20040101.pdf0
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
'1 '2-
CITY ZIP TELEP&NE
2U, Y�
NAME
ADDRESS
CITY ZIP
NAME
TELEPHONE
USE
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JOB
ADDRESS
PLAT NAMEISUBDIVISION NO
I PERMIT EXPIRES �1 t
PERMIT gvcyJ, (yo
NUMBER I/ %_, r
LOT NO,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- FT
METER SIZE LINE SIZE NO. OF FIXTURES
SUITE/APT#
kID NO.
LID FEE $
TESCP Approved
fjW Permit Required
Street Use Permit Roq'd
Inspection Required
Sidewalk Required
underground
Wiring required
PRV REQUIRED
YES 13 NO 0
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
� I --I I . f �� VI VI I I A j
B'_ PRESENT FOH
CBL 4 1
!ANK FILL, RIEN!'"A'AL OR CAP
71 [E;N1.:1NEEkRING REVIEWED BY DATE
ADDRESS U
-7 7
CITY
Sell C
ZIP
TELEPHONE
6 - /
206 306 V 0161
STATE LICENSE NUMBER
-8
EXPIRATION DATE
CHECKED BY
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PROPERTY TAX -/ACCOUNT PARCEL NO.
&D *1 H 5 3 0 6) 00
NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
L-------------------------
REPAIR
FENCE
GRADING FT)
CYDS X
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL FIRE SPRINKLER
ROCKERY FIRE ALARM
(TYPE OF USE, BUSIVE
R ACTFIM EX PLAIN:
L _po
0
ul NUMBER NUMBER OF CRITICAL
M OF DWELLING AREAS ID.
01 STORIES UNITS I I NUMBER
-1 DESCRIBE WORK TO BE DONE
I I
HEAT SOURCE
PLAN CHECK NC
SIXIS
GLAZING %
LOT SLOPE %
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: 160DAYS
PERMIT LIMIM I 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
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 IHIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE 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 THEREW NO PERSON WILL BE EMPLOYED
IN VIOLATIAN OF THE LA13OR CODE OF TIIE STATE OF WASHINGTON RELATING TO
WORKMEVS I COMPENSATION INSLJRfV4CE AND Rq* 10.27,
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP I
LOT COVERAGE
ALLOWED PROPOSED
DATE
SHORELINE OR ADBI I INSPECTION I BOND
REO'D POSTED
OYES ONO S
SIGN AREA HEIGHT
[ALLOWED . PROPOSED I ALLOWED , PROPOSED
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REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (F-Q
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PARKING LOT AREA I PLANNING REVIEWED BY DATE
REO'D I PROVIDED I
REMARKS
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GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ-D - Ej
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
SIG/N
tRE�OWNER Aq I DIE SIGNED V I
4—
FEE Description FEE
State Surcharge
.5 lCity Surcharge
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APP*ROVAL
This application is not a permit until signed by the
Building Official or hisitier Deputy. and Fees are paid. and
receipt is acknowledged in space provided.
ffICI,Aj_S SIGNAI-04RE ATE
&a&,
LEASED BY
lirl
PA I F_ W
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
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
CALL
FOR INSPECTION
(425)
771-0220
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
GREEN - ACCOUNTING
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PI EA E SIGN
____.ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT
SITE ADDRESS 2 7,_ - vz
PERMIT ADB# DATE INSPECTED Lt
DESCRIPTION OF WORK TO BE INSPECTED u s _--r— �ZE/L, oVAL-
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:
GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED K/
u Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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FINAL PROJECT AfftOVAL FORM
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,JL)L 2 6 2004 TO:. 's
I)EVELOPMEN F SERVICES CTR DATE: 14 �4
CITY OF EDMONDS
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DATE 742L In
FROM: __�`NuA - -7
-ENGINEERING DIVISION DATE -
PLEASE SIGN
PLANNING DIVISION DATE
PLEASESIGN
PROJECT- �211)Rz
SITE ADDRESS
PERMIT 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
PERFORMANCE 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
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
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3.
RE -INSPECTED OUTSTANDING ISS I UES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbnns:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
-FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Stab 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
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