20020875.pdfFA
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME
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ADDRESS
PERMIT
N MBER
JOB
ADDRESS SUITE11T1
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FLAT NAMEISUDDIVS'ON NO I LOT NO. LID
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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EXISTING � PROPOSED 13'.Z. I
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REQUIRED DEDICATION— Pr _ U,dd
RV REQUIRED
YES I No 13 E
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONIROUDRAINAGE
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NUMBER OF
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Description
FEE Description FEE
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Plan Check
State Surcharge
T URGE GLAZ %
LOT SLOPE
Building Permit
City Surcharge
PLAN CHEC!KNO:
VESTED DATE
Plu."'Rg
THIS PERMIT AUTHORIZES ONLY THE 0 KNOTED, THIS PERMIT COVER S WORK TO
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Mechanical
BE DONE ON PRIVATE PROPERTYWONLRY. ANY CONSTRUCTION ON THE
a 0 P
3 OMAIN (CURDS. SIDEWALKS, DRIVEWAYS, MARGUESS."TC. unLIC
) WILL REQUIRE
Grading
SCFA
t: RATEPERMISSION.
2 Engr. Revievs,
PEAMITAPPUCATION: I. DAYS
PERMIT LIMIr. I YEAR - PROVIDED WORK IS STARTED IN 180DAYS
SEE BACK 01 PINK PERMIT 1011 MORE IMIORMTATH&
Engr. Inspection
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND
Fire Review
Plan Chk. Deposit
AND HOLD HARMLESS THE CITY OF
WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
—
IDMONDS.
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISS GARDE OF THIS PERMIT ISSUANCE OF THIS ERMIT $HALL NOT BE
Fire Inspection
Receipt #
— )CXC�
'91 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY Ty ORDINANCE
Landscapelnsp.
Total A.t. Due
NOR LIMIT IN ANY WAY THE CITY's ABIL17Y TO ENFORCE ANY GROINACICIE PROVISION, -
MI
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY A THORIZED AGENT OF
THE
APPLICATION APPROVAL
OWNER , I AGREE TO COMPLY WITH C17Y AND STATE LAWS REU ING CONSTRUC.
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSCOULWAILL BE EMPLOYED
CALL
Thl..PPIIIw� P.I. p-4-11 Mp.d by lh�
N VIOLATIOV:,4"E LABOR CODE OF THE STATE OF WASHINGTON nELATING TO
WOFIKMEN'S RATION INSURANCE AND RCW 18.27.
FOR INSPECTION
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(425)
OFFJ�IALS SIG DATE
/'7TUSE
771-0220
*AE
A17ENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL Oil A CERTIFI.
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
OR G HAL - FILE YELLOW - IdSPEC'TOR
04/02
PRESS HARD -YOU ARE
P;NX-OWNER GOUD-ASSESSOn
MAKING 5 COPIES GREEN - ACCOUNTING
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BUILDING DEPA N" i
WORK
APPROVED AS NOTED A L� U)
BY ENGINEERING OWNER_,
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE-
C_ S ENGINEERING DIVISION DATE_�(' - -C)S
PLANNING DIVISION DATE -
PROJECT
SITE ADDRESS, 199'07 9(,,U, VJ
PERMIT #__AOOO� 09'7 5 ADB#-----PATE INSPECTED--L,-L 0 _3
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine final 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 granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u 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 .................
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0
Retaining Wall ...........
0
Slab Insulation
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PLUMBING:
Underground .............
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ID
0
Rough -In ...................
0
Commercial Final
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HEATING:
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Gas Test ....................
Cas Piping ..........
0 -n
Equipment
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Commercial Final
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EXTERIOR SHEATHING
6 Fn
NAILING .................
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FRAMING ....................
IT 0
FIRST FLOOR FRAMING
INSULATION ...................
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Floor Insulation
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Wall Insulation
Ceiling Insulation
SHEETROCK NAILING
0
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SPECIAL INSPECTION
MISCELLANEOUS
FINAL AP ROVAL FOR
P
OccuWmey ..............
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111'1193
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