20020297.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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=PERMIT EXPIRES
PERMIT -),I
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ADDRESS
—PLAT NAME/SUBDIVISION NO.
LID r70—"
LID FEE S
P RLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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EXIST�NG — PROPOSED
REQU RED DEDICATION— FT
�RV REQUIRED
YES C3 NO C3
REMARKS
OWNEAICONTRACT08 RESPONSIBLE F08 EROSION CONIt )UDRAINAGE
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ENGINEERING REVIEWEDIDATE
ADDRESS
FIRE REVIEWED By
DATE
CITY
C
STATE LICENSE NUMBER
EXPIRATION DATE CHECKED BY
iA—RIANd OR CU SHORELINE OR ADB#
INSPECTION
JPRONr
O'D OSTED
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aYAE
ES 13 NO
BEIRA REVIEW SIGN AREA
HEIG14T
4 CEL NO.
COMPLETE EXEMPT ALLOWED PROPOSED
ALLOWED PROPOSED
EXP
I
0 NEW
0 RESIDENTIAL
0 PLUMBING I M-11
LOT COVERAGE REQUIRED ,.KS IFT) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UPSIDE REAR
C
0 ADDITION
COMMERCIAL
C MPLIANCE OR
0 CHANGE OF USE
NPA
PARKING WED BY DATE
REMODEL
71k6�
0 SIGN
RECT) I PROVIDED
0 REPAIR
0 GRADING CYD8
0 FENCE
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REMARKS
0 DEMOLISH
0 TANK
0 OTHER
0 GARAGE
RETAINING WALL
0
0 RENEWAL
CARPORT
ROOKERY
CrYPE OF USE. BUSINESS OR ACTIVITYI EXPLAIN:
CHECKED BY TYPE OF CON WT ON JC�
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NUMBER
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NUMBER F
DWELLING
CRITICAL
AREAS
OCCU "T
STORIES
UNITS _A
NUMBER IVIA
LOAD
DESCRIBE WORK TO BE DONE
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PROGRESS INSPECTIONS PER UBC 10S/FINAL INSPECTION REO'D
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06k 02� 5 /0
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VALUATION $
Description
Plan Check
HEAT SOURCE LOT SLOPE %
Building
PLAN CHECK NO: VESTED DATE
Plumbing
—_
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOT D. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
I
=1 DOMAIN (CURSS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATEPERMISSION.
Engr. Review
PE MITAPPLICATION: UXOAYS
PERMIT Luim I YEAR - PROVID 0 WORK IS STARTED WITHIN Too DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-FPL'-NT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS 0 FICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
HATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
—FRORTH-E-f— "A"IMPTHIIS-PERM17.
ISSUANCE OF THIS PERMIT SHALL NOT BE
Fire Inspection
DEeMED TOSSUANC WAIVE OR REDUCE ANY REQUIRPMENT OF ANYCITY ORDINANCE
MODIFY.
0 NOR LIMIT IN ANY WAY THE CITYS ASIUI Y TO ENFORCE ANY ORDINANCE PROVISION,'
I HERESY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT AND THAT AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
I
rINSPECTIC
THE OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
L
CALL
TION; AND IN DO:NG THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR I CTIC
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
Ao DATE SIGNID
SIGNATURE (9%11�FR ( E-)
(425)
"!R
771-0220
ATTENTION'
EXr 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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
10101
State Surcharge
Plan Chk Deposit
Receipt #
Total Am
Receipt #
APPLICATION APPROVAL
.."di,g Official or Merest D,pty: wal Fees.. Pid,.nd
10clipt 11 Ick-11dold I, space peovided,
IGNATUR, DATE
ORIGINAL -FILE YELLOW -INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: C- --YIRE DEPARTMENT DATE.-3—q—(J-p
GINEERING DIVISION DATE —
PLANNING DIVISION DATE—
PROJE
SITE ADDRESS
PERMIT # (5-2- — -2, q -7 ADB#______pATE INSPECTED 3—
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine final compliance with approved plans. Float 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
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
c3 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 ..........................
0
Pier/Porch .................
Retaining Wall
Stab Insulation ..........
PLUMBING:
OM
C
Underground .............
IT!
0
Rough -in ...................
C
M
q Commercial Final
ITI z
10-1
HEATING:
Gas Test ..............
Gas Piping
On
"n
Equipment .................
—1
ITIM
Commercial Final
Do-
0
EXTERIOR SHEATHING
0
C
NAILING ............ .............
FRAMING ............. ..........
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
RR
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY
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