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ERMIT EXPIRES
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CITY OF EDMONDS
111E
PERMIT
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CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS
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FLAT NAMEISUBDIVISION NO.
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MAILING ADDRESS
D FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL
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CITY ZIP
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FIXTURES
PHI REQUIRED
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YES 0 NO
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ADD ESS
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REMARKS
�IAINEPICONTAACTOR RESPONSIBLE FOR EROSION CONTROUDRAMAGE
IT :�7'
NAME
ADDRESS
CITY ZIP I fELEPHONE — —
FIRE REVIEWED BY DATE
ATAj '4214VEDBYO
STATE LICENSE NUMBER EXPIRATION
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VARIANCE OR OU
SHORELINE 08 ADB#I
NS�PEE.CTION.
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0 YES 6
SEPA REVIEW
COM:PLIETE �EXEMPT
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SIGN AREA
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ALLOWED PROPOSED
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REQUIRED SETBACKS (FT.)
FRON� SIDE REAR
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PROPOSED SETBAC S (Fr.)
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REMODEL APARTMENT SIGN
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KS
[] DEMOLISH 0 TANK 0 OTHER
0 OAR PAGET 0 R
OF %aNING WALL RENEWAL
CAR IV
0 EF
P (TYPE OF USE. BUSINESS OR ACTIVIT
CITED DBY
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JTYPEOFP O*TRUCTION
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GROUP
NUMBER
NUMBER.OF
SPECIAL IN5PE CTOR
OCCUPANT
OF
10 STORIES
DWELLIN
UNITS
JAREA
E
REQUIR DO YES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'l
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4/- Al./'� M,,, N
VALUATION
FEE
PLAN CHECK FEE
HEA;�SO;�E LOT `f-j /a
BUILDING
3LT
PLAN CHECK NO: ]VESTEIDATE
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PLUMBING
0
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
8 DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVE S, MARQUEES, ETC�) WILL REQUIRE
WAY
GRADiNGiFILL
M SEPARATE PERMISSION.
-
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
WITHIN 180 DAYS
50
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG,REVIEWFEES
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ENG, INSPECTION FEE
'APPLICANT. ON SEHAL OF HIS OR HER SPOUSE, HEIRS, A SIGNS AND SUCCESORS
IN NTEREST. AGREES TO INDEMNIFY. DEFEND AND OLD HARMLESS THE CITY OF
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LANDSCAP NO
2 EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
A CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING REOTLY OR INDIRECTLY
THIS PERMIT SHALL NOT BE
INSPECTION FEE
RECEII/4qq,5'
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
ILA" CHECK DEPOSIT
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'OR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY OROINANC 5 PROVISION.'
CEIPT/go
AMOUNT DUE
79 �1,670
IHEREBY ACKNOW EDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
_TOTAL
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE OULY AUTHORIZED AGENT OF
THE OWNER, I AGREE TO DO ELY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
Thl, Ippl,.Io-, A plIld 11 11911d by th,
TION: AND IN DOING THE WORK AD HOHIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
B"I dl�g Offil"I 11 blIlhIl COP11Y: I'd Ed- I. Plld, Ild
FOR INSPECTION P.11 PllldId
WOAKMENSSP'4;ENSATIONIN URANCEANDACWIB.27,
OFFI�IALS StGNATU DATE
AT SIGNED
(425)
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StGNATU AG I
I cj/
771-0220
DATE
AMENTION
EXT 1333
/A 2-
ITIS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW - INSPECT 8
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
FAX
PINK OWNER GOLD -ASSESSOR
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RECEIVED
20.
AUG 0 1 2001
PERMIT COUNTER
5PPROVED
�-' 3, u-
B
CITY COPY
'ACE
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE. —
ENGINEERING DIVISION DATE
PLANNING DIVISION DATE
PROJECT
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SITEADDRESS 0AW
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PERMIT# DATEINSPECTED— 2?
80
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DESCRIPTION OF WORK TO BE INSPECT131)_A�A
A fleld inspection was conducted to determine final 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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n�
PERFORMANCE BONDS and the granting of:
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0 V5
0 �
GRANT FINAL PROJECT APPROVAL
0 M
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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o Copy of CONDITIONS given to owner/contractorby inspector
x
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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u Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
ocaprvl.Aoc.l:ten4):bldg:formsIO/OI
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall .............
Pier/Porch
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Retaining Wall ...........
rill
Slab Insulation
4 -n
PLUMBING:
— --I
Underground
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Rough -In .................
Commercial Final
X M
HEATING:
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Gas Test ...................
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Gas Piping ..............
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Equipment .................
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Commercial Final
M M
0
EXTERIOR SHEATHING
0
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NAILING ..........................
9 -)9 2
(= ca
C 0
FRAMING ...............
M 0
FIRST FLOOR FRAMING
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INSULATION ................
Floor Insulation
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Wall Insulation ...........
Ceiling Insulation
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SHEETROCK NAILING
ITI
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................