20020119.pdfDATE RECEIVED
PERMIT EXPIRES
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
USE
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PLAT NAMEISUBDIVISION NO.
I LOT NO,
LID NO,
LID FEE $
MAILING ADDRESS
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REQUIRED DEDICATION- FT
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NAME
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No. OF "-U...
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YES E3 NO E3
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP ITELEPHONE
NAME
Fit E REVIEWED BY
CDC 19.30.49FJ
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STATE LICENSE NUMBER EXPIRATION .,ITS
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COMPLETE EXEMPT
EXP
SIGN AREA
ALLOWED PROPOSED
HEIGHT
PROP D
ALLOWED OSE
NEW ga�IIESIDENTIAL LUMBING I MECH
ADDITION 0 COMMERCIAL o C MPLIANCE OR
CHANGE OF USE
REMODEL rl APARTMENT SIGN
[I REPAIR 0 GRADING cy,,,E F NCE
( _ X FT)
0 DEMOLISH [3 TANK OTHER
0 BAR ET BETAIN114G
C AG 13 ROOKERY WALL
ARPO RENEWAL
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRO14T SIDE REAR
PROPOSED SETBACKS (FT)
FRONT LIRSIDE REAR
PARKING I
REO'D I PROVIDED t:!as
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LOT Af
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DATE
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FEW... SHALL BE INSTALLED ON THE
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NUMBER
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NUMBER
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REQUIRED 0 YES
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LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER URIC 108/FINAL INSPECTION REO'D
L /&
VALUATION $
Plan Check
HEAT SOURCE LOT SLOPE %
Building
PLAN CH ECK NO. V61TID DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTEDL THIS PERMIT COVER WORK TO
h Be DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
Recording Fee
130AMN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUESS, ETC.) WILL REQUIRE
SEPARATEPERUISSION.
Engr. Review
City Surcharge
PE "ITAPPLIGATION: 1NDAYS
PERMIT MAIM I YEAR - PROVH) WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
State Surcharge
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
—LICA" ON BEHALF 01 HIS OR HER SPOUSE, IIIIRI, AIIIIINI AND IUCCESOFE
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES To INDENPRI DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIt JSSUANC� OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Total Amount Due
NORLIMITINANYWAYTHEC 6 ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscapeinsp.
Receipt #
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNE . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
ThIv vppft.11-1, �.I by ft
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
FOR INSPECTION
Oullfto OftIM., hl.lt Dp�y; d F—..P.id,
_Ipt 11 1ck1-1.dg.d I..p ... p—id.d.
WORKME=SATION INSURANCE AND RCW 18.27.
OFFICIALS SIG DATE
G AURE
S.Y
DATE SIGNED
(425)
1�
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771-0220
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-4�11E*A'BEG
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AITENTION
EXT 1333
IT IS 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 A
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK, OWNER GOLD -ASSESSOR
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FINAL PROJECT APPROVAL FORM
T0461 N A,,L
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIR DEPARTMENT DATE-
-ENGINEERING DIVISION DATE A
PLANNING DIVISION DATE —
PROJECT �41�
SITE ADDRESS C/oz
PERM[IT e-&q--ADB#
INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED—&/4Z& A
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
E BONDS and the granting of:
__�_GRANT FINAL PROJECT APPROVAL
JUL 2 2002
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector ENGINEERING DIVISION
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
o Copy of CORRECTION NOTICE -given to owner/contractorby 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 ................. 6
wait- ..................
Piet/Porch .................
Slab Insulation
PLUM SING:
..............
MUnderground
C
IT!
0
Rough -in ...................
C
commercial Final
-j C
HEATING:
C
Gas Tast
>
Gas Piping .................
0 -n
.................
Commercial Final
1171 pill
0
EXTERIOR SHEATHING
NAILING _ .......................
0
FRAMING ...........
C
ITI 0
FIRST FLOOR FRAMING
Z
INSULATION ....................
Floor,lnsulation
z
Wall Insulation ...........
Ceiling Insulation
z
SHEETROCK NAILING
SPECIAL INSPECTION
pill
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ................