20040114.pdfa
"I DATE RECEIVED
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C1W OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
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CITY
NAME
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NUMBER �L�
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
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19 A &AD C) LAJ5 8 SK-04
LID FEE $
PUBLIC RIGHI OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW permit Required
Street Use permit Raq'd
EXISTING PROPOSED
inspection Required
Sidewalk Required
REQUIRED DEDICATION
FT
underground
Wiring requited
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWEDIDATE
FIRE REVIEWED BY DATE W
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VARIANCE OR CU SHORELINE OR ADS# INSPECTION I BOND
REQ'D POSTED
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SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR 0
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PARKING LOT AREA PLANNING REVIEWED BY DATE
REO'D PROVIDED a.
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PLAN CHECK NO: VESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPILICATION: 180 DAYS
PERMIT LIMIT 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
.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 BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.4
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 THERhBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S C?
,MWSATION INSURANCE AND RCW 18.27.
SIGNATZR7
W VNE R�AGENT), DATE SIGNED
A
A17ENTION
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
10101
CHECKED BY
OF CONSTRUqTION
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Description
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Building
Plumbing
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FEE I Description
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Traffic Mitigation
Fire Review
Fire Inspection
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FOR INSPECTION
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771-0220
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771-0221
FAX
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City Surcharge
State Surcharge
Plan Chk Deposit
Receipt #
Total Amount Due
Receipt #
APPLICATION Al 1AI
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.
OFFICIALS SIGNATURE DATE
,RELkA9U BY DATE
PINK - OWNER - GOLD - ASSESSOR
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CITY OF EDMONDS
121 5TH AVENUE NORTH -EDMONDS, WA98020 * (425) 771-0220 -FAX (425)771-0221
Websile: www.d.edmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
November 16, 2004
GARY HAAKENSON
MAYOR
.Attn: Jeffery Bandy
23507 92nd Ave W
Ednionds, WA 98020
.Building Permit: 2004-0114
Site Address: 23507 92nd Ave W
Expiration Date: 2/10/05
Dear Jeffery Bandy:
The purpose of this letter is to inform you that the last remaining inspection on your
project is a filial inspection(s). The final inspection(s) determines that there are no
outstanding life -safety issues and approval allows the City to close your pen -nit file.
The City considers the final inspection to be one of the most important inspections
conducted on a project. In order to grant filial approval the following must be complete:
smoke detectors, house numbers, guardrails, handrails, self -close doors between garage
and residence, egress from sleeping roonis, safety glazing, weather-stripping, ally
Engineering department requirements etc. Of course not all of these things may
specifically apply to your project but it does give you an idea about tile kinds of things
that must be complete as well as some items that do not need to be installed such as:
paint, carpet, moldings, wallpaper, etc. Please be advised pennits expire one year from
the date of issuance. if you will need more tinic to complete the work, permits call be
renewed prior to expiration for one half fees. If the permit expires without a filial
approval granted by the Building Inspector, full fees are required in order to renew the
permit. This can be very costly to you and we strongly encourage you to check your
perrait expiration date and call for tile required final inspection(s). Note: If more than
one department is required to final your project, this is noted on your Job Card.
Please feel free to contact me at 425-771-0220 if you have any questions.
Sincerely,
iPen-nit ' oordin,/itor
Incorporated August 11, 1890
Sister Citv - Hekinan. Jar)an
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FINAL ]�RQJECT APPROVAle FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOI�, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLLA.SE SIGN
1/)l _L_�A_Jkl ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE
PIXASE SIGN
PROJECT,
SITE ADDRESS 0-7 kyc-
PERMIT ��ADB# -DATE INSPECTED fl 0Lz:;_
DESCRIPTION OF WORK TO BE INSPECTED
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 io the release of
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
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04
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_,
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
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SETBACKS .....................
FOUNDATION:
Footing ...................... 4 A-104
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation .......... L"
PLUMBING:
A ay� Underground ............. ov J0,Y) owo
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment ........ ........
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
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Ceiling Insulation .......
U C) SHEETROCK NAILING ...
SPECIAL INSPECTION ...
Cn :5 -, MISCELLANEOUS ..........
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,:d cd FINAL APPROVAL FOR
C) OCCUPANCY ..................
Tile initials MT are Milton
Thompson, a temporary contract
inspector for the City.
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