20020236.pdf'I DATE RECEIVED
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PERMIT EXPIRES
CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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ADDRESS
—INAME OF BUSINESS
PLAT NAME/SUBDIVISION NO. LOT NO.
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L�D NO.
D FEE $
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TELEPHONE
7 7 6 677
ER SIZE I
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LINE SIZE
I No. OF FIXTURES
YEPRV REQUIRED
a 0 NO 0
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLJDRAINAGE__
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CITY
ITECEPHONE
EPHION
FIRE REVIEWED BY DATE
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STATE LICENSE NUMBER EXPIMHON DATE
I CHECKED BY
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SHORELINE OR A...
'N�Plicn 14
OYERSE 13 0
BOND
EL NO.
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$EPA REVIEW
COMPLETE EXEMPT
EXP I x
SIGN AREA
HEILGI
ALLOWED PROPOSED
6 1 1 6 1
SfNEW RE....NTIAL 0 ..ING I MECH
0 ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
LOT C E .
AILOWfD PROPOSED
AAL
REmIleg. SETBACKS (FT)
FRO SIDE REAR
15' 16 1
PROPOSED SET KS (FT.
FRONT UR SIBAC
BE REAR
PARKING
REOD ROVIDED
LL TAR
P SIR ME E
E] REMODEL I [] APARTMENT 0 SIGN
0 REPAIR 0 GRADING CYDS A f(':a x MREMARK.
E3 DEMOLISH C3 TANK 0 OTHER
o GARAGE RETAINING WALL
CARPORT U ROCKERY n RENEWAL
OF USE, BUSINES60R
ACTIVITY)
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NUMSER
OF
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ITYPE 01 LONG TRUCTION
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0 UPANT,
GROUP
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SPECIAL INSPECTOR JARIA
EQUIRED[:) YES
I OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER URIC 10S/FINAL INSPECTION REO'D
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VALUATION $
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Description
FEE
Description
FEE
Plan Check
HEAT SOURCE GLAZING %
LOT SLOPE %
Building
PLALN CH!M
7ESTED DATE
Plumbing
Mechanical
t: THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBU
I
DOMAIN (CURBS, SIDEWALKS, DR VEWAYS, MARQUEES, ETC.) WILL REQUIRCE
Grading
Recording Fee
SEPARATE PERMISSION.
PE MITAPPLICATION: INDAYS
PERMIT LIMIR I YEAR - PROVIDED WORK 18 STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Review
City Surcharge
Engr. Inspection
State Surcharge
'AAPPUCAANT, ON BELA F OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREE TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMOND , WASHIN N, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
AULCIAMISFID DA ES OF WHATEVER NATURE, AMSING nIRECTIY OR INDIRECTLY
FROM THE I SUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT $HALL NOT BE
DEEMED TO MODIFY, WAIVE OR SEDUCE ANY REQUIREMENT OF ANY CITY ORDINA CE
NOR LIMIT IN ANY WAY THE CLYS ABIUTY TO ENFORCE ANY ORDINANCE PROVISION,'
Traffic Mitigation
Plan Chk Deposit
Fire Review
Receipt #
Fire Inspection
Total Amount Due
Landscapoinsp.
Re eipt#
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK ALIT111,1111 THEREBY, NO PERSON WILL BE EMPLOYED
VJOLAT' NGTO
IN ON OF THE LABOR CODE OF THE STATE OF WASHI N RELATING To
WOMKMENS C=SAR N INSURANCE AND RCYV 1827. a
APPLICATION APPROVAL
CALL Thl-PpI11.1- i—I. lani unuil IAgnunt by Und,
Building Official., hiallid, DOPUty: and Face are paid, and
nlcln"'
FOR INSPECTION reclup; is acknolodged hi apacuo provided,
OFFICIALS ; j1 DATE
(425) '7
771-0220 -R A—T�
IEXT 1333 -7-7
, 9)RI21
171-0221
Sl:=NER R ENT,
DATE
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED.
10101 UBC SECTION 109
ORIGINAL � FILE YELLOW - INSPELITOR
FAX PINK -OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL —FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTNIENT DATE -
ENGINEERING DIVISION DATIEL
PLANNING DIVISION DATE -
SITE ADDRESS_V,5 *L
# �XZ_6r'Z- U
PERMIT �LB#__________PATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED___;���...
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
PERFORMANCE BONDS and the granting of
__��RANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WrM CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractorby inspector
1.
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 .................
wall........... ...........
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Pier/Porch ...........
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
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C 0,
Ill 0
Rough -in � ................
C:
Commercial Final
C
1171
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HEATING:
jo-4
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GasTest ....................
Gas Piping .................
O'n
Equipment .................
Commercial Final
M M
EXTERIOR SHEATHING
0
0 Fn
NAILING .....................
(0
In
M
FRAMING ....................
FIRST FLOOR FRAMING...
0
INSULATION ...................
Floor Insulation
z
Wall Insulation ..........
Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR Aos
OCCUPANCY ..................