20020564.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NA4E/NAME OF BUSINESS
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(TYPE OF USE. BUSINESS OR ACTiV" EXPLAIN:
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NUMBER
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ADDRESS
IPERMIT EXPIRES
PERMIT ;�p
NUMBER "_). /,
FLAT NAME/SUDDIVIStON No.
I LOT 1111.
LID NO.
Lt. FEE I
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING � PROPOSED
REQUIRED DEDICATION— FT
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1EMARKS
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FIRE REVIEWED BY
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INSPECTION
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ALLOWED PROPOSED
ALLOW . PR107EG
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LOT COVERAGE
REQUIRED SETBACK$ (FT.
PROPOS D SETBACKS (FF.)
ALLOWED PROPOSED FRONT SIDE RFAn
PH NT US SIDE HEAR
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PARKING
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REMARKS
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,HECKED BY I TYPE�gOSTA C [ON CL!7,_
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GROUP —"e
SPECIAL INSPECTION NT
R EOUISED JAREA OICU
[I YES LOAD
18EMA ILE
PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION REO'D
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Description
FEE Description FEE
Plan Check
Stale Surcharge
HEA1 SOURCE GLAZING %
LOT SLOPE %
Building Permit
City Surgh rg.
PLAN CHIECM
VESTED DATE
Plumbing
777
—
THIS PERMIT A'
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
BE 00 Ne 0'
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUSL IC
00 N
0 OMAIN
Grading
(CURBS, SIDEWALKS, DRIVEWAYS
B` BE
SEPASATE PERM; MARQUEES. ETC.) WILL REQUI
SSION.
Engr. Revim
PERMITAPPLACATI
N: INDAYS
PERMITUMml
PERMIT La YEAR -PROVIDED WORK 15 STARTED WITHIN 1.0 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
F'
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Revievv
Plan Chk, Deposit
I IN INT
INTEREST, AGREES 10 INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. IT' 0111CIALS, EMPLOYEES. -0 A13EI TI FROM ANY AND
W M , I
ALL CLAIMS FO
Fire Inspection
Receipt #
DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
2
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO
E . TO
MC No
MODIFY, WAIVE OR HE LOS ANY REQUIREMENT OF ANY CITY ONDiNA e
0 'MIT'N ,
0. NORLIMLTINANYWAYTHECITYB B
DA ;UTY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscape Insp.
Total Amt. Due
I/
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, A D THAI I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
-
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
D
TION; AND IN OINr THE WORK
CALL
Th it Fri.` 'it ig YI 0
Vn S n. b b
AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF LABOR CODE OF
BiAl/do P ty: and F11S ino paltL and
,,,THE THE STATE OF WASHINGTON
WORKMEN'S C ENSATION INSURANCE AND RCW 18,17. RELATING TO
FOR INSPECTION
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G_�
OF W IONA USE
SIGN
(425)
I �EltNEJ
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771-0220
BY �GA�TE
eELEASED By
ATTENTION
EXT 1333
DATE
/OWGINAIL-FILE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. LED SECTION 109
- YELL
04102
PINK OWNER - GOLD -ASSESSOR
PRESS HARD -YOU ARE
MAKING 5 COPIES GREEN - ACCOUNTING
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FINAL PROJECT APPROVAL FORM
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DATE
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: _—YIRE DEPARTNIENT DATE —
ENGINEERING DIVISION DATE—
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PLANNING DIVISION DATE--ZL/- �/t'— I
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DESCRIPTION OF WORK TO BE INSPEC Mz
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A field inspection was conducted to determine final compliance with approved plans. Final approval z
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of: 0
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GRANT FINAL PROJECT APPROVAL 0 r-
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
o Copy of CONDITIONS given to owner/contractorby inspector >
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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a Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE-INspECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date_ Sign_
ocaprvl.doc.l:temp:bldg:fomisIO/OI
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
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SETBACKS ............
FOUNDATION:
I D
Footing ....................
Wall ...............
Pier/Porch .................
Retaining Wall ...........
Slab Insulation
PLUMBING:
Underground ..........
OM
Rough -In
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Commercial Final
HEATING:
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Gas Test
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............
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Gas Piping
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............
Equipment
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Commercial Final
EXTERIOR SHEATHING
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NAILING .................
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FRAMING ........................
FIRST FLOOR FRAMING
ITIO
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INSULATION ...................
Floor Insulation
Wall Insulation ...........
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Calling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ................