20020329.pdf0
DATEREC£IVED
PERMIT EXPIRES
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CITY QF®NiONDS
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NUMBER 1
CONSTRUCTION PERMIT APPLICATION
JOB
SWTEIABH,
ADDRESS
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OWNE AMEINAME OF BUSINESS
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PLAT NAMEISUBOIVISION
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LOT NO.
LID NO.
MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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CITY ZIP
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PROPOSED
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REOUIREDDEDICATfON FT
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NAME
METER SIZE
LINE SIZE NO.OF FI%TURFS
PRV REQUIRED
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YES ❑ NO ❑ —
ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE a
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"'NE"IANKFILL, REMOVAL, OR `
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STATE LICENSE NUMBER EXPIRATION DATE
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VARIANCE OR CU
SHORELINE OR ADBp
INSPECTION
REG'D
FBOND
POSTED
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ES ONO
SEPA REVIEW
SIGN AREA
HEIGHT
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COMPLETE I EXEMPT
EXP
ALLOWED PROPOSED
ALLOWED PROPOSED
RESIDENTIAL
❑ NEW 1Z ❑ PLUMBING
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT)
FRONT SIDE REAR
PROPOSED SETBACKS in.)
FRONT LIP SIDE REAR
tl
❑ ADDITION ❑ COMMERCIAL ❑ CHANGE OFUSE
❑ REMODEL ❑ APARTMENT ❑ SIGN
S
PARKING
RED'D
LOTAREA
PROVIDED
PLANNINGREVIEWEOBY DATE
❑ REPAIR ❑/♦GRADING CYDS ❑ FENCE X FT)
PEMA KS
❑ DEMOLISH -'*/I TANK ❑ OTHER
GARAGE Z ❑ CARPORT ❑ RETAINING WALL ❑ RENEWAL
G (TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN;
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YPE GONST TION
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w NUMBER
1. OF
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NUMBEROF
DWELLING
UNITS
CRITICAL (I'J�
AREASfj
NUMBER �"r
OR
ES
r;;
AREA OCCUPANT
LOAD
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DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'O
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PLAN CHECK FEE
HEATSOURCE GLAZING LOT SLOPE
BUILDING
PLAN CHECK NO: v£sT£D OnrE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
fBE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING/F LL
D DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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SURCHARGE
PERMIT APPLICATION: 18D DAYS
PERMIT LIMIT: i YEAR - PROVIDED WORK IS BTARTEQ WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE Cl (V OF
LANOSCAPING
f EDMONDS.W'ASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANYAND
c ALL CLAIMS FOR DAMAGESOF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
INSPECTION FEE
FROM T'HE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
9 DEEMED TO MODIFY', WAIVE OR REDIICEANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'$ ABILITY TO ENFORCE ANY OROINANCF.PROVISION'
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I A. THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING GONSTRUG-
TION. AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
IN VIOLATION OF THE I.ABO DE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTH
WORKMEN SOENSAT CE AND NOW 18,27.
SIGNASN RAGE - DATES( ED
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(425)
-
771-0220
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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
sign
VALUATION I FEE
(CATION APPROVAL
hon is noI a porm,l Un1iI signutl by IM10
or hislbor Doputy: antl Foos re pnttl. antl
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ORIGINAL FILE • YELLOW -INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL. IT
TO:
DATE:
MEMO TO: PERMIT COORDINATOR BUILDING DIVISION
FROM: C' - FIRE DEPARTMENT DATE `S Ste_ <y -2-
tE198810N
ENGINEERING DIVISION DATE
PIP.A8es10N
PLANNING DIVISION DATE
PROJECTS
SITE ADDRESS
PERMIT #. ec) - D 3 2-_1ADB# DATE INSPECTED S=s'-0 2
DESCRIPTION OF WORK TO BE INSPECTED7Pun
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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
,_GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
❑ Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
❑ . Copy of CORRECTION NOTICE given to owner/contractor by inspector
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2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign
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Retaining Wail
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PLUMBING:
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EXTERIOR SHEATHING -
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NAILING ..........................
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FIRST FLOOR FRAMING...
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Floor insulation .........
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Wail Insulation ...........-
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Ceiling insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
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FINAL APPROVAL FOR
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OCCUPANCY .................. 777