20020143.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PERMIT EXPIRES
ISE PERMIT
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70B SUITEJAPTO
ADDRESS
PLAT NAMEISUDDIVISION NO,
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,LID FEE $
PU,,IR; RIGHT 01 WAY PER OFFICIAL STREET MAP
EXISTING - PPOPOSED�
REOUIRED DEDICATION� IFT
METER SIZE
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PRV REQUIRED
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REMARKS
owNFRICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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PROPOSED SETBACKS (Fr)
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ADDITION OMMERCIAL o C MPLIANCE OR
*1C CHANGE OF USE
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DATE
REMODEL APARTMENT SIGN
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REPAIR GRADING C,DS FENCE
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REMARKS
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VAUJATION $
Description
Plan Check
HEA1 SOURCE GLAJ!ING I
LOT SLOPE IK
Building
PLAN CHECK NO:
IE6TEO DATE
Plumbing
Mechanical
WIG PERMIT AUTHORGDES ONU THE WORK NOTED. THIS PERMIT COVERS WORK TO
h 11 GONE 11111 PROPERTY 111, ANY INSTRUCTION IN THE PUBLIC
Grading
a
po"N (CURBS, SIDEWALKS, DRIVEWAYS, � UEES. ETC.) WILL REQUIRE
t: SEPARATE PERMISSION.
Engr. Review
2
PERMITAPPUCATION: 160DAYS
PEFMffUMM.I YOM - PROVIDED WORK 15 STARTED WITHIN INDAY8
EngLInSpection
, 8U RACKOF PINK PERMTT Pon MORE INFORMATION
'Ap,,UCANT, ON BEHALF OF HIS OR HER BPOUIE, HEIRI, ASSIGNS AND 5UCCEIOIS
Traffic Mitigation
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOW HARMLESS WE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
A CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
Fire Inspection
DEEMED To MODIFY, WARN! OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN AM WAY THE CrTYS ABILITY TO ENFORCE ANY ORDINANCE PROVISIOW
Landscapainsp.
I HERESY ACKNOWLEDGE THAT HAVE REAQ THIS "PUCATION; THAT THE INFORMATION
GIVEN Is CORRECT. AND THAT AM THE OWNER. OF THE U1 AUTHORIZED AGENT OF
�
T E OWNER. I AGREE TO COMPLY WITH CrTy AND STATE .. REIR.111N. .01,�TRUC-
CALL
TION; AND,IN DOING THE WORK AUTHORIZED THERE BY, No PER50N WILL BE EMPLOYED
IN VIOLAT ON OF THE LABOR WASHINGTON REI.ATING TO
FOR INSPECTIC
CODE OF THE STATE OF
WORKMENS COMPENSATION INSURANCE AND SCW 18 27.
Blom OWN BE DATE SIONED
(425)
771-0220
1ATTEtftION
/BUILDING
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY 08 STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI.
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
FAX
total
FEE
Recording Fee
City Surcharge
State Surcharge
Plan Chk Deposit
ra Receipt #
TotelArnountOue
Receipt * I
APPUCATION APPROVAL
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FINAL PROJECT APPROVAL FORM
TO:_
DATE: -
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE--�-22L--o
ENGINEERING DIVISION DATE -
PLANNING DIVISION DATE -
PROJECT
SITE ADDRESS
PERMIT #--2-W ADB#-DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
oducted to determine final compliance with approved plans. Final approval
A field inspection was co s
ere are no objections from the above signed Department to the relea e of
denotes that th
PERF tMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH cONDMONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
(3 Copy ofCORRECTION NOTICE given to owner/contractorby inspector
I
2.
3.
RF-INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date_ Sigq---�
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FE �L PROJECT APPROVAL ORM
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DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: �E DEPARTMENT DATE
ENGINEERING DIVISION DATE—
ri,PLMNIAU UIV�-N
PROJEC
SITE ADDRESS A'a S�
PERmrro,�,w(— ADB#------PATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED—r-W.& 4L:18�
A field inspection was conducted to determine final compliance with approved plzns. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
A
GRANT PROJECT APPROVAL WITII CONDITIONS NOTED
Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
I .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL Plf!1APPROVAL
Date O'l, Sign
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RECORD OF INSPECTIONS
j.,
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Ratalning Wall ...........
0'
Stab Insulation ..........
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PLUMBING:
Underground
.........
Rough -in ...................
Commercial Final
HEATING:
C
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Gas Test ....................
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Gas Piping .................
Equipment
.................
Commercial Final
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EXTERIOR SHEATHING
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NAILING ..........................
FRAMING ........................
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FIRST FLOOR FRAMING
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INSULATION ..................
Floor Inautallon
Wall Insulation ...........
Calling Insulation
SHEETROCKNAILING
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SPECIAL INSPECTION
5
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MISCELLANEOUS ..........
FINAL. APPROVAL FOR
OCCUPANCY ..................
DATE RECEIVED
10
PERMITEXPIRES
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FEDMONDS
CITY OF EDMONDS
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PLAT NAMEISUBDIVISION NO,
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ROPERTY TAX ACCOUNT PATIO L .
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PROPOSED SETBACKS Fn
0 NEW RESIDENTIAL PLUMBING I MECH
ALLOWED PROPOSED
MOW SIDE REAR
FRONT UR SIDE FEAR
o COMPILIANCE OR
0 ADDITION *COMMERCIAL
V
#
P KING
LOT A
REVIEWED By DATE
CRINGE OF USE
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REUD PROVIDED
0 GRADING [3 FIE CE
0 REPAIR CYOS ( X Fit
REMARKS
0 DEMOLISH TANK
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-
GARAGE RETAINJ�G
RENEWAL
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LOAD
DESCRIBE WORK TO BE DONE
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.... CTION REOD
annrRFqq 1149PECTIONS PER UBC 1001FINAL INSPE
Plan Check
HEAT SOURCE GLAZING
LOT SLOPE
Building
PLAN CHECK NO:
�""o DATE
15--
Mechanical
'THIS PERMIT AIJITHOR�S ONXI( THE WORK NCITM TH:S PETUW COVERS WORK TO
t:
BE DONE ONI PRIVAM PROPERTY ONLY ANY OOTUTITTUCTTOH ON THE PDBUC
Grading
Recording Fee
3
DOMAIN CURSS, SIDEWALKS. DRIVIEVAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARAMPERMISSION.
Engr. Review
City Surcharge
PERMITITUMM I PERNITTAPPLICATI � IN DAYS
YOM-PROVIDED ORKISISTARIrEDINTFIRIN 100DAYS
SEE SAG Of PINK PERMIT � MORE INFORMATION
Engr. Inspection
State Surcharge
'APPLICANT, Oil BEIVU 111 HIS OR HER SPOUSE, HEIM, ASSIGNS AND IUCCTSORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND He. HARMLESS THE CITY OF
EDMOND ITS OFFIGIALS. EMPLOYEES. AND AGENTS ROM ANY AND
Fire Review
Receipt III
ALL CLAIIWASHINGTON.
FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTILY OR INDIRECTLY
MIGM THE ISSUANCE OF THIS PERMIT!, ISSUANCE OF THIS PERMIT SHALL NOT BE
Fire Inspection
TotdA...ntDu.
0 CE
=FyWAjVIO1MDUGEAHY
HrMITO REQUIREMENT OF ANY CITY OR"""
WAY THE CqyS ABILITY TO ENFORCE ANY ORDINANCE PROVTSION.-
Landscapoinsp
Receipt #
1 HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; I. THE INFORMATION
APPLICATION
APPROVAL
GIVEN 0 CORKGT� Me THAT I AM THE OWNER, OR THE OULY AUTHORIZED AGENT OF
-..w I..W. 1, — p.� vYrd .1gd by
THE CONSTRUC.
OWNE'L I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING
TION; AND IN DOING THE WORK AUTHORIZED THEREBY W PERSON WILL BE EMPLOYED
CALL
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W..krw"- 0 -P—
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
—.1p,
wQRKUEJV8 COMPEN N INSURANCE AND AGIN 18,27.
OFF] GNA DATE
810���
(425)
ID
771-0220
7
ytm.y- /,ZATE
I , ATTEWrION
/BUILDING
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY OR STRUCTURE UNTIL
�
771-02 21
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
OR FILE YELI&, INSP`ECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
FAX
PINK - OWNER DOM - ASSESSOR
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