20020114.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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FPERMIT EXPIRES
USE PERM T
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a PLAT NAMEISUDDWISION NO, _rT N36. L�O NO,
'LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 1—I, AF—se
EXISTING — PROPOSED
REQUIRED DEDICATION— FT —
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METER SIZE I LINE SIZE 10. OF 1IXTURE1 11V REQUIRED
YES 0 No 13 -
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REMARKS i
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTR IL/DRABIAGE 11
I�U' 7 1�— I �c 1 —1 1� FIRE REVq!.WED BY DATE
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STATE LICENSE NUMBER Fo BY VARIANCE OR CU S140HELINE OR ADS# INSPECTION PBOND
KEG BY REO'D OSTED
1 [3 YES t3NO
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
44 z�o EXP
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RAGE REQUIRED SMACKS IFT.1 PROPOSED S I BACKS (FT.)
LOT COVE T
-T COVE
NEW RESIDENTIAL PLUMBING I MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URESIDE REAR
ADDITION COMMERCIAL o C MPLIANCE OR
CHANGE OF USE
PARKING I LOT AREA PLANNING REVIEWED BY DATE
[3 REMODEL APARTMENT SIGN REaD I PROVIDED
[3 REPAIR [3 GRADING Y., 0 F NCE
I X FT) REMARKS
DEMOLISH E] TANK
o GARAGE RETAINING WALL
0 RENEWAL
CARPORT OCKERY
ITYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED By TYPE OF COWSUCTION OCUPANT
_ I C77 GROUP
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NUMBER NUMBER OF CRITICAL
OF AREAS. SPECIALEINECTEOR OCCUPANT.
STO NUMBE S JAREA
RIES UDWELLING
'4 REOUIN Y
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20 LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION REOD
or
VALUATION $
VALLI AT'ON $
FEE
Description
FEE
r'Pt'On
Description
Des"
an Check
Plan Check
LOT SLOPE
HEAT' SOURCE GLAZING Is LOT SLOPE
Building
STE. DATE
PLAN CHECeZ STED DATE
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Mechanical
It IT 'S'
R.." C."ER.W..."
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
to 'ng
Recor ding Fee
00 GlW'LL.
z MAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
---- - --
city Surcharge
PURMMARPUQATI N: ISODAYS
PERMIT LIMM 1 YEAR � PRO`B ED WORK IS STARTED WITHIN Her DAYS
=W.Gilon
e_�lj State Surcharge
SEE BACK OF P UK PERMIT MR MORE INFORMATION
'APPLICANT ON BEHALF F HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 IDMONIII,WAIHIN 11, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
Receipt #
IGTO
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
3 FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL 140T BE
DEEMED OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINAN
Fire Inspection
Total Amount Due
TO MODIFY. WAIVE
NOR umrr IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVSK) C E
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Receipt III
1 HEREBY ACKNOWLEDGE THAT I HAVE REM 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 AGRE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
ThIl.pplicflan Is net . "'t—fil.darunibyffi.
TION; AND IN DOING THE WORK AUTHORIZEO THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE "BOB CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Offial.I.,hisM., Ds'p',ty; and Feacard pals. and
nacelpt Is Ickn,,I,dgod 1, space pToAded.
WORKMEN'S COMPENSATION IN$UIttNCE AND RCW 18.27.
DATE
to R (OWNER BE I DATE SIGNED
(425)
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771-0220
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EXT 1333
U E BUILDING OR STRUCTURE UNTIL
IT IS UNLAWFUL To S OR OCCUP
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
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FINAL PROJECT APPROVAL -FORM
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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ENGINEERING DIVISION DATE—
PLANNING DIVISION DATE —
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DESCRIPTION OF WORK TO BE IN spEcTED r�7z&g
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A rield inspection was conducted to determine rmal 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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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ....................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation
PLUMBING:
Underground
Rough -in
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Commercial Final
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80
HEATING:
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Gas Test ..........
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Gas Piping .................
Equ!pment .................
Commercial Final . .....
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EXTERIOR SHEATHING
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NAILING ..........................
FRAMING
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FIRST FL60R FRAMING
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INSULATION ...................
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Floor Insulation
Wall Insulation ...........
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Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
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