20040123.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF 13USINESS
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CITY ZIP
STATE LICENSE NUMBER
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
RESIDENTIAL
ADDITION
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EXPIRATION DATE
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REPAIR
GRADING CYDS
DEMOLISH
TANK
oGARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
OF
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STORIES
UNITS
DESCRIBE WORK TO BE DONE
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HEAT SOURCE I GLAZING %
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
LOT SLOPE %
PLAN CHECK N� 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: 180DAYS
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 INTERES17, 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 MODIFN� 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 T14E OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRLIC-
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 COMPENSATION INSURANCE AND RCW 18.27.
SIGNATUPE (OWNER Of,�AGENT) DATE SIGNED
PERMIT EXPIRES
USE PERMIT
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NAMEISUBDIVISION NO. LOT NO, LID NO
1\1C - --I �1" LID FEE $
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TESCP Approved E3
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 13
Street Use Permit Roq'd 0
EXISTING — PROPOSED inspection Required 13
Sidewalk Required C3
REQUIRED DEDICArION— FT Underground
Wiring required [3
METER SIZE LINE SIZE NO. OF FIXTURES PAV REQUIRED
I I YESM NO 0
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
'E�NGINEERING REVIEWED BY D
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SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP I
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LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (FT)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE REAR
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REMARKS
CHECKED BY I TYPE OF CONSTRUCTION I CODE
SPECIAL INSPECTION JAREA
REQUIRED [] YES
OCCUPANT
GROUP
OCCUPANT
LOAD
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION, REQ'D
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
4�510/11
Building Permit.._
City Surcharge
1-6
Plumbing
Mechanical
Grading
Engr. Review
Engr. lnspection�
14
Fire Review
Plan Chk. Deposit
Fire Inspection
63
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
APPLICATION APPROVAL
CALL
I his application is not a Permit until signed by the
FOR INSPECTION
Building Official or hisitier Deputy: and Foes are paid, and
receipt is acknowledged in space provided.
(425)
OFF I IGNAT DATE
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771-0220
RELEASED BY / �DAT�
ATTE TIO I I= YT 1 -01-04-01 --- // , A,
IT IS UNLAWFuLr6USE 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
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE, DEPARTMENT DATE_��
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DESCRIPTION OF WORK TO -BE INSPECTED >
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GRANT PROJECT APPROVAL WITH CONDITIONS -1
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of'CORRECTION NOTICE given to owner/contractor by inspector.
2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL.
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RF_C_,5'V5D FINAL PROJECT APPROVAL FORM.
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
r�_P� FIRE DEPARTMENT DATE
FROM PLE, SIGN
.7 ENGINEERING DIVISION DATE
I'LEASI! SIGN
PLANNING DIVISION DATE
PLWE SIGN
PROJECT
SITE ADDRESSI
ADBA DATEINSPECTED
PERMIT
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 B.ONDS and the granting of:
FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
n Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES . ctor by inpector
11 Copy or CORRECTION NOTICE given to owner/contra
1.
2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tenip:b1dg:rorms: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 -
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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