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CONSTRUCTION PERMIT APPLICATION
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PLAT NAMEISUBDIVIS;ON No. [ LOT NCL
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
17 a R eso
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EXISTING — PROPOSED
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CITY ZIP TEL EPHIONE
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MITS1 SIZE I LINE SIZE I NO. OF FIXTURES
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YES E3 No E3 es
R ARKS 15
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OWNERUCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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NAME
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ENGINEERING
REVIEWEDIDATE
FIRE REVIEWED BY
ZIP,
ITILEPHOIE77
STATE LICENSE NUMBER
4
EXPIRATION DATE
-115 ?--;2
4
VARIANCE OR CLI
SHORELINE OR AD"*
1111PECTI ON
E.-D
YES ' No
HEIGHT
BOND
POSTED
PROPERTY I ACCOUNT PAR EL NO,
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
ALLOWED PROPOSED
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EX I
,
,
NEW
RESIDENTIAL
PLUMBING I MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACK$ (FT.) PROPOSED
FRONT SIDE BEAR
SETBAC (FT.)
FRONT LIRSIDE KRSFAR
0 ADDITION
COMMERCIAL
C MPLIANCE OR
CHANGE OF USE
... PARKING
D I PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
E3 S EMODEL APARTMENT SIGN
0 REPAIR
0 GRADING us F NCE
_ X _ FT)
REMARKS
DEMOLISH
0 TANK
R
AS
c3 GAR E
CARPORT
0
[1 0 STAINING WALL
ROOKERY
0 REb&17V;VX
(ME OF USE, BUSI�� EXPLAIN:
CHECKEDBY
ItPE.OFCONSTIBUCTION,
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707
WIPANT
ROUP
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NUMBER
OF
STORIES
'U'UNIT'S" OF
DWELLING
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NuMBE
SPECIAL.1NSPECTOR ..
RE UN AREA
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OCCU MT
LOAD
DESCRI89 WORK
TO BE DONE
.REMARKS
PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION RECrD
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VALUATION $
Description
FEE
Description
FEE
Plan Check.
HEAT SOURCE GLAZING I LOT SLOPE �
rBuilding
,
PLAN CHECK NO: IISTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t:
HE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU`U`C
MAIN (CURBS. EQUIR.
2 GO SIDEWALKS, DRIVEWAYS, MARQUEES, ETC., WILL .
Grading
Recording Fee
SEPARATEPERMISSION.
Engr. Review
City Surcharge
PERMITAPPLICATI N: INDAY.
PERMIT UMrR 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANt, ON BEHALF OF HIS OR HER SPOUSE, HEIRS ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Traffic Mitigation
Plan Chk Deposit
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY Alto
Fire Review
Receipt ly
ALL CLAIMS 10 DAMAOIS OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT $HALL NOT BE
DEEMED TO MODIFY
Fire Inspection
Total Amount I)..
WAAW OR REDUCE ANY REQUIREMENT OF ANY CITY ORINNAN
NOR LIMIT IN ANY WAY THE GIFTS ABILITY TO ENFORCE ANY ORDINANCE PROVIStOCE.
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Receipt. I tqq05
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS COMRECT� AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC'
CALL
Ths—pplication Is not a penaft until signed by Me
ION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN V ION OF THE USDA CODE OF THE STATE OF WASHINGTON RELATING TO
N'S COMPENSATION INSURANCE AND RCW 18.27,
W04*
FOR INSPECTION
Builds F .. ... paid, ad
"j.01ficial or his/her Deputy; and
.lot Is acluxedodged 11 space rowided.
SIMTPRE'iow:�� SIGNED
(425)
&1 �IONATURA, DATEJ
�' j, 1
771-0220
ATTENZON
DATE
EXT 1333
-?—
(
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
0
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
-ORIGINAL -FILE YELLOW -INSPECTOR
PINK - OWNER GOLD - ASSESSOR
10/01
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FP�L PROJECT APPROVAL rJRM
TO:
DATE:
M[EM0 TO- PERMIT COORDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DATE
FROM:
ENGINEERING DIVISION DATE-
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PLANNING DIVISION DATE
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PROJEC
65 --1
SITE ADDRES
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PERMIT # -L���.ADB#_______DATE INSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED YeL_04.
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A field inspection was conducted to determine compliance with�approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
O'n
PERFORMANCE BOND nd the granting of:
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M M
X- GRANT FINAL PROJECT APPROVAL
0 Fa
0 �
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0
X
GRANT PROJECT APPROVAL WrM CONDITIONS NOTED
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0 Copy of CONDITIONS given to owner/contractor by inspector
CD
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE-1 NSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbnns*caprv1 3/25/04
Footing _ ....................
Wall..........................
pu�
Pier/Porch .................
Z
Retaining Wall
Slab Insulation ..........
PLUMBING:
Underground .............
M
C
Rough -In ...................
ITI 0
0
—40
Commercial Final
—4
HEATING:
M
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GasTest ....................
—4
Gas Piping
.................
Equipment .................
0
0 -n
Commercial Final
-4
3:
EXTERIOR SHEATHING
M M
NAILING ..........................
0
0
FRAMING ............
C
FIRST FLOOR FRAMING
0
INSULATION ...................
Floor Insulation
Wall insulation ...........
Ceiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
ITI
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...............
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