20020457.pdff
,DATE RECEIVED
PERMIT
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CITY OF EDMONDS jo� NUM13ER
CONSTRUCTION PERMIT APPLICATION AODDDRESS SUITEIAPT#
—AME OF BUSINESS
I? PLAT NANIC11USDiVISION NO, LOT NO- I'D NO*
��GRE AS I LID FEE $
PUBLIC RICLIT OF WAY PER OFFICIAL STREET MAP
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ZIP JTEIEILIONI 'EXISTING — PROPOSED--- P.'I 11.
REQUIRE[) DEDICATION— FT
MIFTER SIZE I LINE S. TNO. OF IIXTUFI�. PRV SECURED
YEs13 NO 13
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIORAINAGE
CITY
NAME
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PSTE U0E"1E NUMBER
PROPERTY TAX ACCOUNT PAR EL NO.
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FIRE REVIEWED BY DATE
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VARIANCE OR CU I SHORELINE 02 AGRI jjPE�GTIOI BOND
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EXP N/A
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LO COVERAGE REQUIRED SETBACKS (FT,,) P POSE ETBACKS (Fr.)
IF
ALLOWED PROPOSED FRONT SIDE LIn") NT U SIDE RMR
ADDITION
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ROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge
STED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE POOL[
Grading
iIL FIC
3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS MARQUESS, ETC.) WILL REQUI E
t: SEPARATEPERMiSSION.
2
PERMITAPPLICATI M: INDAYS
Engr. Review
T PERMIT LIMIT. I YEAR- PROVID WORK IS STARTED WITHIN 180DAYS,
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'A P N BEHALF F HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESONS
Fire Review
Plan Clik. Deposit
I INTERE , AGREES T INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
DMONDS WASHINGTON ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGE� OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Receipt #
12 FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT 8"ALL NOT BE
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
1
Landscapeinsp.
Total Aft
NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
. —
Re ording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE RE 0 THIS APPLICATION; THAT THE INFORMATION
.2—CO-1-
APPLICATION APPROVAC—
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGRE'TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
TbIs applicati- i� - Ii pft 111 �Ign0 by M.
TION; AND IN DOING THE WOR AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLAT 0 HE LASO" C DE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
BLII,11�g Offid.1 .1 hith., cp.ty: nd F p1d. zInd
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ENSATION INSURANCE AND ROW 18.27.
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OFFICIALS I NATURE DATE
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771-0220
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORtGINAL.FRE YELL'IN-INSPECRIR
CATE OF OCCUPANCY HAS 13EEN GRANTED. UBC SECTION 109
PJNK-OWNER GOLO,A11ESS0H
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTMG
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FINAL PROJECT PPROVAL FORM
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DATE-_4VW,�
MEMO TO: PERM COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTNIENT DATE�_
4 ENGINEERING DIVISION DATE-
ANNING DIVISION DATE
PROJEC
PERMIT �ADB#_________PATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED.. -
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
PEREORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL wiTH comrrioNs NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u 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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RECEIVED
jUN 19 2002
DATE:..
ENGINEERING DIVISION 7
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIR DEPARTMENT DATE
IC On ENGINEERING DIVISION DATE2(�a(10�
PLANNING DIVISION DATE
PROJECT
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smADDRESS—
PERMIT INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine final compliance with approved plans. III approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of
—4GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRE CTION NOTICE given to owner/contractorby 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 ..........
Pier/Porch ..........
Retaining Wall ...........
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Slab Insulation ..........
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PLUMBING:
Underground
Rough -in ...................
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Commercial Final
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HEATING:
Gas Test .................
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Gas Piping
Equipment .................
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Commercial Final
EXTERIOR SHEATHING
MR11
NAILING ..........................
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FRAMING ........ ........
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FIRST FLOOR FRAMING
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INSULATION ...................
Floor Insulation
Wall Insulation ...........
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Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
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MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ...............