20010729.pdf"WINI DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
MAILING A DRESS
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CITY ZIP TELEPHONE
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NAME
IPERMIT EXPIRES '��
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ADDRESS 34 �64 A ve. (-4j -
FLAT NAMC/SUBDIVISION NO I _OrNO. tL.�D NO,
FEE S
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EXISTING — PROPOSED— oo'P� "'"d
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NAME
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ENGINEERING REVIEWEDIDATE
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ADDRESS
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FIRE REVIEWED By DATE
CITY ZIP
TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE
VARI NCE OR CU
SHORELINE OR ADSo
INSPECTION
REDID
YES §21110
BOND
POSTEC
1
PROPERTY TAX ACCOUNT PARCEL NO
AaEXP
SERA REVIEW
COMPLETE EXEMPT
ION AREA
ALLOWED PROPOSED
0
HEIGHT
ALLOWED PROPOSED
C:] NEW NTIAL 0 PLUMBING I NECK
ADDITION 0 COMMERCIAL c3 C PLIANCE OR
CHANGE OF USE
REMODEL 0 APARTMENT El SIGN
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M DEMOLISH TANK OTHER
n GARAGE 11=TA'11
CARPORT cl R E,1,1,1 WALL 0 RENEWAL
LOT COVERAGE
ALLOWED PROPOSED
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REQUIRED SETBACKS (FT.) PROPOSED
FRONT SIDE PEAS
1
SETBACKS [FT)
FRONT URSIDE REAR
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r ITYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER NUMBER OF OR
OF DWELLING An
0 STORIES UNITS E�
CHErKEDIEY
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[&&nUOTION
OCCUPANT
GROUP
EF. JAREA
SPECIAL IN 6 CT.F
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RE. YES
REQUIRE 0
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LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'
0 v
VALUATION I FEE
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HEAT SOURCE GLXZING % LOT SLOPE %
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PLAN CHECK NO: DATE
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_ IVISTED
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
MECHANICAL
BEDONEO PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
OMAIN (CURBS. SIDEWALKS, DRIVEWAYS' MARQUEES, ETC.) WILL REQUIRE
GRADINGIFILt,
SEPARATE PERMISSION,
PE MIT APPLICATION: 180 DAYS
A. PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG� REVIEW FEES
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
'A PLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
ENG� INSPECTION FEE
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLCIIHARMLESS THE CITY OF
LANDSCAPING
2 EDMONDS. WASHI GTON, ITS OFFICIALS. EMPLOYEES, AN AGENTS FROM ANY AND
INSPECTION FEE
ALL CLAIMS FOR DAMAGESOF WHATEVER NATURE, ARISING DIRECTLYOR INDIRECTLY
FA M THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
"'C"
Y ,
D EMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF AN Cn`YORO1NANC_
PLAN CHECK DEPOSI,
0., NOR LIMIT 114 ANYWAY THE CITY S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,'
RECEIPT
TOTAL AMOUNT DUE
IHEREB ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INP RMATION
GIVEN IS CORRECT. AND THAT I A. THE OWNER, OR THE DULY AUTHORIZED AGENT OF
I AOF jfLk
Puc ION APPROVAL
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
TI'll PoIll.11—1 . o P.—I ."', l'q�oo E, ".
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
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FOR INSPECTION 01PI-110111odg'd P l,ol. p—d-
WORKMEN'S COMPENSATION INSURANCE AND RrW 1827�
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11C NATU OATJ
DAT:��
(425)
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771-0220
1 �j
R"MASEDBY& OAT
ATTENTIOa_
EXT 1333
IT IS UNLAWFULTO USE OR OCCUPY ABUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
'CT.A
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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FINAL PROJECT AP FORM
TO:
DATE:--
M[EM0 TO: PERMTr COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE—
C,�, ENGINEERING DWISION DATE (o o2,
�WN
PLANNING DMSION DATE —
PROJECT
SITE ADDREs�LIZLzP-2— gn�
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PERmrr #o���ADB# DATE INSPECTL
DESCRIPTION OF WORK TO BE INSPECTED—L-� 45
A field inspection was conducted to determine rmal compliance "gi approved plans. Final approval
I ase 'of
denotes that there are no objections from the above signed Department to the re e
PEREORMANCE BONDS and the granting of
--�LGRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
U Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE-INSpECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date Si
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .............
Wall.......... ...............
Pier/Potch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in .............
Commercial Final
HEATING:
Gas Test ....................
Gas Piping
Equipment ....... . ........
Commercial Final
EXTEnIOR SHEATHING
NAILING ..........................
FRAMING ....................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Watt Insulation , ..........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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