20020383.pdfjD E RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP JTELEPII.NE
LJPERMIT EXPIRES
PERMIT —
JOB SUITEIAPT#
ADDRESS
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PLAT NAMSISUBDIVISION NO.
LOT NO.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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METER SIZE
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REMARKS
OWNERICONTRACTOR RESPONSIBLE
FOR EROSION CONTROLIDRAINAGE
ADDRESS
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STATE LICENSE NUMBER
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PLUMBING / MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT UR SIDE REAR
ADDITION
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REMARKS
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RENEWAL
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REMARKS
PROGRESS INSPECTIONS PER UBC 10811FINAL INSPECTION REDD
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Description
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Plan Check
GWING %
LOT SLOPE %
Building
PLAN CHECK 1110:6�2
sTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: B DONEONPRIVATEP OPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
:I DOMAIN (OLIFIRS, SIDEWALKS, DRIVEWAYS MARQUEES. ETC.) WILL REQUIRE
2
t: SEPARATE PERMISSION.
PER IT APPLICATION: 180 DAYS
PERMIT LIMIe I YEAR - PROVIDED WORK IS STARTED WITHIN 180DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Grading
Engr. Review
Engr. Inspection
-APPLICANT, ON BEHALF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESOHS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF MY CITY ORDINANCE
Traffic Mitigation
Fire Review
Fire Inspection
NOR LIMIT IN ANY WAY THE CITYS ABIUTY TO ENFORCE ANY ORDINANCE PROVISION�
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AT 1 HAV READ THIS APPLICATION; THAT TH INFORMATION
I HEREBY ACKNOWLEDGE TH E E
GIVEN IS CORRECT. AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TIQN; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL a
IN VIOLATION OF THE "BOB CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMENS ��SATION INSURANCE AND RCW 1817.
7 (425) or
DATE SIGNED
771-0220
A17ENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL on A CERTIFI- 771-0221
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109 FAX
IBM
State Surcharge
Plan Chk Deposit
Receipt #
Total Amount Due
Receipt #
APPLICATION APP
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ORIGINAL - FILE YELLOW - INSPECTOR
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WA �j L) BUILDING DEPT.
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19.55.030 Fence and gate.
The
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pool area shall be completely sur-
rounded by a substantial fence at least six feet
high. No openings shall be greater than two
inches, and a self -closing self -latching gate
must be provided, with an inside lock inacces-
sible to children five
age years or younger. The
gate shall be securely locked when the pool is
APPROVED 114' TE: 61WV1--)g2
unattended. Any pool not presently fenced as
BLDG. C)z:"('IAL
required by this section must be fenced within
60 days of the effective date of Ordinance No.
PaRMIT FMUWWBC-:R
998 adopted in 1963. [Ord. 3215 § 1, 1998;
Ord. 1522,19701.
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FINAL PROJECT APPROVAL -FORM
TO:
DATE:
MEMO TO: pERNuT COORDINATOR, BUILDING DIVISION
FROM: — FIRE DEPARTWENT DATE —
ENGINEERING DIVISION DATE-44�03
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DESCRIPTION OF WORK TO BE INSPECTED
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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
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date_ Sign_
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE —
ENGINEERING DIVISION DATE—Y1522—
PLANNING DIVISION DATE —
PROJECT
SITE ADDRESS ILL 3E
PERMIT #_qaA3n--ADB#_-----DATE INSPECTED—Wfi�4�.
DESCRIPTION OF WORK TO BE INSPECT :gut
Final approval
A field inspection was conducted to determine final compliance with approved plans.
denotes that there are no objections from the above signed Department to the release of
PE ANCE BONDS and the granting of
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
c3 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�_ Si
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
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FOUNDATION:
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Slab Insulation
PLUMBING;
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EXTERIOR SHEATHING
NAILING ..........................
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FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION .............
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ...............