20020176.pdfI DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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MAILING ADDRESS
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CITY
PERMIT EXPIRES
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NUMBER
JOB SUITEJAPTI
ADDRESS
C(I /I
PLAT NAMEISUBDIVISION NO. LOT NO, LID NO,
LID FEE I
T—P App—d
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW P-4 A�Ild
Si""" " "" 0
EXISTING — PROPOSED— 0
0
REQUIRED DEDICATION— FT — u—g—nd
METER SIZE I LINE SIZE RV REQUIRED
5 0 NO 0
'40
R MARKS
OWNERICONTRACTOR RESPONSE LE FOR EROSION CONTROUDRA:INA:G�E�
ENGINEERING REVIEWEDIDATE
ADDRESS
OC�, Q774 AVIS. 5
FINE REVIEWED By DATE
CITY
STATE LICENSE NUMBER 'EXPIRATION DATE
I Cn
't�y
"VARIANCE OR CU
SHORELINE OR ADEN
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DION
0 RECORD
1 '130 N.D.
ST
SERA REVIEW
COMPLETE I EXEMPT
Exp
SIGN AREA
ALLOWED , PROPOSED
HEIGHT
ALLOWED , PROPOSED
PROPERTY T��,go ,73ARCEL NO.
/';�9 Arq 15�1?
0 NEW RESIDENTIAL PLUMBING / MECH
0
Lo COVERAGE
ALLOWED PROPOSED
REQUIRED SETB CKS IF Q
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT URSIDE REAR
0 AD to. COMMERCIAL o 0 MPLIAN Eon
D" C14ANGE OF U E
0 REMODEL 0 APARTMENT 0
7�7
FD—BY DATE
0 REPAIR 0 G14ADING cYDs 0 x m
REMARKS
0 DEMOLISH 0 TANK IR
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oGARAGE 0 RETAIN N'6 'NAIL 0 RENEWAL
CARPORT '.".4
(TYPE OF USE.7�;ESS OR CTIVITY) EXPLA3N:
ra ni—t
—CRITICAL,
—CHECKEDBY
JTYPIWRUCTION
OECD
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at NUMBER
or
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NumBEROF
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uwELUNG
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AREAS R
NU mBE
SPECIALEINSPECTOR JAREA
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OCCUPANT
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DESCRIBE WORK TO BE DONE
ALL, LjL_' E,^/
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REMARKS
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PROGRESS INSPECTION$ PER UBC 108/FINAL INSPECTION REO'D 5
I I I VALUATION I FEE I I
PLAN CHECK FEE
LOT SLOPE %
BUILDING
DA TI
PLAN CHECK NO: TED DA B
E�
JVCSTED
W
rA L ff4J SALf
THIS PERMIT AUTHORIZES ONLY THE WORK NOTEM THIS PERMIT COVERS WORK TO
BE DONE ON FEW E PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
R."'LL
GRADINGIFILL
S, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.� WILL REQUIRE
DOMAIN (CURB ETC'W LL
SEPARATE PERMISSION.
L/
PE MITAPPLICATION: 180DAYS
PERMIT LIMIT. I YEAR � PROVIDED WORK IS STARTED WITHIN 18B DAYS
ENG, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
A PLICANT, ON BEHALF OF HIS OR HER SFOUSE� HEIRS, ASSIGNS AND SUCCESORS
�AP
ENG, INSPECTION FEE
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY Or
LANDSCAPING
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
INSPECTION FEE
1 0 DIP
. A L CLAIMS FOR DAMAGES F WHATEVER NATURE. ARISING E TLYORINDIRECTLY
RECEIPT
X FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
a E
DEEMEDT MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY DITYORDINANC
PLAN CHECK DEPOSIT
,
Ox NOR LIMIT IN ANY WAY I HE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
TOTAL AMOUNT DUE
11ECIIPT
7 177
I HERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAI THE INFORMATION
ON APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER� OR THE DULY AUTRORZED AGENT OF
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
n
[ON AND IN DING HE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
T 0 T
d,Ag 011,,,,l N,A/1,0, DOPJty: Ind F ,, d.
.,'IT
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RE LATING TO
FOR INSPECTION
—0,1 �S c-1—odgod In space providedg
WORKMEN S COMPENSATIO SURANCE AND RCW 1IF21-
RE
Sl:�URE (OWN DATE SIGNED
(425)
G�ICIA"
11Z j M1711,7,
7� 1A
j"I
771-0220
EA E BY DATE
ATTEfiTION
EXT 1333
4�vj
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-
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
FAX
ORIGINAL - FILE - YELLOW INSPECT&
PINK OWNER - GOLD -ASSESSOR
5198
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FINAL PROJ &_CT APPROVAL �FQRM
TO:
DATE: —
MEMO TO: pERmrr coORDINATOR� BUILDING DWISION
FROM: FIRE DEPARTMENT DATE—q-:::� �--O -z—
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE�
PROJECT
SITE ADDRESS S
PERMIT421� �26' ADB#--PATEINSPEC
DESCRIPTION OF WORK TO BE INSPECTED,8r= �—If/
A field 'inspection was conducted to determine final compliance with approved plans. Final approval
rtment to the release of
denotes that there are no objections from the above signed Depa
PERFORMANCE BONDS and the granting of:
�,.—GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL wrrH CONDMONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
I
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
o Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date—, sign----------
ocaprvl.do4�l:tenip:bldg:formslO/01
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ...................
wallI .........................
Pier/Porch .................
Retaining Wall ..........
Slab Insulation
PLUMBING:
Underground .............
Rough -in ...............
Commercial Final
HEATING:
Gas Test ............
Gas Piping .................
Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING .............. ..........
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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