20020805.pdfDATE RECEIVED
PERMIT EXPIRES
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CITY OF EDMONDS IN
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CONSTRUCTION PERMIT APPLICATION A00GRESS
OWNER NAMEINAME OF BUSINESS 1. NO, — LID NO.
4 1 WA (�—e_ 777—
MAILING ADDRE S LID FEE I
210 03 396 PUBLIC RIGHT OF WAY PER OFF14 STREET MAP
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CITY HONE EXISTING — PROPOSED—
Wl� q 2,5-- 677 —e,37g REQUIRED DEDICATION— PT —
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NAME METER SIZE
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NAME
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CITY zip TELEIIIONE
STATE LICENSE NUMBER EXPIRATION A
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FIRE REVIEWED By DATE
VARIANCE OR CU SIIOIELINIOIADDI I I'SPECTIO
RE �D
SEPA REVIEW SIGN AREA E3YES ONO EP3.T
COMPLETE , EXEMPT ALLOWED , 1ROP.!IEG , PROPOSED,
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PLUMBING I MECH
LOT COVERAGE REQUIRED SETBA Ci's (Fr PROPOSED S ACKS (F`[)
NEW
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_ FRONT US SIDE AFAR
LOW HEAR
ALI
AL ED PROPOSED FRONT SIDE
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E] ADDITION
0 COMMERCIAL
COMPLIANCE OR
0 CHANGE OF USE
E] REMODEL
0 MULTIFAMILY
SIGN
PARKING LOT AREA PLANNING REVIEWED AY DATE
REQQ I PROVIDE
0 REPAIR
[3 GRADING cy..
PENCE
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REMARKS
F1 DEMOLISH
gt TANK
OTHER
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CAR
AFTAININGWALL
C3 ROCKFRY
0 FIR SPRINKLER
FIRE ALARM
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(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
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DESCRIBE WORK TO BE DONE
PROGRESS INSPECTIONS PER UBC 1001FINAL INSPECTION REOI
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Description
FEE
Description
FEE
Plan Check
State Surcharge
GOTING % 'Or "OFF %
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
P
IV
Mechanical
THIS PERMIT AUYHORIZES ONLY THE ORKNOTED. THIS PERMIT COVERS WO"KTO
t BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION 0. jr.E PUBLIC
Grading
1
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS ETC.) WILL REQUIRE
2 GNU "B"
t: 5 EPARATE PERM;SMSAI
Review
2 - -JEngr.
PEA ITAPPLICATION: INDAYS
MPROVIDED
PERMIT LIMIT. I YEAR � WORK IS STARTED WITHIN 180DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICAW. ON RENAL OF HIS OR HER SPOUSE, HEIRS�ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
11. INTEREST, AGREES TO INDEMNIFY, DEFEND AND NO 0 HARMLESS THE CITY OF
IDMON11, WASHINGTON, ITS OF1ICIAL1* EMPLOYEES, AND AGENTS FRO" ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARE No DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE F THIS PERMIT SHALL NOT BE
DEEMED TO MODIF`r� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp.
lTotalAmt.Due
NOR LIMIT IN ANY WAY THE CITYS AINUTY TO ENFORCE ANY ORDINANCE PROVISION, -
Recording Fee
Receipt # LOB
I HERESY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
0 COM
THE OWNER. I AGREE T PLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL XX XIgn.d by 11P,
"i I
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
RAMP
FOR INSPECTION
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4.dI,,"P4�- �Ided.
WORKMENA,q�ON INSURANCE AND RCW 18.27�
OF1I:tjR4=
SIG A I AGENT E SIGNED
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(425)
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REVSED By
DATE
77E'NTION
BIN 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-FtLE
YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK
-OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES,
GREEN -ACCOUNTING
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
Nmmo,ro: PE G DIVISION
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FROM: FIRE DEPARTNMNT DAXE
ENGINEERING DIVISION DATE -
PLANNING DIVISION DATI�-
PROJECT
SHE ADDRESS-
PERMrr ADB# INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED---.!:�-1-"'
A Held inspection was conducted to determine flual compliance with approved plans. Final approval
denotes that there are no objections from the above signed Department to the release, of
PERFORMANCE BONDS and the grantine of:
--.:�GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WIIH CONDITIONS NOTED
o Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
C3 , 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 ..........................
Pier/Porch .................
z
Retaining Wall ...........
0
Stab Insulation
M
PLUMBING:
Underground .............
am
0,
Rough -in ..............
m
0
0
Commercial Final
C:
HEATING:
m
m z
Gas Test ....................
Gas Piping
.................
Equipment .................
0 -n
-n
-4
Commercial Final
x
M M
EXTERIOR SHEATHING
0
NAILING ..........................
0
0
FRAMING ........................
M 0
FIRST FLOOR FRAMING
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INSULATION ...................
Floor Insulation
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Wall Insulation ...........
Ceiling Insulation
0)
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SHEETROCK NAILING
SPECIAL INSPECTION
m
p MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY