20020300.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAMENAME OF BUSINESS
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ZIP TELEPHONE
NAME /__�
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PERMIT
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NUMBER
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PLAT NAMEISUDDIVISION NO,
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED —
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WNEPUCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDLAINAGE I
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VARIANCE OR CU SHORELINE OR ADS# INSPECTION
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STATE LICENSE NUMBER RE OSTED
0 YESO'103NO I'S
$EPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL No. EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
ECOMPLETI I
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N LOT COVERAGE REQUIRED SETBACKS LIFT) PROPOSED SETBACKS (Fr.)
Star fe-fiESIDE IAL [I
PLUMBING I MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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ADDITION 0 COMMERCIAL OMFLUUICE OR
0 CHANGE OF USE
PARKING I LOT AREA I PLA NING REVIEWED BY DATE
REMODEL r] APARTMENT 0 SIGN Reen PROVIDED
FENCE I I FIdEMARSHAL
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[3 REPAIR [j GRADING CYDS ( _ X Fr) REMARKS MU6T BE PRESENT FOR
0 DEMOLISH _Jjj,'TANK Er OTHER !ANK NLL iiEMOVAL, OR GAP
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DESCRIBE WORK TO BE DONE I
REMARKS
OGRESS INSPECTIONS PER USC IOS/FINAL INSPECTION REO'D
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Plan Check
HEAT SOURCE 14WING LOT SLOPE
Building
PLAN CHECK NO:
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THIS PERMIT AUTHORQrS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE CN PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ONT EPUBLIC
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Grading
Recording Fee
3 OMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.), WILL EQUIRE
: 2 D R
I= SEPARATE PERMISSION.
PERVITAPPLICATION: TSODAYS
Engr. Review
City Surcharge
A, PERMIT LUMB I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
State Surcharge
SEEMCKOF INK PERMIT FOR MORE INFORMATION
'AIPUC . ON BEHALF 01111101 HER SPOUSE. 111111, ASSIGNS AND IU0C11ORS
Traffic Mitigation
Plan Chk Deposit
IN INMEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES AN" AGENTS FROM ANY AND
Fire Review
Receipt #
ALL CLAMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE I SUANCE OF THIS PERMIT. ISSUANCE F THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE
Fire Inspection
Total Amount Due
OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
121 NOR LIMIT IN ANY WAY THE crrYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscapainsp.,
Receipt #
I HERESY ACKNOWLEDGE THAT I HAVE READ 7H S APPLICATION: THAT THE INFORMATION
GIVEN 11 CO111CTjAND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
Co
THE OWNS., , ADS To PLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This applK, to, Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Official or herher Dapvty� and Fees are paid, and
receipt Is rek—loolgad In space pmided.
WORKMENS COMPENSATI NCE AND Row 18.27.
OFFICIALS SIGNATURE DATE
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GE�L BIG
(425)
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771-0220
RE' EASED BY DATE
ATTENTION
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-
ORIGINAL , FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD . ASSESSOR
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ENGINEERING DIVISION DATE—
PLANNING DIVISION D.ATE----------�--
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DESCRIPTION OF WORK TO BE IN SPECTED-- P(JAP,
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A field inspection was conducted to determine final compliance with approved plans. Final approval
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denotes that there are no objections from the above signed Dep artment to the release of.
PERFOR_MANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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u Copy of CONDMONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
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2.
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RE -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date_ Sigq�
ocaprvl.doc.l:tenip.bldW.fonnsIO/OI
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch
Retaining Wall ...........
Stab Insulation ..........
PLUMBING:
Underground .............
Rough -in .............
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C: 0
Commercial Final
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0
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"EATING:
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Gas Test ...........
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Gas Piping
10-4
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Equipment .................
3:
Commercial Final
0
EXTERIOR SHEATHING
NAILING
..........................
FRAMING .................
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FIRST FLOOR FRAMING
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0
INSULATION ................
Floor Insulation
Wall Insuiation ...........
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Ceiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
-4
0
ITI
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ...........