20000408.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PLAT NAMEJSUBDIVISION NO,
LOT NO,
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PUBLIC RIGHT OF WAY PER OFFICIAL
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EXISTING � PROPOSED—
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REQUIRED DEDICATION—
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FIRE REVIEWED By DATE
CIT Zip
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s LICENSE NUMBER EXPIRATION DATE CHECKED By
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ALLOWMED PROPOSED
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REQUIRED SETBACKS (F-n
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ALL ED PROPOSED
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0 REMODEL 0 APARTMENT 0 SIGN
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REMARKS
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PLAN CHECK NO:
PLUMBING
MECHANICAL
THIS PERMIT AUTHOR"" 1"I THE WORK NOTED, THIS PERMIT COVERS WORK TO
BE .. E ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN 'CUR., SIDEWALKS, DRIVEWAYS ETC.) WILL REQUIRE
SEPARATE PERW,MARQUEES.
SSION.
STATE SURCHARGE
PEMIT APPLICATION: 180 DAYS
PER
IS
PERMIT LIMIT'. I YEAR 'PRoV`DEDWORK STARTEDWITHIN 180DAYS
ENE. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIFS� ASSIGNS AND SUCCESORS
IN INTEREST AGREES TO �NDEMNIFY� DEFEND AND HQLD HARMLESS THE CITY OF
LANDSCAP N
G G. H NTS FROM ANY AND
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EDMONDS, WASHINGTON, TS OFFICIALS. EMPLOYEES, AND AGE
INS PECTION FEE
ALL.".S E C RECTLYORtNDIRECTLY
OR A.B. E
NOT BE
RECEIPT
FROM THE I S OF T PE IT, SHALL
E I'... )FANY C TYORDINANCE
.
PLAN CHECK DEPOSIT
HIDINANCE PROVISION
TOTAL AMOUNT DUE
AllEIlT
<-XI
ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION Arr
I HEREBY
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY A THORIZED AGENT OF
THE OW BEE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
DYED
CALL
d`9 o
TION D D G THE WORK AUTHORIZTED EREB OPERS N LL BE EMP
it YN.ASHIo `AN RE LATING TO
OF NGTO
FO R INSPECTION
IN AT N THE LADD Coo' OF H STATE
,
R E ' PENSAT I uRANCE A RCW 18.2T
FICIALS SIGNATU DATE
T (OWNER 0 GEN DATE SIGNED
(425)
-2
o E
771-0220
A EASED By
EXT 333
ENTION
ITS UNLAWFULTO USEOROCCUPY ABUILDINGOR STRUCTURE UNTIL
771-0221
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE - YSLLOW -INSPECTOR
A FINAL
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
FAX
PINK � OWNER - GOLD � ASSESSOR
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Project Review Checklikt;:�
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ProjectName:
ProjectAddress: Sk (,�W
Receipt Date:
T—
Underground Wiring Required
Hydraulics Permit
Plat/Subdivision Requirements
Street Dedications
Easements - Public/Private
Engineering Storm Drain Review Feel
Engineering 2.2 inspection Fee
Drainage Plan (On -site)
Setback.w Storm Drain Line
Open Ditch - Existing
C�dvert Required
culvert Size
Shoulder Drainage/Shale Open Runoff
Catch,Basin Required
Driveway Slope & Vehicle Access
Sidewalk Required
Curb& Gutter Required
Curb Cut for Driveway Required
street Paving Required
Right -of -Way Constructi on Permit Required
",Bond Required for Public Improvements
FEMA Map Check/Water Table
Side Sewer Availability
Calculate Sewer Fee if No LID#
Water Meter Size
Water Meter Charge Required
Hydrant Required
Street Cut
Miscellaneous
RW Pertnit # Date Issued
Receipt#
SS Permit # Date Issued
Receipt#
Meter Size Paid$ Date
Receipt#
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FINAL PROJECI APPROYAL FORM
TO:
DATE: —
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: DEPARTMENT DATE—
M-, R _ENGINEERING DIVISION DATE �M-1211,C,
PLANNING DIVISION DATE—
PROJE
SITEADDRESS.
-1 (-Q ADB#
PERMIT# —QWS ---------DATE INSPEC (Jo
DESCRIPTION OF WORK TO BE INSPECTED----�l
rmin iance with approved plans. Final approval denotes that
A field inspection was conducted to dete e compl
there are no objections from the above signed Department to the granting of:
approval ofthe described work
_____---Yerfbrrnance Bonds associated with the project may be released
L_GRANT FINAL PROJECT APPROVAL
�—GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
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_FAILED FINAL INSPECTION -1 OUTSTANDING ISSUES CxF(6D-
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GRANT FINAL PROJECT APPROVAL
_RE -INSPECTED OUTSTANDING ISSUES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
wall..................
Pier/Porch
Retamirig Wall ...........
Slab Insulation ..........
PLUMBING:
m
Underground .� ..........
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Rough -in ..........
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Commercial Final
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Gas Test ...............
Gas Piping .................
Equipment ..............
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I Commercial Final
EXTERIOR SHEATHING
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NAILING .............. ...........
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FRAMING ........................
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FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
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SPECIAL INSPECTION
MISCELLANEOUSL
FINAL APPROVAL FOR
OCCUPANCY ..................
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CITY OF EDMONDS
NUMBER -
CONSTRUCTION PERMIT APPLICATION JOB
-iMbo-7
2 2 Sl S10'
OWNER NAMEINAME OF BUSINESS
el-1v-1
PLAT NAME/SUBDIVISION
40� I LOT 10, I'D NO
'0 LOT NO
. ............
"EID FEE $
'1EID 'E'E $
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.... p "p' 0
OFFICIAL STREET MAP ReY n "d -
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
n"..' _ ---d 0
0
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EXISTING
REGU,.�.
PC C_
PROPOSED
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0
UM
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PRV .
NO. OF FIXTURES PRV REQUIRED
NAME
METER SIZE
LINE SIZE
YES 0 NO 0
REMARKS
OWNERICONTRACTOR
RESPONSIBLE 1.11 EROSION CONTROUDRAINAGE
CITY
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NAM;:�,
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STA E LICENSE NUMBER EXPIRATION DATE
CHECKED By
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......
SIGN AREA
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HEIGHT
p7jV?CCOUNT .1FLN..
PLIII I
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REQUIRED SETBACKS (Ft)
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LUMBING t MECH
ALLOWED PROPOSED
FRONT SIDE REAR
0 ADDITION
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0 COMMERCIAL
o COMPLIANCE OR
CHANGE OF USE
LOTAREA
DATE
REMODEL
0 APARTMENT
0 SIGN
REO'D
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0 REPAIR
0 DAIIIN. Cy., I INCE X IT)
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CODE ROD
NUMBER
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NUMBS R
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LOAD
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MECHANICAL
TH S PERMIT COVERS WORK TO
THIS PERMIT AUTHOR,.S=E WORK 1OTFD I
Y ONEy.jANY NSTRUCTION ON THE PUBLIC
L BE DONE ON PRIVATE .6
REQUIRE
2 WAYS, MARGUEES, ETC.) WILL
M DOMAIN JCURBS, SIDEWALKS, DRIVE
t SEPARATE PERMISSION.
STATE SURCHARGE
L4 S-0
PER PEI T 0 THIN ISO DAYS
MR-Al"1 DAV
BN�`�-SDTA 'W'
�4G. REVIEW FEES
PIT
PE DART LI M I T: I Y EA IT , B E--0
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
A,�T`.',CCES,' S
APPLICANT. ON BEHALF OF HIS OR HER SPOUSE� HER`�LAS"G'S
id INT IT ST. AGREES TO INDEMNIFY. "'E' W. ) HAFM,, C, I
IN
i
LAW NG
E�,VQ. ADAG7
ED pM ANY A 0
a MON'D'S,WASKING'ON T"" AL
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�D.S.CTAP
I. EE
I A LCLAIMSFOfIDAMA.��ol.AT'�'�E'��ATUIIE.A�l�INGI)IIE
. THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
F'R M THE ISSUANCE OF
1 0 CE ANY REOUIREMENTOF ANYCITY ORDINANCE
DEEMED TO MODIFY. WAIVE OR REDD
IR
R;;T
o NOR LIMIT IN ANY WAY THE CITY S ABILITY To ENFORCE ANY ORDINANCE
TOTAL AMOUNT DUE
I DEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
A PLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
AN. STATE LAWS HE GULATING CONSTRUC-
CALL
This Ippn0aell I' 'It I PlInin el signed by -
D-endY: "d F ... Aid pid. end
T y_,T
C -- T.-TITE-WOREL ED THER CYCNO PERSON WILL BE EMPLOYED
,�01E'.�? AUTH.,FC,,y
IN TO
Beilihng Offidmi el tilidn-1
F OR INSPECTION ipt 1. .,d,d..ldd9-d in end. p--d.
B CODE OF TH, WASHINGTON RELATING
T HE STA F
DATE
;&L�AT
MPENS I RANCE A�,
�K EN�W ALTAI
(425)
CIAILSSIGNATUIE,�,
Texv,,-b
DINER EN
DATE VGNED
-
,-, '11, "1, _7
0
6 ,
771-0220
FE�FASI. BY
EXT 333
ENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTI L
771-0221
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIF I
-
ORIGINAL - FILE YELLOW - INSPECTO
A
HAS BEEN GRANTED, LIS C SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
CATE OF OCCUPANCY
RECORD OF INSPECTIONS