20040462.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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CC MAILING ADDRESS
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CITY ZIP TELEPHONE
NAME
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STATE LICENSE NUMBER EXPIRATION DATE CHE
(V.s 7-1 *i 10 _j C j- I e14-
dc PROPERTY TAX ACCOUNT PARCEL NO.
0 0 IS 15"5 3
NEW r5 RESIDENTIAL PLUMBING / MECH
COMPLIANCE OR
E] ADDITION 1:1 COMMERCIAL E] CHANGE OF USE
REMODEL MULTIFAMILY 1:1 SIGN
GRADING FENCE
REPAIR CYDS 11 X FT)
DEMOLISH TANK 01
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY 1:1 FIRE ALARM
I[TYPE OF USE, BUSINESS OR ACTIVITY) EXPLA,lp:
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w NUMBER NUMBER OF CRITICAL
0 OF DWELLING AREAS
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01 STORIES UNITS NU
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DESCRIBE WORK TO BE DONE
HEAT SOURCE
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GLAZING %
LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
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1IL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
In
11 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 INDIREC1LY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMEN I OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABIL11Y TO ENFORCE ANY ORDINANCE PROVISION *
FPERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB SUITE/APT#
ADDRESS
PLAT NAME/SUBDIVISION No LOT NO. LID NO.
L' D N 0
dq C, tj T ff . T-M LID FEE S
/A00, Ali, 16' lit'f- 141 CP
IESCP Approved (3
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW ( it Ritmulmd [3
Street use Permit Roq'd C3
Inspection Required 13
EXISTING PROPOSED----:�� sidewalk Raqvired 131
underground
REQUIRED DEDICATION- FT wiringtriquifad [3
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I YES 0 NO 0
REMARKS
OWNER/CONIHACTO2 RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING
FIRE REVIEWED BY
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DATE
DATE
VARIANCE OR Cu
SHORELIN E OR ADB#
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INSPECTION
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BOND
POSTED
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NO
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SEPA REVIEW
COMPLETE EXE I
SIGN AREA
ALLOWE PROPOSED
HEIGHT
ALLOWED PROPOSED
EXP
,
LOT COVERAGE
REQUIRED SETBACKS JFT)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/R SIDE REAR
PARKING
OT AREA
P� R
DATE.
Rrn'D
I PR7DED
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REMARKS
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CHECKED BY ITYPE OF dONSTRUCT
SPECIAL INSPECTi6N AREA
REQUIRED [] YES 1 4?'0
OCCUPANT
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OCCUPANT
LOAD
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D S
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VALUATION
Description
FEE
Description
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due 1`7
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
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 CONSIRUC- CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27.
OFFICIALS SIGNATURE DATE
SIGNATU7R (OWN I E�.,h)R AGEN-0 DATE SIGNED (425)
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771-10220 RELEAS i DATE
A17ENTION E)ff 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL L r". 4"
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLO,'V. lNoSPECT6R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
FEE
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
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FINAL PR03ECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DATE 0 �3 bzw_�
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FROM:
KFASESIGN
ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE
PLEASESIGN
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PROJECT
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SITE ADDRESS
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PERMIT # ",7004-64U2- ADB4 DATEINSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED OW 1) (A 4,11 M
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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 FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by inspector
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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:ten1p:b1dg:fonns:ocaprv1 3/25/04
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION*
Footing ......................
Wall.......................... ---------------------
Pier/Porch .................
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Retaining Wall ........... 0
Slab Insulation .......... 0
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PLUMBING:
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Underground ............. Ui --I
0 M
Rough -In ................... C
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0
Commercial Final ...... 0
0
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HEATING:
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GasTest ....................
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Gas Piping .................
Equipment ................. Cn
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Commercial Final .......
EXTERIOR SHEATHING M M
NAILING .......................... 0
Z 0
0 M
FRAMING ........................ C C/)
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FIRST FLOOR FRAMING ... rn 0
Z
INSULATION ................... .1
Floor Insulation .........
Wall Insulation ........... z
—4
Ceiling Insulation .......
SHEETROCK NAILING ... z
0
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SPECIAL INSPECTION ... OT 0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR 0
OCCUPANCY ..................