20040081.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
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ADDRESS
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CITY ZIP TELEPHONE
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NAME CBL4
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ADDRESS
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CITY ZIP ELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE TCHFCKED BY
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PROPERWTAX ACCOUNT PARCEL NO'
11ka 2_'7042_906)3D7-+
NEW
El RESIDENTIAL
PLUMBING / MECH
EADDITION
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COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
( X FT)
DEMOLISH
TANK
OTHER
GARAGE
RETAININGWALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE AL -AR M
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER
NUMBER OF
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CRITICAL
OF
STORIES
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DWELLING
I UNITS 15
AREAS
UM S
NUMBf R
DESCRIBE WORK TO BE DONE
ADD 'r-t NEW -SPR(NKLER 14EAD.S
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PERMIT EXPIRES �4-
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PERMIT
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NUMBER
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JOB
SUITE/APT#
ADDRESS.:,2 _51
PLAT NAME/SUBDIVISION NO
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGIn OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
13
13
Street Use Permit Hoq'd
13
EXISTING PROPOSED
inspection Required
13
Sidewalk Required
0
REQUIRED DEDICATION—
FT
Underground
Wifing required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YES 13 NO
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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ENGINEERING REVIEWED BY
DATE
FIRE REVIEWED BY DATE of
VARIANCE OR CU HORELINE OR ADS# INSPECTION BOND
REOID POSTED
OYES ONO IS
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE I EXEMPT ALLOWED I PROPOSED ALLOWED , PROPOSED
P
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
[ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR I
PARKING
REQ'D I PROVIDED
REMARKS
LOT AREA I PLANNING REVIEWED BY
CHECKED BY [TYPE OF CONSTRUCTION
SPECIAL INSPECTION JAREA
REQUIRED [] YES I
DATE
GROUP /P
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OCCUPANT
LOAD
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D I �
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VALUATION
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Description FEE Description FEE
Plan Check State Surcharge
EAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing
tlll� I Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
2 Engr. Review
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
in 'APPLICAN1, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review `0� Plan Chk. Deposit
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or IN INTERES1, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NAT URE, ARISING DIRECTLY OR INDIREC RY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF JHIS PERMIT SHALL NOT BE Landscapeinsp. t. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Total Am
Ol NOR LIMIT IN ANY WAY THE CITYS ABILITY 10 ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee Receipt #
BY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVtN is CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH C;TY AND STATE LAWS REGULATING CONSTRUC� CALL I his application is not a perinit until signed by the
TION; AND IN DOING TIIEwonK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON FIELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18,27. OFFICIALS SIG TURE DATE
(425)SIGNArUR�(OWNER OR GEN-0 DATE SIGNED
2- 771-0220 _6E(E S`E DATE
ATTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING Oil STRUCTURE UNTIL )jz)u 11�?e?le4
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILE - YELLOW-16EC R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER - GOLD-ASSESStR
04;02 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: FIRE DEPARTMENT DATE40:�2-��
;;�'�L FAS E 9 1 G N
ENGINEERING DIVISION DATE
PLEASESIGN
PLANNING DIVISION DATE
PL&MRSIGN
PROJECT
SITE ADDRESS'12,f�
PERMIT d2e�'l -60E) ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED/
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
PERF, ORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
I
2.
3.
RE -INS I PECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1Jemp:b1dg:rornis:ocaprv1 3/25/04
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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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