20020089.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER N'ME/NAME OF BUSINESS
MAILING ADDRESS
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CITY ZIP PHONE
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NAME
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PERMIT EXPIRES
USE PERMIT
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PLAT NAMEISUBDIVISION NO.
LOT NO-
LID NO,
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
93
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EXISTING - PROPOSED-
13
REQUIRED DEDICATION- FT
METER SIZE
LINE 1111
110, 01 IIXTUHES
PRV REQUIRED B,
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YES E3 NO C3
REMARKS
FOR EROSION CONTROUDRAINAGE
;N�VO;TR�,CT2.7ESPONSIBLE
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ADDRESS
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ALLOWED PROPOSED
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PROP MY TAX ACCOUNT PARCEL NO.
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NEW RESIDENTIAL 0 PLUMBING I MECH
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ADDITION COMMERCIAL [j CHANGE OF USE
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REPAIR 0 GRADING CY.S F ROB
( _ X Fr)
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LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT L/R$1DE REAR
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REMARKS FE
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/11FINAL INSPECTION RECI'D
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Plan Check
HEAT SOURCE GLAZING
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PLAN C
VESTED
ADATE.PI-IRIbing.
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THIS PERMIT AUT ORGES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
D REQUIRE
ETC) W. R ..
ONUUM (CURBS, SIDEWALKS, DRIVEWAYS, MMOUEES, ETC.) WILL SO
Engr. Review
SEPARATE PERMISSION.
PE MITA�PPJJCAT.011! ISODAYS
Engr. Inspection
PERMIT LOOM I YEAR -PROVIDED ORK IS STARTED WITHIN ISODAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
—PUCAK ON BEHALF 01 HIS OR 11111 11OU11. HEIII. A11IG11 AND IUCC ESORS
Traffic Mitigation
Fire Review
IN INTEIIErT. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE ITY OF
EDMONDS, WASHINGTON , ITS OFFICALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE ARISING DIRECTLY 01,114-111-C.-
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
Fire Inspection
DEEMED TO MODIFY, WA VE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CIWS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
LandscapoInsp.,
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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 CONSTRUC.
CALL
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR ODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTI(
WORKMENS COMPENSATION INSURANCE AND RCW 10,27,
DATE SIGNED
(425)
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j 771-0220
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
10/01
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City Surcharge cl�7
State Surcharge
Plan Chk Deposit
Receipt # 2L
Total Amount Due Y-4550
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Receipt #
APPLICATION APPROVAL
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ORIGINAL - FILE YELLOW - INBPECTO-
PINK - OWNER GOLD � ASSESSOR
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE—_
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PERmrr#'2_015'2--0S�D ADB# DATE INSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED
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A field 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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PERFORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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2,
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_
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FINAL PROJECT APPROVAL FORM
TO-k -4 LZL-LL6,-V--
DATE:--4
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: DEPARTMENT DATE —
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE
PROJECT
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SITE ADDRESS I -
PERMIT ADB4-0,& �-LYATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine final compliance with approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
--,XL-GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
c3 Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date— Sign_
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
�SETBACKS .....................
FOUNDATION:
Footing....................
Wall ...............
Pier/Porch ...........
Retaining Wall ...........
M
Slab Insulation ...........
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PLUMBING:
M
Underground .............
M 0
Rough -in ...........
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Commercial Final
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10
HEATING:
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Gas Test
Gas Piping ................
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Equipment .................
3:
Commercial Final
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EXTERIOR SHEATHING
NAILING ..........................
01
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FRAMING ... .....................
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FIRST FLOOR FRAMING...
INSULATION
...................
Floor Insulation
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Wall Insulation ...........
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Ceiling Insulation
SHEETROCK NAILING
ITI
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
3,v
OCCUPANCY ..................