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DATE RECEIVED 49� 1 1 -/h? _�3 1 1 PERMIT EXPIRES
I USE PERMIT
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWN NAMEINAME OF BUSINESS
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MAILING ADDRESS
CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY
ZIP I TELEPHONE
ZONE N U M B E R
JOB SUITE/AP I #
ADDRESS 51
PLAT NAMEISUBDIVISION NO LOT NO. LID NO.
LID FEE S
TIESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required [3
Street Use Penrn't Roq'd 13
EXISTING - PROPOSED inspection Required
Sidewalk Required
REQUIRED DEDICATION IFT Underground
Wiring required
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES NO 13 z
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REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLYDRAINAGE 3
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VARIANCE OR SHORELINE OR ADB4 INSPECTION BOND
STAITE LICENSE NUM13ER !XPIRATION DA E ny
SEPA REVIEW SIGN AREA HEIGHT
1-1" 1 EXE ALLOWED PROPOSED ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO. . MPT
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EXP
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT)
NEW RESIDENTIAL PLUMBING MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
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COMPLIANCE OR 2 i
ADDITION MMERCIAL z
CO CHANGE OF USE PARKING LOT AREA ED BY DATE 5
_j,RLAhWIqG REVIEW
E REMODEL MULTIFAMILY SIGN REQ'D PROVIDED
GRADING Ei FENCE
REPAIR CYOS X FT) RE RKS
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OTHER
DEMOLISH TANK M �v -Gi r' -�
Ei GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN;
CHECKED BY TYPE OF CONSTRUfON 1COnr OCCUPANT
GROUP
In
Lu NUMBER NUMBER OF CRITICAL OCCUPANT
a OF DWELLING AREAS SPECIAL INSPECTION JAREA
M LOAD
0 STORIES UNITS NUMBER REQUIRED [] YES
DESCRIBE WORK TO BE DONE
REMARKS z
PROGRESS INSPECTIONS PER UE1C 108/FINAL INSPECTION REO'D
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61,02W - 6�1� VALUATION
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Dil§scription FEE Description FEE
Plan Check ZO 1 State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % ril City Surcharge
I Building Permit
HECK NO- VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 160 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
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
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt 0
ALL CLAIMS FOR DAMAGES OF WHATEVER NAT URE, ARISING DIRECTLY OR INDiREC I LY
* FROM 1-14E ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT 13E Landscape Insp. Total Amt. Due
* DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,'
x Recording Fee Receipt N
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
LATING CONSTRUC- This application is not a perinit until signed by the
THE OWNER. I AGREE TO COMPIY WITH CITY AND STATE LAWS REGU Building 011icial or his/lier Deputy: and Fees are paid, and
TION; AND IN DOING 'THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED icceipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO F_61`1 INSPECTION
WORKMEN'S COMPENSATI W 1827. URE DATE
,��URANCE AND RC OFF1 I�ALS SIGNt\T
SIGNATURE E R N10 DATE SIGt4ED
(WNE 11), (425) ILL
-0220
/2J 771 AELF 0 fATE
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ATTENb6N T_ EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE NTIL x
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CER IFI-,' ORIGINAL FILE YELLOW - INS4CTOR'
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ;)-aeli A 13_�31� PINK - OWNER GOLD - ASSESSOR
0.1,02 PRESS HARD -YOU %AE-MAKING 5 POPIES GREEN ACCOUNTING
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MEMO TO:
FROM:
PROJECT
FINAL PROJECT APPROVAL FORM
TO:
DATE:
PERMIT COORDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DATE
PLWF SIGN
ENG19EERING DIVISION DATE
PLEASESIGN
G—) ,__YLANNING DIVISION DATE S�1)11911124
SITE ADDRESS- (Y I
PERMITO�2�*�_C�0/7�ADB# DATE INSPECTED(D/�p 2/0
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DESCRIPTION OF WORK TO BE INSPECTED �5 / /1:)j
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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
PERFORNL4NCE 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
0 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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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLZASE SIGN
ENGINEERING DIVISION DATE
PLZASESIGN
PLANNING DIVISION DATE
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PROJECT
SITE ADI
PERMIT 42W�— GO �1ADB#__________PATE INSPECTED
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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:
11�/ GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
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0
Retaining Wall ...........
0
M
Slab Insulation ..........
PLUMBING: 71
Underground ............. M
C: 0
Rough -In ................... ITI 0
—1 0
Commercial Final ...... 0 C:
M
HEATING: M Z
Gas Test .................... C
Gas Piping .................
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Equipment ................. 0 -n
Commercial Final .......
M M
EXTERIOR SHEATHING 0
NAILING .......................... 0
0 M
FRAMING ........................ C: Cn
Cn
M 0
FIRST FLOOR FRAMING... Z
INSULATION ...................
Floor Insulation .........
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Wall Insulation ........... --I
Ceiling Insulation ....... Cl)
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SHEETROCK NAILING ... 0
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0
SPECIAL INSPECTION ... M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...........
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