20040088.pdfDATE RECEIVED
C1W OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PLAT NAME/SUBDIVISION NO.
L PERMIT EXPIRES
PERMIT
NUMBER
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OT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
PHONE EXISTING — PROPOSED
REQUIRED DEDICATION— Fr
METER SIZE LINE SIZE NO. OF FIXTURES
TELEPHONE
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NEW
RESIDENTIAL
PLUMBING MECH
1:1
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
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DEMOLISH
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EiGARAGE
CARPORT
RETAINING WALL
ROCKERY
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FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR Af.14VIT)3.9jPqIN:
NUMBER NUMBER OF' CRITICAL &)��
OF DWELLING AREAS
STORIES .3 UNITS NUMBER
DESCRIBE WORK TO BE DONE
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SOURCE GLAZING % I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 100DAYS
W
IL 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 SUCCESORS
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!I 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
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
9 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY THE C17YS ABILITY TO 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 WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABpa-r,,ODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATff I1q5TANCE AND RCW 18.27.
SIGNATURE (OWNER If DATE SIGNED
SUITE/APT#
IL L 2
LID NO.
LID FEE $
TESCP Approved
RW Permit Required 13
Street Use Permit Arict'd [3
inspection Required C3
Sidewalk Required [3
Underground
Wiring required E3
PRV REQUIRED
YES 13 NO 1:3
IREMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
SEPA REVIEW
COMPLETE EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPP N
SHORELINEORADB4 INSPECTION
REO'D
OYES ONO
SIGN AREA
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PARKING LOT AREA PLANNING REVIEWED BY
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SPECIAL INSPECTION [AREA
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REMARKS
PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION RE�'- z
VALUATION
$
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
FEE
Description
FEE
State Surcharge
City Surcharge
CALL
FOR INSPECTION
(425)
771-0220
ATTENTI(M 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
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This 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.
1 A L S/t /G) (�T U DATE
7/
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
ED BY DATE
ORIGINAL -FILE YELLOW- INSPECTOR
PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
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FINAL PROJECT APPROVAL FORM
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DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DAT
PLEASESIGN
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PLANNING DIVISION DATE =n-
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PROJECT
SITE ADDRESS /_6 2-3
PERMIT # 100 q ADB#----------.-PATE INSPECTED '2, -0-0
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DESCRIPTION OF wORK TO BE INSPECTED 'P C)- A-P
A field inspection was conducted to determine final compliance with approved plans. Final approval
d Department to the release of
denotes that there are no objections from the above signe
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PERFORMANCE BONDS and the granting of
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GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 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
1 .
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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 ...................
Ccmmercial 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 ..........
FINAL APPROVAL FOR
OCCUPANCY .................
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