20040040.pdfj
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
CC MAKING ADDRESS
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CITY TELEPHONE
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NAME
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ADDRESS
CITY ZIP TELEPHONE
NAME
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ADDRESS
1660
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CITY
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TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE
CljECKED
X C�
PROPERTY TAX ACCOUNT PARCEL NO.
7�
NEW
RESIDENTIAL
PLUMBING MECH
E ADDITION
lix-M MMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
1:1 REPAIR
GRADING
CYDS
FENCE
El I X FT)
1:1 DEMOLISH
TANK
OTHER
EiGARAGE
CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
MPE OF USE, BUSINESS�OFI ACTIVITY) EXPLAIN
4.
PERMIT EXPIRES /_ I ' f ' �7
USE
ZONE
PERMIT
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NUMBER
JOB
SUITE/APT#
ADDRESS
PIAT NAME/SUBDIVISION NO.
LOT NO
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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Siteril Uso flotmit Req'd
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EXISTING — PROPOSED
Inspri.ction Requinid
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13
HFOUIRED DEOICAIION_
FT
Underground
Wifing
[3
requirod
METER SIZE
LINE SIZE
I
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NO. OF FIXTURES
PAV REQUIRED
YES 13 NO 1:1
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER Allo�—
DESCRIBE WORK TO BE DONE I
A--r
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: 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.
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR FIER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN IN1ERESr, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS rHE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGEN FS FROM ANY AND
ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIREC FLY OR INDIRECT LY
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 CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
REMARKS
OWNERICONFRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
PURSUANT TO UPC 605.2
SHALL BE INSTALLED ON THB
LINiE As IT ENTM THE BMDINC
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
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VARIANCE OR CU SHORELINE OR ADBI I INSPECTION I BOND
REO'D POSTED
OYES ONO IS
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE_ , EXEMPT ALLOWED , PROPOSED ALLOWED I PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE 5
REQ-0 I PROVIDED (L
REMARKS
CHECKED BY
ITYPEIF
CON,9TR2,CTION
COM:
OCCUPANT
GROUP
SPECIAL INSPECTION-
OCCUPANT
REQUIRED E
JAREA
LOAD
REMARKS
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PROGRESS INSPECTIONS PER LIBC 108/FINAL INSPECTION REO'D
-
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscape Insp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
ATTENnON f EXT 1333
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
09,'03 PRESS HARD -YOU ARE MAKING 4 COPIES
I HEREBY 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
WORKMEN'S COMPENSAT19N-INSURANCE AND RCW 18,27.
SIGNATURE (O�NER 0 ACj6NT) DATE Sl ED
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a pennit until signed by the
Building Official or hisitier Deputy: and Fees are paid, and
receipt is acknowledged in space provided
OFFICIALS SIGI` ATURE D TE
RF1 FAS;rD 13Y DATEV.
0111GINAL 171LE YELLOW -INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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FINAL PIROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE--�
_0ENGINEERING DIVISION DATE
PLANNING DIVISION DATE ----
PROJECT
SITE ADDRESS Vt,,' 1VILAW4-
PERMIT ADB# DATRINSPECTED k&�
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was con , ducted 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
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
C, Copy of CONDITIONS given to owner/contractor by inspector
FAMED FINAL INSPECTION - OUTSTANDING ISSUES
a 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 ... .............
Ft6tAining
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 .................. Iz
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