20020950.pdfI DATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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OWNER NAMEINAME OF SLIS17S
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NAME
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NAME
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STATE UCENSE NUMBER EXPITA-tON DATE
CHECKED BY
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW 0 PLUMBING I MECH
ADDITION o C MPLANCE OR
CHANGE OF USE
REMODEL 'P-EI-N
REPAIR 0 GRADING PENCE
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DEMOLISH TANK 0 OTHER
Ei GARAGE RETAINING WALL [3 RENEWAL
CARPORT 0 ROOKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: irr
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NUMBER
OF
NUMBER OF
WELL NO
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AREAS
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
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PLAN CRIED '�'_7
DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: HE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
X 0 DRIVEWAYS, MARQUEES, ETC.) W
M OMAIN (CURIMI, SIDEWALKS, ILL REQUIRE
It SEPARATEPERMISIHON.
PER ITAPPLICATION: INDAYS
PERMIT UNIT I YEA. -PROVH3 D WORK IS STARTED WITHIN IGODAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND IUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FR M THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY WAIVE OR REDU E ANY REQUIREMENT OF ANY CITY ORDINANC
0 N OR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNS . I AGREE TO COMPLY WITH CITY AMC) STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATIO OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18,27,
"GMTU" (OWNER Oq� �RT)
DATE SIGNED
LPERMIT EXPIRES
PERMIT h
OR ES
DDA SC�� 5(X, A
SUITEAPTI
PLAT NAMEISUBDIVISION NO,
LOT NO.
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0 FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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EXISTING - PROPOSED
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REQUIRED DEDICATION- FT
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13
METER SIZE LINE SIZE No, .1 IIXTURE.
REQUIRED
YPRV
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AEMARKS
aWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
:IRE REVIEWED By DATE
VARIANCE OR CU
SHORELINE OR ADB#
INSP 'ON
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I BOND
POSTEC
XFIEO.
ES C3 NO
SEPA REVIEW
SIGN AREA
HEIGHT
'OMPLETE EXEMPT
ALLOWED PROPOSED
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LO COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ILLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
PARKING
LOT AREA
P)AJ/JG ATE
JED D I PROVIDED
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ECIALINSPECTOR AREA OCCU NT
JEOUIRED 0 YES L AD
EMARKS
IROGRESS INSPECTIONS PER UBC 110811FINAL INSPECTION REOO
VALUATION $
Descirlietion I FEE D ... rlpticI7 FEE
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Plumbing
Mechanical
Grading
Recording Fee
Engr. Review
City Surcharge
Engr. Inspection
State Surcharge
Traffic Mitigation
Plan Chk Deposit
Fire Review
Receipt #
Fire Inspection
Total Amount Due
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Landscapoinsp.
Receipt #
CALL
FOR INSPECTIi N
(425)
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APPLICATION APPROVAL
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ATTENTION EXT 1333 /At�'a -
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 119712�
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 771-0221
ORIGINAL � FILE INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109 FAX PINK - OWNER - COLD - ASSESSOR
rotor
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE,—.
PLANNING DIVISION DATE -414:,-3-
PROJECT
SITE ADDRESS po L..) t-1
PERMTF# 01-- f2fO ADB#--DATE INSPECTED
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
1.
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
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION'
Footing ......................
Wail ............
Pier/Porch .................
Retaining Wall ...........
Slati Insulation
PLUMBING:
Underground . ............
Rough -in
Commercial Final
HEATING:
Gas Test ...........
Gas Piping
Equipment
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAfV,!NG ........................
FIRST FLOOR FRAMING
NSULMION .1 .............
Floor Insulation
Wall Insulation ...........
Coiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ...............
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