20040095.pdfT)L`�l DATE RECEIVED FPERmT EXPIRES
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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CITY ZIP TELEPHONE
NAME
ADDRESS
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USE PERMIT
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NUMBER
JOB SUITE/APT#
ADDRESS ).2 e,'I. /4�r /V/
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
13
RW Permit Required
13
Street Use Permit Roq'd
0
EXISTING — PROPOSED
inspection Required
13
Sidewalk Required
0
REQUIRED DEDICATION— FT
underground
Winne required
0
METER SIZE LINE SIZE NO. OF FIXTURES I PRV REQUIRED
I I YES13 NO 0
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP TELEPHONE
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NAME CBL #
ENGINEERING REVIEWED BY DATE
ADDRESS
y- FIRE REVIEWED BY DATE
CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
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CKNEW RESIDENTIAL PLUMBIN7/ MECH
EADDITION OMMERCIAL COMPLIANCE OR
] X� CHANGE OF USE
REMODEL MULTIFAMILY ;IGN
GRADING SENCE
REPAIR CYDS ( X FT)
DEMOLISH TANK OTHER
oGARAGE RETAININGWALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
M NUMBER NUMBER OF R 'AL
C ITIC
OF DWELLING AREAS
ci STORIES UNITS NUMBER 14-
71
DESCRIBE WORK TO BE DONE
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HEAT SOURCE I GLAZING % I LOT SLOPE %
PLANCHECIKNO' VESTED DATE
THIS PERMIT AUTHOnIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
W PERMIT APPLICATION: 180DAYS
CL PERL41T LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPI ICAN 1. ON IIEHAL F OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTERESI. AGREES 10 INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGION, Its OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
At I. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM IHE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED to MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR IIMII IN ANY WAY flir CITYS AE14-11Y TO ENFORCE ANY ORDINANCE PROVISION."
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VARIANCE OR CU SHORELINE OR ADB# INSPECTION
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SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE
REO'D I PROVIDED._ , I n(-7A
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REMARKS
CHECKED BY
TYPk�PF�qONSTRUCTION
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OCCUPANT
GROUP
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SPECIAL INSPECTION JAREA
OCCUPANT*
REQUIRED [] YES
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
I HEREBY ACKNOWt EDGE THAT I HAVE READ rillS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF ZPPLICATION APPROVAL
THE OWNER I AGREE TO COMPLY WITH CITY AND STAIIE LAWS REGULATING CONSTRUC- CALL This application is not a perinit until signed by the
TION, AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Official or his/tier Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
,wc3Aki�L�ig—co�PENSATI��_UfW4C�, AND RCW 18.27.
OF,�CIALS SIP'NATURE DATE
LNE"RtjE'11 DATE SIGNEO' (425)
10
WNE"R GEN't)
.SIGNATUR
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et 771-0220 DATE
ATTENTION f E)ff 1333
IT IS UNLAWFUL, TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CEFITIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04!02 PRESS HARD -YOU ARE MAKING 5 COPIES
ORIUINAL-FILE YELLOW- INSPECTOR
PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
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FINAL PROJECT APPROVAL FORM
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM:
PROJECT
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TO: L&I
DATE:
FIRE DEPARTMENT DATE
PLEASE SIGN
_ENGR*�EERING DIVISION DATE
PLEASESIGN
PLANNING DIVISION DATE L(
PLEASE SIGN
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SITE ADDRESS ;� D �Q 1
PERMIT # ADB# DATE INSPECTED C4 A s�;- k c
DESCRIPTION OF WORK TO BE INSPECTED— CS I \ 0)�)
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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:
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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 inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:f6nns:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........
...............
Pier/Porch .................
Retaining Wall ...........
Slab Insulation .......... M
PLUMBING: Zi 9
Underground ............. r
M
Rough -In ................... M 0
0
Commercial Final ...... 0 C
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HEATING: M
M Z
Gas Test ....................
Gas Piping .................
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Equipment ................. 0 -n
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Commercial Final .......
M ITI
EXTERIOR SHEATHING
NAILING .......................... co
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FRAMING ........................ C C/)
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FIRST FLOOR FRAMING ... Q 0
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INSULATION ...................
Floor Insulation ......... a:
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Wall Insulation ........... z
Ceiling Insulation ....... C/)
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SHEETROCK NAILING ... 0
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SPECIAL INSPECTION ... 0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................
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