20040046.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEJNAME OF BUSINESS
MAILING ADDRrss
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CITY ZIP jTiEL.EPHONE
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NAME
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ADDRESS
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STATE LICENSE NUMBER EXP ATI 7N TE Y
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PROPERTYX
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NO.
211
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NEW RESIDENTIAL
PLUMBING/ MECH
ADDITION
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COMPLIANCE OR
CHANGE OF USE
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NUMBER
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CRITICAL
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UNIT
NUMBER
7
DESCRIBE WORK TO BE DONE
17
/14'
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LOT SLOPE %
PLAN CHECK NO P��/? VESTED DATE
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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.
ILI PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
in 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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
X FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
'3 DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY 10 ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THATTHE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WI1H 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 COMPENSAT19�;�URANCE AND RCW 18.27.
SI RE (OWNE/RR (GEN�V
DATE �RNED
USE
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ADDRESS
PLAT NAMEISUBDIVISION NO.
PERMIT EXPIRES d!�=zj
PERMIT
NUMBER
SUITE/APT#
LOT NO. LID NO.
I I LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
TESCP Approved
RW Permit Required
Street Use Permit Roq'd
inspection Required
Sidawalt, Required
Underground
Wiring required
PRV REQUIRED
YES 13 NO 0
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLYDRAINAGE
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07 7 1.0 t-2-0 1:3
ENGINEERING REVIEWED BY
2) - A, (L'66r
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
EXEMPT
EXP I
LOT COVERAGE
ALLOWED PROPOSE[
PARKING
REO'D I PROVIDED
REMARKS
i
SHORELINE OR ADBN INSPECTION BOND
REO'D ;3 OSTED
OYES X�o Is
SIGN AREA HEIGHT
ALLOWED PROPOSED ALLOWED I PROPOSED
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REQUIRED SETBACKS (IT) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT L/R SIDE REAR
�(OT AREA I PLANNING REVIEWED BY DATE '7
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CHECKED BY JTYP� nRUCION C?
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SPECIAL INSPECTION AREA OCCUPANT
REQUIRED [D YES LOAD
REMARKS z
PR2GRESS INSPECTIONS PER UBC 11081FINAL INSPECTION REO'D
,Y.-J-PhyliQ 9141 Ma_,il�
VALUATION
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Ad py-1 i rq
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Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
.
Landscapelnsp.
Total Amt. Due
Recording Fee
LReceipt #
APPLICATION APPROVAL
CALL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Foes are paid, and
FO INSPECTIO
receipt is acknowledged in space provided.
OF '�LS SIGNA UBE DATE
25
(425)
771-0220
I r I
RELEASED B bAftE
ATTENTION I I
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL L4
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI_
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
0.1102 PRESS HARD -YOU ARE MAKING 5 COPIES
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE-------
MAWSM ENGINEERING DIVISION DATE. -1 '
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PLANNING DIVISION DATEL ------ - —
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PROJECT U*-ftda
SITE ADDRESS-10-L. B# ECTED
PERMIT
DESCRIPTION OF WORK TO BE INSPECT-ED (-26A
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 .
RMANCE BONDS and the granting of:
PERFQ
____7�,_GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
U copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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FINAL PROJECT APPROVAL FORM
TO:
D A T E:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLeME SIGN
IlAt &X,(A 1-4, 14 —ENGHSTEERING DIVISION DATE
PLEA
SESIGN
PLANNING DIVISION DATE
PLWP SIGN
PROJECT
SITE ADDRESS
PERMIT# INSPECTED 1AL'.�—'104
DESCRIPTION OF WORK TO BE INSPECTED
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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
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
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 Si
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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:
GasTest ....................
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 ..................
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