20020750.pdf_?
IT EXPIRES
CITY OF
ERMIT
EDMONDS
NUMBER
CONSTRUCTION PERMIT APPLICATION
JUD
SUDE/APT#
ADDRESS
PI.AT NAMEISUBDIVISION No. COT ho� I
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MAILING ADDRESS f.0
LO FEE
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PUBLI SIGHT OF WAY PER OFFICIAL STREET MAP
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EXISTING — pRopoSCD—
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REQUIRED DEDICATION—
NAME
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.-S. SIZE LINE SIZ7 NO. OF FIXTURES
P a ou'�S.
PRV REQUIRED
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YES E3 NO E3 M
REMARKS
WNERICONTRACTOR RESPONSIBLE FOR EROSION CONIROLiDMINAGE
ZIP ITELEPHONE
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CITY ZIP y I TE��l
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7ST E LICENSE NUMBER EXPIRATION
FIRE REVIEWED BY DATE
VASIANCEORCU I SH RELINEOnADB# INSPECTION BOND
REO'D POS
Es LINO S
SEPA REVIEW SIGN REA I H1IG11T
COMPLETE , EXENIP I AILOWEI) I PIIOPOI AILOWEV , �11IPOIEII
EXP X 118� 118; v5 r=,,Xtw Lq
NEW PLUMBINGIMECH LOTCOVERAGE U RE1,1U1'R1DSETBACKS.1F1) O1.SED SETBACKS IR)
A F C LT SID. aL FRONT US SIDE R
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COMPLIANCE OR
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_PA*NG LOTAREA G REW ED ATE
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rl REMODEL I-L 'D� —PROVIDED
REPAIR
El GRADING CyUS
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MARKS
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[3 TANK
o OTHER
[3 GARAGE
C ARPORT
RETAININGWALL
ROCKERY
111
ci F SPRINKLER
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(TYPE OF USE. BUSINE EXPLAIN:
64/t
CHECKED BY JTYPE��ION
77 OC UPANT
GROUP
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OF
DWELLING
SU..E. O��
I CRITICAL
AREAS
SPECIAL INSPECTION
OCOUPANT
STORIES
UNITS
R
NUMBER
JAREA
REQUIRED _S
(3 YE
LOAD
DESCRIBE WORK TO
BE DONE
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTIC
$ '*_0
ad )18 IF
Description
FEE
Description
FEE
.,yeov,�,
Plan Check
State Surcharge
HEAT SOURCE GIAZING % LOT SLOPE %
Building Permit
City Surcharge
_I
PLAI,
Plumbing
Mechanical
THIS PERMIT AUTHORIZED ONLY Yk WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
2 DOMAIN (CUFI6S,SIDEWAUKS,DflIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATEPERMISSION.
C
PE NUTAPPLICATION: IN DAYS
Engr. Review
PERMIT LUMM I YEAR - PROVID 0 WORK IS STARTED WITHIN 480 DAYS
Engr, Inspection
SEE SACK OF PINK PERMIT 10 MORE 11110104ATION
11
"S."
ON BEHAI F OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESOSS
Fire Review
F
Plan Chk. Deposit
;APPLKAN1.
S
�j INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
'1 0
AN Y AN.
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
F
Receipt #
DIRECT Ly
ALL CLAIMS FO DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY 08 INDIRECTLY
Nor CE
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT HE
DEEMED TO MODIFY' WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
]TO
Landscape map.
L
Total Amt. Due
0 NOR Lim r IN ANY WAY THE CIM ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
R.C.Ipt A,
HEREBY ACKNOWLEO E THAT I HAVE SEID THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE To COMP WITH CITY AND SrATE LAWS REGULATING CONSTRUC.
CALL
T1IppRI..1I.p.r.R H.Ip.dbyft
TION: AND III DOING THE WORK AUTHORIZED THEREBY, NO PERS N WILL BE EMPLOYED
CODE OF THE OF WASHINGTON RELATING
ld 111, 11, 111, 1,1
I,, .p dL0dI0spI?1PIq0j.
IN VIOLATION OF THE LABOR STATE
WORKMENe COMPENSATJ��SURAN r AND RCw HLZI.
FOR INSPECTION
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111EASED BY DATE
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER G LO - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING
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FINAL PROJECT APPROVAL FORM
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MEMO TO: PERMrF COORDINATOR, BUILDING DIVISION
FROM: -------YIRE DEPARTMENT DATE
NGINEERING DIVISION DATE
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PLANNING DIVISION DATE
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DESCRIPTION OF WORK TO BE INSPECTED—A&,������
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A field inspection was conducted to determine flual compliance with approved plans. Final approval
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denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
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FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_
ocaprvl.doc.l:temp:bldg:formsIO/OI
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall ....................
Pier/Porch
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
M
C
Underground .............
0
Rough -in ...................
C
Ac
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Commercial Final
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HEATING:
>
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Gas Test
0
Gas Piping .............
Equipment ............
3:9
M M
0
Commercial Final
0
EXTERIOR SHEATHING
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NAILING ... .......................
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FRAMING ........................
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FIRST FLOOR FRAMING
INSULATION _ ..............
Floor Insulation
Wall Insulation
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Ceiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................