20031001.pdf0
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY
ZIP I TELEPHONE
PLAT NAME/SUBDIVISION NO.
PERMIT EXPIRES
PERMIT
NUMBE
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- FT
METER SIZE LINE SIZE NO. OF FIXTURES
SUITE/APT#
LID NO.
LID FEE $
I ESCP Approved
RW Permit Required
Street Use Permit Req'd
InspecUon Required
Sidmalk Required
Undergromd
Wiring required
PRV REQUIRED
YES 13 NO 13
REMARKS
OWNER/CONTRAC7OR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
NAME
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STATE LICENSE NUMBER EXPIRATION PATE
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COMPLETE I EXEMPT
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SIGN AREA
ALLOWED I PROPOSED
HEIGHT
ALLOWED , PROPOSED
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PROPERTY TAX ACCOUNT PARCEL NO.
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LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT URSIDE REAR
NEW RESIDENTIAL PLUMBING / MECH
COMPLIANCE 08
ADDITION COMMERCIAL CHANGE OF USE
PARKING
REO'D I PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
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REPAIR GRADING FENCE
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REMARKS
DEMOLISH TANK OTHER
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NUMBER OF
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NUMBER
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DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REO'D
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VALUATION
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge_
PLAN CHECK NO: VESTED DATE
Plumbing
Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Lu PERMITAPPILICATION: 180 DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Grading
Engr. Review
Engr. Inspection
/9
APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 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
Fire Inspection
LandscapeInsp.
Receipt #
Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
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Recording Fee I
Receipt #
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DU& AUTHORIZED AGENT OF
APPLICATION APPROVAL
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
CALL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt Is acknowledged in space provided.
WORKMEN'S COMPENSATIO
,�PNG�IRANCE AND RCW 16,27.
sl OW E 0 GE T) DATE SI NED
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(425)
1 771-0220
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OVFIVI/jL4 SIGN k R DATE
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ATTENfION
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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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLWE SIGN
HAA110'3 b4 ENGINEERING DIVISION DATE. 41
PLEASESIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJEC
SITE ADDRESS q 16
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PERMIT # -ADB# DATE INSPECTED --
DESCRIPTION OF WORK TO BE INSPECTED vk/�'
A field inspection was conducted to determine 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
El Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
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2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall ..........................
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Pier/Porch .................
Retaining Wall ...........
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Slab Insulation ..........
PLUMBING:
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Underground ............. M a
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Rough -in ................... 0 0
Commercial Final ...... M
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HEATING: 0
GasTest ....................
Gas Piping .................
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Equipment .................
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Commercial Final .......
EXTERIOR SHEATHING o Fn
NAILING .......................... C 0)
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FRAMING ........................
FIRST FLOOR FRAMING...
ANSULATION
..................
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Floor Insulation .........
Wall Insulation ........... CA
Ceiling Insulation ....... z
SHEETROCK NAILING ... 0
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SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVALf-eW
'GoetmMy .................. riv-7
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DATE RECEIVED
CITY OF EDIVI ONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
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UITY zip TELEPHONE
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NAME
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CITY ZIP ITELEPHONE
NAME
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CITY ZIP I TELEPHONE
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STATE LICENSE NUMBER EXPIRATION
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PROPERTY TAX ACCOUNT PARCEL NO
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ADDRESS'
I PERMIT EXPIRES
PERMIT
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SUITE/APT#
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Street Use Permit Req'd
EXISTING — PROPOSED
Inspection Required
13
SideviaA Required
13
REQUIRED DEDICATION— FT
Underground
Wiring required
0
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES13 NO 13
REMARKS
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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FIRE REVIEWED BY
DATE
DATE Lu
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VARIANCE OR CU SHORELINE 08 ADB# INSPECTION -BOND
REQ'D POSTED
[:IYES ONO 1$
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE . EXEMPT ALLO I AIIOWED . PROPOSED
NEW RESIDENTIAL PLUMBING / MECH
19
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT QRSIDE REAR
'M
COMPLIANCE OR
0 ADDITION COMMERCIAL CHANGE OF USE
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PARKING
REO'D I PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
1:1 REMODEL MULTIFAMILY SIGN
GRADING FENCE
1:1 REPAIR E] CYDS ( X_ FT)
REMARKS
E] DEMOLISH TANK OTHER
[3 GARAGE RETAINING WALL o FIRE SPRINKLER
13
CARPORT ROCKERY F RE ALARM
(ME OF USE. BUSINESS OR ACTW" EXPLAIN:
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CHECKED BY
OCCUPANT
J,2
]TYPE
JCOI)
GROUP
A�l _j
NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
SPECIAL INSPECTION
OCCUPANT
UNITS
NUMBER
REQUIRED
]AREA
LOAD
.11A I
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG-0
VALUATION
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLbPE %
Building Permit
4/7— city surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
a TC.) WILL REQUIRE
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, E
SEPARATE PERMISSION.
Engr. Review
PERMITAPPILICATION: ISO DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
611
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAJMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscape Insp.
Total Amt. Due
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.'
zi
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION AP )ROVAL
GIVEN IS CORRECT AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPI.Y WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLAT ON OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt Is acknowledged In space provided.
WORKMEN!S COMPENSATION INS�RANICE AND RCW 18.27.
041 S SIGNATLIFIV DATE
si I W_ POP/AGE" DATE St NED
(425)
V,
/E
1.2 M /6
771-0220
RELE�Slfb(BY jPUA It:
Armffiom
W 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 -FILE - YELLON- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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