINAL PROJECT APPROVAL FORM
TO:
DATE:
NG DIVISION
FIRE DEPARTMENT DATE /.0(.
-ENGINEERING DIVISION DATE
PLEASE SIGN
-PLANNING DIVISION DATE
FLEASL SWN
k1fkthWw K,&Af tk & &xam
SITE ADDRESS &MOO-V r -v A
PERMIT# ADB# DATE INSPECTED I
DESCRIPTION OF WORK TO BE INSPECTED AA-Lt-
A field inspection was conducted to determine compliance with -approved plans. Final approval
denotes that there are no objections from (lie above signed Department to the release of
PERFORMANCE BONDS and the -ranting of:
QdZI)GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
Copy of CONDITIONS given to owner/contractor by inspector
I .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of CORRECTION NOTICE given to owncr/contractor by inpector
3.
RE-INSPECTIED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tenip:b1dg:fomis:ocaprv1 3/25/04
z
0
M
0 M
C
M 0
0
--i ()
0 C:
-1 K
r M
M Z
10-1
C:
0 -n
n ;d
_4 >
3: K
M M
05)-
0 r-
0 M
C C/)
K (f)
M C)
Z r-
7-1 M
;U
z
--i
:C
C/)
z
0
i
0
M
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
z
Pier/Porch ................. 0
--I
0
Retaining Wall ........... IT11
Slab Insulation .... I ......
PLUMBING:
M
Underground ............. C
M 0
0
Rough -In ................... __10
0 C
--I
Commercial Final ...... x M
M Z
HEATING:
C: _Z
GasTest ....................
Gas Piping .................
o -n
Equipment ................. -n
3:9
Commercial Final ........ M M
0
0
EXTERIOR SHEATHING
................ 0 M
NAILING .......... C
Cn
FRAMING ........................ Q 0
Z
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation ......... z
Wall Insulation ...........
Ceiling Insulation ....... z
0
SHEETROCK NAILING ...
M
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................