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CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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OWNER NAMEINAME OF BUSINESS lz-lj^lvr
PLAT NAMSISUDDIVISION NO.
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L D FEE $
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PUBLIC RIGHT OF WAY PER
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDMINAGE
CITY ZIP
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NAM
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ENGINEERING
REVIEWEDIDATE
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FIRE REVIEWED BY
DATE
ZIP
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STATE LICENSE NUMBER EXPIR
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SIGN AREA I
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HEIGHT
ALLOWED PROPOSED
4,
NEW RESIDENTIAL PLUMBING I MECH
[3 ADDITION COMMERCIAL 0 COMPLIANCE OR
CHANGE OF USE
LOT COVERAGE
ALL07;/;77;D
REQUIRED SETBACKS (Fr.) PROPOSED
11 SIDE REAR
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SETBACKS (Fr.)
FRONT UPSIDE REAR
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REMODE [3 APARTMENT
REPAIR GRADING [3 F NCE
GYDS ( _ X Fr)
REMARKS
DEMOLISH 0 TANK OTHER
[3 GARAGE o RETAINING WALL [3 RENEWAL
CARPORT ROCKEHY
ITYP9 OF USE. �/USINESS OR ACTIVffY) UP
CHECKEDBY ITY%
A�STU ION
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OCCUPANT
GROUP
NUMBER NUMBER OF
OF as 6&j j= U WELLING
STORI IV�q_
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AREA ER
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SPECLALINSPECTOR
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DESCRIBE WORK TO BE DONE
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REMARKS
PROGRESS INSPECTIONS
PER USC 1108/FINAL INSPECTION REO'D
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VALUATION $
Description
FEE
Description
FEE
6 71 "' 1--,eom 450P.IVAJOS (-)r`It/ 0ZCA13 �11&?B
Plan Check
HEAT SOURCE GLAZING LOT SLOPE %
Building
16-
PLAN CHECK NA VESTED DATE
Plumbing
THIS PERMIT AUTHORIZES ONLY THE WbRK NOTED. THIS PERMIT COVERS WORK TO
HE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
D Eau
ONAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL Fr IRE
SEPARATE PERMISSION.
PE M"App"CATION: ISODAYS
Mechanical
Grading
EngL Review
Recording Fee
City Surcharge
PERMIT LIMM I YEAR - PROVIDED W RK IS STAFrF9D WITHIN 180 DAYS
SEC BAD. 01 PINK PIERMIT FOR 140FIERIFORMATH).
Engr. Inspaction
State Surcharge
*APPLICAN7' ON OE-11 01 HIS OR 1111 1POU11. HEIRS� ASIKINI AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, 05FCND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. IT$ OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. AR11W. DIRECTLY OR INDIRECTLY
FR. .a OF 'HIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
IVIED TO I WAIVE
as. - T3 .=F OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0. NOR LIMIT IN ANY WAY THE CITY'S ASILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Traffic Mitigation
Fire Review
Fire Inspection
Landscapelnsp.
Plan Chk Deposit _&)L)
Receipt #
Total Amount Due q7. >1'
I
Receipt #
I HERE ACKNOWLEDGE THAT I HAVE READ I.I. APPLICATION; THAT THE INFORMATION
GIVEN IS COB ECT. AND THAT I ALI THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGRE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR Coos OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATI W 18.2 �
APPLICATION APPROVAL
CALL Tha-pple.1i.. is.., a pannh.pIll signed by .
OUIW17 y: and Res are pale, and
FOR INSPECTION 'Inj p an W dead In space pr-Ided.
AT
L:::'�.E �JOE E SIGNED
(425)
1 -r7l-02:20
I
OfFic IGNATURE
01la-
IYEASED BY DATE
ATTENTION(K'00 E 1333
;�
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTI
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CE . RTIFL 771-0221
CATE OF OCCUPANCY HAS BEEN GRANTED. U13C SECTION 109
FAX
ORIGINZL-1�4/. YELLOW- 114SPEKTOR
PINK-OWi& - GOLD -ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: DEPARTMENT DATE
JENGINEERINGDIVISIONDATE�-
PLANNING DIVISION DATE
SITE ADDRESS C-Dmbf4vt� WAY
PERmrr # 20�,- 0798 ADB#-.�L--M DATElNsPEcTED
DESCR IPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine final compliance with approved plans. Filial approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a 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�._ Sign,
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall ................
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Pier/Porch .................
0
Retaining Wall ...........
Slab Insulation
PLUMBING:
3:
M
C
Underground
rn 0
0
-40
0
Rough -in ............
a
Commercial Final
171
M z
10-4
HEATING:
c
Gas Test ....................
Gas Piping
_n
Equipment ..........
ITIM
Commercial Final
0
0 Fn
EXTERIOR SHEATHING
C 0)
NAILING ..........................
C ,
M 0
FRAMING
r
FIRST FLOOR FRAMING
W
INSULATION
Floor Insulation
Wall Insulation ..........
Ceiling Insulation
z
0
SHEETROCK NAILING
M
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
dM
OCCUPANCY ...............