20040016.pdf0
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS 1
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CITY ZIP [ELEPHONE
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NAME
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CITY ZIP ITELEPHONE
NAME CBL #
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ADDRESS
CITY ZIP
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STATE LICENSE NUMBER
PROPERTY TAX ACCOUNT PARCEL NO
VONA
TELEPHONE
EXPIRATION DATE
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NEW
RESIDENTIAL
ADDITION
..kCOMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
PLOCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) E4XPL,�IN:
^ Afn A # A
PLUMBING/MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
EiFENCE
( x FT)
El OTHER
FIRE SPRINKLER
FIRE ALARM
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
0 STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
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PERMIT EXPIRES
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USE PERMIT
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NUMBER _2XJ�l
JOB
SUITEIAPT#
ADDRESS UILI 'Iq
100
PLAT NAME/SUBDIVISION NO.
LOT fiO.
LID NO.
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LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TIESCP Approved
HW Permit Required
street Use Permit nort-ci
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EXISTING — PROPOSED
Inspection Required
Sidewalk Romiund
[3
13
REQUIRED DEDICATION— FT
Undeiground
Wiring required
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METER SIZE
LINE SIZE
NO. OF FIXTURES
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PRV REQUIRED
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� YES 13 NO
13
REMARKS
OWNER/CONIRACTOR RESPONSIBLE FOR EROSION CONIROLIDRAINAGE
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE , EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
N C�l
PARKING
REQ'D PROVIDED
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HEAT SOURCE
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GLAZING %
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PLAN CHECK NO: 6 �2— 0 VESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
cc PERMIT APPLICATION: 180DAYS
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PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
13 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 I HIS PERMIT SHALL NOT BE
a DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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0 NOR LIMIT IN ANY WAY THE CITYS ABILIrY TO ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY ACKNOWLEDGE 1HAT 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 V�6LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
�n&A0t:N1ZATInN1b&11iURANCr AND AGW 18.2T
NT) DATE SIGNED
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REMARKS
DATE
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SHORELINE OR ADB#
INSPECTION
BOND
REQ*D
POSTED
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SIGN AREA
HEIGHT
ALLOWED PROPOSED
ALLOWED,
PROPOSED
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REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (IF111
FRONT SIDE REAR
FRONT
UR SIDE REAR
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PLANNING REVIEWED BY
DATE
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CHECKED BY
ITYP CON?�UCTI
OCCUPANT
GROUP
SPECIAL INSPECTION
OCCUPANT
JAREA
LOAD
REQUIRED E
REMARKS
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PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
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VALUATIOKI
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
LandscapeInsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE Description FEE
qState Surcharge
City Surcharge /4��7
Lo—
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
I ttis application is not a permit until signed by the
Building oflicial or hl$/h(,t Deputy: and Foes are paid, and
jecoipt is acknowledged in space provided.
At
ATTENTION t:,& I I JJ13
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
04,02 PRESS HARD -YOU ARE MAKING 5 COPIES
AIGIqAL FI).E YELLCA/V - INSFSECTO
PINK`,,Q�IvNER GOLD - ASSESSOR
GREEN - ACCOUNTING
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FINAL PROJECT APPROVAL FORM
TO:
DATE: t Pr/-+ -
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PL-A "S N
PROJECT T
SITEADDRESS-- 2-2-S11
'�?00 (-t- 0c) 1(0 '5W DATE INSPECTED /I eel 7--- 4-
PERMIT#.=4:��-'
DESCRIPTION OF WORK TO BE INSPECTED- wwt( 5 "9,^ -
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
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
o Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
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 ...........
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0
Slab insulation ......
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PLUMBING:
M
Underground .............
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Rough -in ...................
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Commercial Final
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HEATING:
M
Gas Test ....................
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Gas Piping .................
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Equipment .................
Commercial Final .......
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EXTERIOR SHEATHING
NAILING ..........................
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FRAMING ........................
0 M
FIRST FLOOR FRAMING...
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INSULATION ...................
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Floor Insulation .........
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Wall Insulation ...........
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Ceiling Insulation .......
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SHEETROCK NAILING ...
SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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