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use PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION jos sUlllFlA T#
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OF FIAT NIME'SUaDiVISION NO. LOT N&
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PUBLIC RIGHT OFAVAY PER OFFICIAL STREET MAI p=N In
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NO� OF FIXTURES
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RE�ARKS
OWNEWCONTRACTOR
RESPONSIBLE FOR EROSION CONTROLIORAINAGE
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NAME
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ENGINEERING
ADDRESS
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"HE REVIEWED By DATE
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ALLOWED PROPOSED
HEIGHT
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PROPERTY TAX ACCOUNT ACEL NO.
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NUMBER OF
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DESCRIBE WORK TO BE DONE
REMARKS
P� OGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURB$. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
zi SEPARATE PERMISSION,
'ADING'F'LL
GRADINGtFILL
TAT, SURCHARGE
STATE SURCHARGE
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PERMIT APPLICATIOW 180 DAYS
PERMIT LIMIT. I YEAR . PROVIDE. W �K Is STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
END REVIEW FEE S
ENG, REVIEW FEES
FLANDSCAPiNG
�A PLICAN ONBEHALF F HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
!� N NTEREST. AGAEESTO:NDEMNIFY. DEFEND AND HOLD HARMLESSTNE-1 -
2 EDMONDS. WASHINGTON� TS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
c ALL CLAIMS FDA DAMAGES OF WHATEVER NATURE. ARISING DHIECTLYOR INDIRECTLY
=0 FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS FERMI T SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE AN REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,'
ENO. INSPECTION FEE
INSPECTION FEE
RECEI17
PLAN CHECK DEPOSIT +
<
JRECE17q� Z/
TOTAL AMOUNT DUE
I HERE Y 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
THEOWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION 01 THE jMOF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENS SURA CE AND HCW 18,27
=ER O�AGINTI ATE SIGNED
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OTENTION
APPLICATION APPROVAL
CALL Cly ,d F111 ,, p1d. 1�d
FOR INSPECTION .�M.dpd,,, IF- P-dod
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(425) 6,z,
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771-0220 REdASED
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- JRIGINAL, FILE - YELLOW 4INSPECTOR
OF OCCUPANCY HAS BEEN GRANTED. LED SECTION 109 FAX PINK - OWNER - GOLD - ASSESSOR
CATE
5198
Height Calculation Worksheet
Address -
Date:
Inspector(s): (Y),3
1. Datum Point: SLry"
2. Datum Point Elevation:
3. Average Grade: 9 U, 00
'01
70
q&, grade)
4. maximum Elevation Allowed 0
65
_(average
5. Reference Point Elevation Shot to House:
am,
In 0
(datum elevation) + (grade to transit level line shot to house)
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6. Measurements from line shot onto house to roof ridge:
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Total 07.
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7, Actual Elevation: Lo Velerence point elevation) dc), �mesuremeuts
from #6) 1 A
conclusion:
(actual) is greater/<Vesis—thiit� t �Uiub (allowed); therefore the house is/
is not over the height requirement -p-e-r-fCDC 16.20.30 requirements
FINAL PROJECT APPROVAL-1-,jRM
TO.
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE-
6((-Ae?z-1 —...--.-.ENGINEERING DIVISION DATE
PLANNING DIVISION DATE—
PROJE
slTBADDRESS
pERMrr AO09-OA(,-OL ADB#--------PATEINSPECTEI�--V,�X-7,10S
DESCRIPTION OF WORK TO BE INSPECTED A --------
A field inspection was conducted to determine rmal compliance with approved plans'. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFORM-ANCE BQNDS and the granting of:
_-�-GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WTIH CONDITIONS NOTED
a 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
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 .....................
PiedPorch .................
Retaining Wall ...........
0
Slab Insulation
PLUMBING:
Underground .............
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C
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Rough -In ...................
C)
Commercial Final
M
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HEATING:
GasTest
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Gas Piping ..............
Lit
Equipment ...............
0 -n
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Commercial Final
3:
M M
EXTERIOR SHEATHING
0
NAILING ...........
FRAMING
0
C
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........................
FIRST FLOOR FRAWNG
M -S
INSULATION ...................
Floor Insufation
Wall Insulation
Calling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
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MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY
no