20020772.pdfMR GA-WIIECEIVED
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CITY OF EDMONDS NUMEIER�),/
CONSTRUCTION PERMIT APPLICATION JOB SUFTEJAPT#
ADDRESS
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OWNER
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MAILING ADORES D FEE $
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CITY EXISTING - PROPOSED
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REMARKS
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONITA,
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ADDRESS PRESENT FOfrE
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FIRE REVIEWED BY
CITY
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STATE LICENSE NUMBER EXPIRATION VARIANCE OR CU IHORELINEORADSs INSPECTI N BOND
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AT' CHECKED BY REDD POSTED
OYES ONO S
SEPA REVI To" AREA HEIGHT
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AFENCE
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PRO ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO. cc XEMPT ALLOWED lease
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P'UM-1N vmEcH L LOT OVERAGE REOUJI ED SETBACKS I".) P OPOSED SET ACKS (FT.)
NEW PLUMBING H A LOWEIC PROPOSED FRONT SIDE BEAR FRONT LIASIDE FEAR
COMPLIANCE OR
ArrorrION CHANGE OF USE
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Mo PARKING LOT A;97[TM.IN. REW.. BY DATE
M BE DEL n SIGN REGQ I PROVIDED
GRADING
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El REPAIR [j CYDS X FT) REMARKS
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c3GARAGE [3 RETAINNGWALL r-1 FIRE SPRINKI. A
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(TYPE OF USE, BUSINESS OR N:
CHECKED BY ITYP=N )ION CUFA-;'r_�
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NUMBER
NUMBER OF CRITICAL
DWELL No AREAS. /V/�_ SPECIAL INSPECTION GOOD NT
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RED" JAREA
ST LOAD
UNITS NUMBS IRED [I YES
DESCRIBE WORK TO BE DONE ()Ip 'flif (I I REMARKS ONREOID
PROGRESS INSPECTIONS PER UBC 11081FINAL INSPECTI
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Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE NO % LOT SLOPE
Building Permit
City Surcharge 4-
PLAN CHECK NO:
Plumbing
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
t: 3 DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ONTHE PUBLIC
Grading
DOMAIN (CURDS,SiDEWALKS, DRIVEWAYS E S, ETC.) WILL REQUIRE
SEPARATE PERM;SSIODU
Engr. Revies;
PERMITAPPLICATIOW INDAYS
PERMIT LIM t I YEAR - PROVIDED WORK IS BTARTEO WITHIN led DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON SERIAL OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Fire R-1"
Plan Chk, Deposit
IN INTEREST, AGREES To IN11MIDFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS' WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Receipt #
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THI PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF NYCI
S W ORDINANCE
Landscapeinsp.
Total A mt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,'
Recording Fee
Receipt #
I HERE ACKNOWLEDGE THAT I HAVE READ 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 ABBE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
This appinsion Is not a pennitentil signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATIO;AIHEALABNOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Brotding Officia; or hisihe, Deputy; and Fees are paid. and
necolpt 1, arlernavladged In space proWded,
WORKMEN'S ERR TIC INSURANCE AND RCW 18,27.
DATE
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LSIGN4ATURER
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DATE
ATTEN N
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IT IS UN FUL 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 00 -ASSESSOR
04102 PRESS HARD -YOU ARE
MAKING 5 COPIES GREEN ACCOUNTING
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FINAL PROJECT APPROVAL FORM
TO:
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DATE:
BUILDING DIVISION
MEMO TO: P7fto
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FROM: -do --YIRE DEPARTMENT DATE 10(bial—
ENGINEERING DIVISION DATE --
PLANNING DIVISION DATE.—
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PERMIT # 02- ADB#---------PATE INSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED �-477
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A field inspection was conducted to determine compliance with approved plans. Final approval denotes that
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there are no objections from the above signed Department to the granting of
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____Yinal approval of the described work
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FINAL PROJECT APPROVAL S TT
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____�GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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AILED FINAL INSPECTION - OUTSTANDING ISSUES
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___YE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
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INSPECTOR DATE APPROVED
SETBACKS ..............
FOUNDATION:
Footing ..................
wall ....................
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Pier/Porch .................
Retaining Wall ...........
Stab Insulation ..........
PLUMBING:
Underground
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Rough -in ...................
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Commercial Final
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HEATING:
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Gas Test ....................
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Gas Piping .................
Equipment . ............
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Commercial Final
EXTERIOR SHEATHING
NAILING
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FRAMING ........................
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FIRST FLOOR FRAMING
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INSULATION ...................
Floor Insulation
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Wall Insulation ...........
Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...............
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