20040048.pdfI
DATE RECEIVED �PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAMENAME OF BU5INESS
RiPLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS LID FEE S
TESCP Approved 0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 13
street use Permit Roq,d 0
CITY EXISTING - PROPOSED inspection Required 13
ZIP TELEPHONE Sidewalk Required CI
I 0� - Underground [3
1� REQUIRED DEDICATION- FT Wiring required
r,�� �;06 6131-3 .- // 4/
NAME METER SIZE LINE SIZE NO, OF FIXTURES PRV REQUIRED 0
YES NO 9
4
ADDRESS REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE (5
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CITY ZIP TELEPHONE 7 f, `H AL
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NAME CBL:
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ENGINEERING'�A\(4 ATE
ADDPX-$s �Pj 67 FIRE REVIEWED BY
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CITY . ZIP TELEPHONE
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VARIANCE OR CU SHORELINE OR ADS# INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DAT CHECKED)jY REO'D POSTED
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c"D C 1 11' ., %_1 I I I OYES ONO S HEIGHT
SEPA REVIEW SIGN AREA ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE , EXEMPT ALLOWED , PROPOSED
14 o coLD-1 kc 62 0 U EXP
LOT COVERAGE REQUIRED SETBACKS (Fr) PROPOSED SETBACKS (Fr.)
El NEW RESIDENT!AL ED PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
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COMPLIANCE OR 2
ADDITION COMMERCIAL 13 CHANGE OF USE z
PARKING LOT ARE LANNING REVIEWED BY DATE
0 REMODEL MULTIFAMILY 1:1 SIGN REO'D PROVIDED
GRADING FENCE I I
REPAIR CYDS 1:1 ( x FT) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE. BUSINESS OR ACTIVIM EXPLAIN: UCT E
CHECKED BY ITYPE ION con OCCUPANT Pj
)N 11 GROUP
IA16 CT t
Dec S
NUMBER NUM13ER OF CREITICAL
OF WELLING AR AS SPECIAL INSPECTION JAREA OCCUPANT
STORIES NITS NU REQUIRED [] YES LOAD
DESCRIBE WORK TO BE DONE C3
REMARKS z
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ
LUATION
ELL 7MA 1
F1_1YA4":_- RAA $
Renov-� I //,o i- g,P4�� 1�: Description FEE Description FEE
C hp *r/wm m 4 Ive N-t fy — Plan Check State Surcharge
HEAT S GLAZING % LOT SLOPE %
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON HE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WI L REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr, Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review Plan Chk. Deposit
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
J
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt 0
r ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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r FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapeinsp. Total Amt. Due
3 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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D NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION
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Recording Fee Receipt #
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
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
THE OWNER. CALL Building Official or his/tier Deputy: and Fees are paid, and
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 FOR INSPEC7 receipt is acknowledged in space provided.
WORKMEN'S C C
��SATION ll� �RCE AND R,V 18.27. 0 FI I S SIGNATU DATE
S)GNAT OWNER 0 GEN DATE SPNED (425)
71- - DATI!
� =:L /P -:�4 0 771-0220 AEASED BY
ATTENTION tA I I jjj
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW, INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
04i02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: C I- ' FIRE DEPARTMENT DATE 2--_2
PLPASE SIGN
ENGINEERING DIVISION DATE
PLYASE SIGN
PLANNING DIVISION DATE
PLEASESIGN
PROJECT
SITEADDRESS- Cf— 2- OL S'
PERMIT —ADB#_______--DATE INSPECTED 2-
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
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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
Date Sign____,
ocaprv1.doc.1:temp:b1dg:fbnns 10/0 1
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ............ ...... 7
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 ..........
--TIT.
FINAL APPROVAL FOR
OCCUPANCY .................. A
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