20040075.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OW ER NAME/NAME OF BUSINE�4
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MAILING ADDRESS
CITY ZIP TELEPHONE
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NAME
ADDRESS
PERMIT EXPIRES
USE PERMIT
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NUMBER
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ADDRESS
PLAT NAME/SUBDIVISION NO. LOT NO,
LID NO
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ID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW P,mit Miquiled
sifeet uso Porinit Reri'd
EXISTING - PROPOSED
inspection Required
sidewaik Requirod 13
REQUIRED DEDICATION� FT
underground
wiring tocitntod E3
METER SIZE
LINE SIZE
NO. OF FIXTURES
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CITY
ZIP
TELEPHONE
NAM
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ADDRESS
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CITY
ZIP
TELEPHONE
STATE LICENSE NUMBER
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CHECKED BY
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PROPERTY TAX ACCOUNT PARCEL NO
NEW
ADDITION
REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
(TYPE OF USE, BUS
NUMBER
OF
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0 STORIES
DESCRIBE WORK
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HEAT SOURCE
ESIDENTIAL
PLUMBING / MECH
F�
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
MULTIFAMILY
SIGN
GRADING
CYDS
FENUt
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TANK
OTHER
EiRETAINING
WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
OR ACTIVITY) EXPLAIN:
NUhiBER OF CRITICAL
DWELLING AREAS ----------
UNITS I I NUMBER
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6`4
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
OAPPLICANT. 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 DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REViEWED BY F-] R M A R S H A L DATE
FIRE REVIEWED -BY. --DATE
!ANK FILL, REMOVAL, OR CAP
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VARIANCE OR CU SHORELINE OR ADB# I INSPECTION P101OND
REO'D STED
EIYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
PRO a
EXP I
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D I PROVIDED
REMARKS
CHECKED By
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IREQUIRED SETBACKS (Fr.) PROPOSED SETBACKS IFO
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FRONT SIDE REAR FRONT UR SIDE RE 0
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LOT AREA PLANNING REVIEWED By DATE
OCCUPANT
GROUP
OCCUPANT
SPECIAL INSPFL; I IUNII ANCA LOAD
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EQUIRED
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1137RROGGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 5
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VALUATION
Description
FEE Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge_
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
ng r. I nspectlon
Fire Review
Plan Chk- Deposit
i
Fire Inspection
Receipt #
Landscapeinsp.
Total Amt. Due
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION� THAT THE INFORMATION APPLICATION APPROVAL
GEN F
CAL
S
R By C T Oj
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED A I GENT OF
ING CONSTRUC- This application is not a permit until signed by the
L
LV 0 IS Co I P Y CALL Building Official or his/her Deputy: and Fees are paid. and
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULAT 0 ED
11 W I L
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Oded.
�T I To receipt is ac"oWledged in space pro i
RELATING TO FOR INSPECTI
10 VI ' OL 10 1 —
[SIN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON DATYE
T
W W M S C
ORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. F LS SIGNAT RE
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SIGNATURE (CWNER - - I . DA (425)
771-0220 /R EAS'
------ATT - ENTION 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
BY
ORIGINAL - 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 DAT
PLEASE SIGN
ENGINEER_1NG DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASUSIGN
PROJECT C-(�IAJ /
SITE ADDRE . SS J7_ 6tva"
PERMIT#- —ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECT L, P 7-An/k- 6) C., 4) L'
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: C-1 AZTr I/-
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GRANT FINAL PROJECT APPROVAL U r
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
o 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
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ........... z
0
Slab Insulation ..........
0
M
PLUMBING:
Underground .............
(n —4
Rough -In ................... 0 M
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Commercial Final ...... 0
0 C
HEATING:...
M
M z
Gas Test ....................
Gas Piping ............. > z
Equipment.................
Cn
0 _n
Commercial Final .......
EXTERIOR SHEATHING
NAILING .......................... M M
0 Cn
0
FRAMING ........................ 0 171
C
Cn
FIRST FLOOR FRAMING ... C0
Q 0
Z
INSULATION ................... 71
Floor Insulation .........
Wall Insulation ........... >
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Ceiling Insulation .......
SHEETROCK NAILING ... co
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SPECIAL INSPECTION ... 4
0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .................. r-7
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