20030278.pdf04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
DATE RECEIVED
1 1PERMIT EXPIRES
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CITY OF ED70NDS ZO
CONSTRUCTION PERMIT APPLICATION JO
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OWNER NAME/NAME OF BUSINESS
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STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
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RESIDENTIAL PLUM13ING MECH
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ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
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REPAIR CYDS ( _W" & Fn F
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Ei GARAGE RETAINING WALL FIRE SPRINKLER
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
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PERMIT UMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. 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
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY; WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
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I HERE13Y 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 OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRLIC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLAT ON OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN!S COMPENSATIO��NCE AND RCW 16,27.
WNER ORA ENT)
DATE SIGNED
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NUMBER
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PLAT NAM E/SU BDIVI SION NO.
LOT NO.
L�D NO.
L D FEES
UBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP APP(oved
RW Permit Requ:r0d
Street Use Pa mt Roq'd
XISTING — PROPOSED
InspoctionRoquirad 13
Sidewalk Required 13
REQUIRED DEDICATION— FT
Underground
Wiringroquired E3
METER SIZE
LINE SIZE
NO. OF FIXTURES
REQUIRED
YEPSRIV 13 39
NO
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EMARKS
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WNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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REVIEWED BY , DATE
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/ARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND
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LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
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,PEC�IAL INSPECTION JAREA OCCUPANT
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EMARKS
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110GRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG'D 9
iALUATION
Description
FEE
Description
FEE
)Ian Check
State Surcharge
3uilding Permit
City Surcharge
3lumbing
Oechanical
3rading
=ngr. Review
=ngr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fe
Receipt #
CALL
FOR INSPECTIO
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APPLICATION APPROVAL
5 ap % lion is not a permit until signed by the
B I�d)Olfpic tialor his/her Deputy: and Foes are paid, and
7B ceipt Is acknowto in space provided.
ATURE D/AT
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ATTENTION EXT 1333
4SPEC/TOR
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- OR41GINAL F1
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWqEU-,e GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
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DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE,
ENGINEERING DIVISION DATE_!Pj�
PLANNING DIVISION DATE--.:--
PROJE
SITE ADDRESS yj_
PERMIT# ouo-362na ADB#--------PATEiNspEcTED—L2LqJo3—
DESCRIPTION OF WORK TO BE INS
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
P ERFORMANCE BONDS and the granting of:
�_GRANT FINAL PROJECT APPROVAL
GRAM PROJECT APPROVAL WITH CONDM- ONS NOM
a. Copy of CONDMONS given to owner/contractor by inspector
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FAHM FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
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2.
3.
RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date— Si
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....
................
Gas Piping .................
Equipment.................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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A IiDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEtNAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
vV WA- 10 -;-, 3
NAME
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ADDRESS
CITY ZIP TELEPHONE
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NAME CB N
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ADDRESS
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PERMIT EXPIRES
USE PERMIT
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NUMBER
JOB SUITE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
L D NO.
;241
L�D FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP APPFOVOU
my Permit Required
Stroat Use Permit Req'd
EXISTING — PROPOSED
inspection Required [3
Sidewalk Required [3
REQUIRED DEDICATION— FT
undorgrowd
Wiring required
METER SIZE
LIN�'�
NO. OF FIXTURES
PFIV REQUIRED
ES C3 NO 13 9
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
CITY ZIP
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INSPECTION
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STATE LICENSE NUMBER EXPIRATION DATE
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SEPA REVIEW
COMPLETE EXEMPT
FIGN WAREA -
ALLOWED PROPOSED
HEIGHT
ALLOWEk PRIP7ED
PROPERTY TAX ACCOUNT PARCEL NO.
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EXP ,
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[IrNEW RESIDENTIAL 0 PLUM13ING / MECH
COMPLIANCE OR
ADDITION COMMERCIAL 0 CHANGE OF USE
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT LJRSIDE REAR 0
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PARKING
RECID I PROVIDED
LOT AREA
I PLANNING REVIEWED BY DATE
512 7Ji
REMODEL MULTIFAMILY SIGN
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0 REPAI R 13 ( 0,111/ x
REMARKS
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DEMOLISH TANK [:I OTHER
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GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY F RE ALARM
OWE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
aw Q_Ittaoye
CHECKED BY
TYPE
OCCUPANT
GROUP
NUMBER
OF"
STORIES
NUMBER OF
DWELLING
UNITS
CRITICAL
AREAS P
UMBE
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SPECIAL INSPECTION JAREA,
REQUIRED [] YES
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE ljf:)�IeA )
REMARKS z
GRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG-D
Tr:n
el*,,. 1"A P, L, &4 4 —A
VALUATION
Plan
HEAT SOURCE
GLAZING %
LOT SLOPE %
Bdii'dfng Permit
Plumbing
PLAN CHECK NO: VESTED DATE
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
1=
32
CL
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: ISO DAYS
PERMIT UMM I YEAR " PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Review
Engr. Inspection
Fire Review
2
IALL
9
0
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CI1YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Fire Inspection
Landscapeinsp.
Recording Fee
I HERE13Y 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 OWNER. I AGREE 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 CODE OF THE STATE OF WASHINGTON RELATING TO
CALL
FOR INSPECTR
WORKMEN'S COMPENSATI��NCE AND RCW 18.27.
1
1A9
111-25)
—
SIGNATURE (OWNER OR
DATE SIGNED
VAkEN"T)
771-0220
FEE Description FEE
city
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROWLL
Xs application is not a permit until signed by the
�§ Official or his/her Deputy: and Fees are paid, and
ilecolot Is acknowloiddeA in space provldo,i.
/,� 1. -, �
ATTENTION t:A I I jjj '1—" / L
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YELLOW - I SPECTOR
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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