20040020.pdfDATE REC
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
CITY
NAME
ADDRESS
141110
NAME
ioo
CITY
4�1 (il lz�, 5 L't-) —
ZIP TELEPHONE
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J blIP-7
LICENSE NUMBER
kf.V4
M119
TELEPHONE
CBL 90
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ZIP TELEPHONE
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EXPIRATION DATE 1,,,�ECXED 01
Tr_9 )441 �3 �� 1-1/01. �__64
PARCEL NO.
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
El
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
th
NUMBER NUMBER OF
OF DWELLING
0 STORIES UNITS
DESCRIBE WORK TO BE DONE
-!n t� 10�/; /
HEAT SOURCE I GLAZING %
PLAN CHECK NO:
NJ PLUMBING I MECH
7�
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
LOT SLOPE %
VESTED DATE
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.
Lu PERMIT APPLICATION: 100DAYS
IL PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 100 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 DIREc rLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 'I HIS PERMIT SHALL NOT BE
_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
21 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
ZONE
110D
ADDRESS
PLAT NAME/SUBDIVISION NO.
PERMIT EXPIRES —L-4—!:�-
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PERMIT
NUMBER
SUITE/APT #
Cl [O+h 5, - __
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LOT NO. LID NO.
LID FEE $
JESCP Appfovea
0
13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
m Pormil Hnquiwd
st"ni use Permit RDq,d
[3
EXISTING — PROPOSED
I
inspoction Required
Sdawalk Hoqtjtl(,d
Q
13
REQUIRED DEDICATION— FT
undotgtound
Wiringfoquired
[3
METER SIZE
LINE SIZE
NO OF FIXTURES
PRV REQUIRED
I
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YES [I NO 13
REMARKS
OWN ER/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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'AADit-OLAD
ENGINEER
FIRE REVIEWED BY
DATE
DATE
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VARIANCE OR CU SHORELINE OR ADBI I INSPECTION I BOND
REO'D I POSTED
OYES ONO IS
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP I
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE 5
REO'D I PROVIDED I (L
REMARKS
CHECKED BY I TYPE OF
OCCUPAN.n
GROUP
SPECIAL INSPECTION
OCCUPANT
JAR5A
REQUIRED [] YE
LOAD
REMARKS
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PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REQ'D
5
VALUATION
Description
FEE
Description
ME!
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Base ee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
LandscapeInsp.
Total Amt. Due
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATI01]N
GIVEN IS CORRECT; AND THA1 I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF TP'PLICATION APPROVAL
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- I his application is not a permit until signed by the
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TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
ro SP C 0 receipt is a
IN V61LATION OF THE 0 R C ODE OF THE STATE OF WASHINGTON RELATING TO (O:R:l N S P E cknowledged in space provic)ecl.
WORKMEN'S COMPENSA7TN INqURANCE AND RCW 18 27.
SIGNATU DAT
LDATE SIGNED
—SMN�TURE (OWNER 3�AGENVT) (425)
771-0220 EASt-LJ HY
ATTENTI EXT
IT IS UNLAW 0 USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL Oil A CERTIFI_
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
TE
0131GINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PI EA E SIGN
01f 1� ENGINEERING DIVISION DATE Zz�
PLANNING DIVISION DATE---.
PLEASE SIGN
PROJEC
SITE ADDRESS ---
PERMIT # 20 ozf—
ADB#___________PATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED Ll"-Tg�fe �_-/
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
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
I .
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 .................
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
cd
OCCUPANCY .............
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