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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING
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PERMIT EXPIRES 44 Z/1' L.
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PERMIT
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(._ 1 " ) SUITE/AP_T.
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ME/SUBDIVISION NO LOT LID NO
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STATE LICENSE NUMBER EXPIRATI N DATE CHECK BY
PROPERTY TAX ACCOUNT PARCEL NO.
NEW ❑ RESIDENTIAL ❑ PLUMBING/MECH
❑ ADDITION COMMERCIAL ANCE OR
❑ CHANGE OF USE
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN
❑ REPAIR ❑ GRADING CYDS ❑ FENCE X
FT)
❑ DEMOLISH ❑ TANK ❑ OTHERor
All r'GARAGE
RETAINING
❑ CARPORT ❑ ROCKERY WALL FIRE SPRINKLER
❑ FIRE ALARM
(TYPE OF US BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER NUMBER OF
OF CRITICAL Ar
DWELLING AREAS 1
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
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HEAT SOURCE
GLAZING %
LOT SLOPE %
PLAN CHECK NO: q L�), CL/ 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
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H SEPARATE PERMISSION.
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PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCFSOHS
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
i EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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c FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
J DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT nJE INFORMATION
GIVEN IS CORRECT, AND TITAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUE'IION, 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 COMPENSATION INSURANCE AND RCW 18.27,
SIGNATURE (OWNER U GENT) DATE SIGNED
OCCUPANT .,t
GROUP
SPECIAL INSPECTION AREA OCCUPANT` /
REQUIRED ❑ YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RECI'D o
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LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
rESCP Approved ❑
RW Permit Required ❑
EXISTING PROPOSED
Street Use Permit Roq'd ❑
Inspection Required ❑
REQUIRED DEDICATION FT
Sidewalk Required ❑
Underground
Widng required ❑
METER SIZE LINE SIZE NO. OF FIXTURES
PRV REQUIRED
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YES ❑ NO ❑
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING REVIEWED BY
DATE
FIRE REVIEWED BY DATE
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VARIANCE OR CU SHORELINE OR ADBp INSPECTION/ BOND
REQ'D POSTED
ES �%QNO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXPO Ci
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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LOT AREA PLANNING REVIEWED BY DATE REQ'D PROVIDED s
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CHECKED BY ITYPE
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr, Inspection
Fire Review
FEE Description FEE
State Surcharge
r,
City Surcharge f
Base Fee
Plan Chk. Deposit
EReceipt N
Total Amt. Due
Receipt k
APPLICATION APPROVAL
I tus application Is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFFICIALS SIGNATURE DATE
in 01
RFI - SFD BY DATE
ATTENTION 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 10g ! ORIGINAL FILE YELLOW -INSPECTOR
09-03 PRESS HARD -YOU ARE MAKING 4 COPIES PINK.OWNEH GOLD -ASSESSOR
Fire Inspection
Landscape Insp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
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MEMO TO:
FROM:
PROJECT
SITE AD
PERMIT # tq;:�/ CO ^ wq7ADB# DATE INSPECTED a C.� lI e
L PROJECT APPROVAL FORM
DATE: C j
PERMIT COORDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE Cv c-
�= PLEASESIGN
DRESS e� 0v Tp
DESCRIPTION OF WORK TO BE INSPECTED 0�
A field inspection was conducted to determine 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
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
❑ Copy of CORRECTION NOTICE given to owner/contractor by inpector
I.
2.
3.
REINSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
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MEMO TO:
FROM:
NAL P
' APPRO`
TO:
DATE:
PERMIT COORDINATOR, BUILDING DIVISION
DEPARTMENT DATE LL27 Q L(
PLEASE SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT P O-C - U Lf�)d/v 141::26�Fzd—g
SITE ADDRESS
PERMIT # � ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED �,- %I IF272
A field inspection was conducted to determine 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
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
❑ Copy of CORRECTION NOTICE given to owner/contractor by inpector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
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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 ...........
. 41
v ,,.`Ceiling Insulation
SHEETROCK NAILING ... '
SPECIAL INSPECTION ...
MISCELLANEOUS Q
FINAL APPROVAL FOR�`�`�
OCCUPANCY ..................
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