20060192.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAM [NAME OF BUSINESS
C'Ory)e-k- co�`Fee,
MAILINGADDRESS
16401 -+(_#T"1 Prvle VV. c3t-e 10-3
CITY ZIP I TELEPHONE
edmond-s '11&0-)(0
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L91 00 1 a T'i" Ave. 5 0 L4 rj'?
CITY ZIP
13 01810e)
TELCF'HONE
STATE LICENSE NUMBER EXPIRATION DATE
grHooD*085GL. R / I / 0 -1-
1 Aii �Gy
PROPERTY TAX ACCOUNT PARCEL NO,
11;�5 / 1919 /5
DS NEW IE�IDENTIAL PLUMBING I MECH
0 ADDITION COMMERCIAL Ei COMPL ANCE OR
MIXED USE CHANGE OF USE
REMODEL rl MULTIFAMILY E3 SIGN
E] REPAIR GRADING cyca FENCE
— X—FT,)
DEMOLISH TANK
R 'jUPPMS
[3 GARAGE RETAINING WALL F RE SPRINKLER
CARPORT OCKERY FIRE ALARM
) EXPLAIN
(TYP;5
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NUMBER
OF
STORIES
RUM ERO'
OW LLING
UNITS
PERMIT EXPIRES —
PERMIT
NLIMBER
IOU SUITEIAPT#
0 1 U T- w
PILAT NAMEISUBDIVISR)N NO, LOT NO LIO NO
L$D FEE
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
S"�
EXISTING PROPOSED
REGUtRED DEDICATION IT
METER SIZE I LINE SIZE I NO OF IU(TURES PRV REQUIRIG
YES Ci o
R MARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED By DATE
'N'
FIRE REVIEWED BY
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DATE
VARIANCE OR DO
ISHORILINEORADBI
INIP11TION
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WAIVER 13
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LOT COVERAGE
BROWSED
SETBACKS ET)
I PROPOSED
SETBACKS ET)
ALLOWED PH ... SE.
FRONT SIDE REAR
I
I FRONT LIP SIDE FEAR
PARKING I
LOTAREA I PLANNING REVIEWED
BY DATE
OCCUPANT
GROUP
SPEOIALIISPICTION I CONSULTANT 11CU T
REQUIRED 13 YES LOAD
REMARKS
GEOTECH REPORT
Descrlptlonj]
FEE
Description
FEE
Plan Check
VPlumbing
State Surcharge
LOTSLOPE% VESTED DATE
Building Permit
Base Fe,
PLAN CHECK NO: _0? L
THIS PERMIT AUTHORIZES ONLY THE WORK NOTE , THIS PERMIT COVERS WORK TO
Mechanical
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY C NSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APP ICATION: SEE ECDC 19,00.005(A)IS)
Engr. Inspection
PERMIT LIMIT. SEE ECDC 10.00.005(A)(6)
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
i
F,e Review
Plan Chk. Deposit
IN * TEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
w N
—
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
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
c DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp.
Total Amt. Due
Ox NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
Receipt Is
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION A PROVAL
TbI
GIVEN 15 CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
TNs aPPIKIIIII 11 wt A P"' �U.. V, In.
THE OWNER. t AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
Oudd,,g 016-1 or h,, D.p.y �rd F..s - p,d, rd
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF TH LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27,
OFFICIALS SIGNATURE DATE
SIGNATURE (OWNER AGENT):
(425)
39 _16i�
TATEs'GNE'
9"J",
771-0220
DATE
ATTENTION
EXT. 1333
:RL
ITISUNLAWFULTOUSEOROCCUPYA BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
ORIGINAL - FILE - YE&OW - ASPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I ISC110 I IRC110.
PINK � OWNER - GOLD - ASSESSOR
10104 PRESS HARD -YOU ARE MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
C- FIRE DEPARTMENT DATES�____�!�)
FROM:
ENGINEERING DIVISION DATE
PLANNING DIVISION DATE—
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PERMIT 13 1_ADB#___________�DATE INSPECTED QC,—
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A field inspection was conducted to determine compliance with -approved plans. Final approval
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denotes that there are no objections from the above signed Department to the release of
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PERFORMANCE BONDS and the granting of:
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tetnp:b1dg:fbnTLs:ocaprv1 3/25/04
Permit Inspection Details
Permit: BLD20060192
PERMITTPA.,�
05104/2006 SMITH 30 APPROVED
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Total Time: 30
Total Inspections:
1 Total Time: 30
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Page I of I
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .................
wall..........................
Pier/Porch .. ...............
Retaining Wall ...........
Slab Insulation
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final
HEATING:
GasTest .................
Gas Piping ................
Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING..........................
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ..............
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR...
OCCUPANCY ...............
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