20040104.pdfDATE RECEIVED
USE (I C'.'
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CITY OF EDMONDS
JOB
CONSTRUCTION PERMIT APPLICATION ADDRESS
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PROPERTY TAX A. -COUNT PARCEL NO.
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11 RESIDENTIAL
1:1 ADDITION
[9--'COMMERCIAL
ID/REMODEL
11 MULTIFAMILY
F� REPAIR
11 GRADING CYDS
DEMOLISH
13 TANK
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RETAINING WALL
11
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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PERMIT EXPIRES
PERMIT
SUITE/APT#
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LOT NO. LID NO.
LID FEE $
IT 0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 0
RW Permit Required 13
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REMARKS
OWNER/CONTRACIOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY 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
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
OAPPLICANT, 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 THIS 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 f HE CITY'S 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 TIIE OWNER, OR THE DULY AUTHORIZED AGENT OF
TtIE 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 LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATRI147-INSI)RANCE AND RCW 18 27.
SIGNAYJN (CI R GEN DATE SIGNED
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
FEEj Description FEE
iri ./
-Ael. 'S_0
State Surcharge
City Surcharge
'��C_)
CALL
FOR INSPECTION
(4225)
771-0220
Plan Chk. Deposit
Receipt U
Total Amt. Due
Receipt #
APPLICATION APPROVAL
I his application is not a permit until signed by the
Building Official or his/tier Deputy: and Fees are paid, and
receipt is acknowledged in space provided
-FICIALS SIGNATURF DATE
I 7_1.)�L
—2,7
ZA �Ty DATE
ATTENTION t:A I I jjj I Y_ V
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
0,1)02 PRESS HARD -YOU ARE MAKING 5 COPIES
ORIGINAL - FILE YELLOW - INSPkCTC
PINK - OWNER GOLD - ASSESSOR
GREEN - ACCOUNTING
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FINAL PROJECT AP AL FORM
OR
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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FROM: FIRE DEPARTMENT DATE C7f-
PIXASE SIGN
ENGINEERING DIVISION DATE-
PLWE SIGN
PLANNING DIVISION DATE
PLEASESIGN
PROJEC
13o
SITE ADDRESS 0c)
PERMIT# '10L - 6 t 0 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
Copy of CONDITIONS given to owner/contractor by inspector
4- S_ i1v
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
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2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbnus: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:
lip Gas Test ....................
N Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
14 SHEETROCK NAILING ...
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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