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DATE RECEIVED tv2i /
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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MAILING ADDRESS
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NAME
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NAME
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ZIP i TELEPHONE
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TELEPHONE
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PERMIT EXPIRES
USE PERMIT
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JOB SUITE/APT#
ADDRESS 6 M TIOM <��
PLAT NAME/SUBDIVISION NO LOT NO. LID NO.
CAL I "Y\ TO LID FEE S
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street Use Permit Roq'd E3
EXISTING - PROPOSED Inspect,on Required [3
Sidewalk Required C3
REQUIRE[) DEDICATION- FT Underground
Wiring required
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES NO 0
REMARKS
OWNER/CONIRACTOR RESPONSIBLE FOR EROSION CONIROL/DRAINAGE
ENGINEERING REVIEWED BY
DATE
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P-0. AOA (CA-A FIRE REVIEWED BY DATE
CITY ZIP rELEPHONE L(
'E1U`Ak0W1_)S 9 �c 14 26 -4-4/4 6244 9' -"
WRIANCE OR CU SHORELINE OR ADBO r INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE CHEC ED BY REO'D POSTED
V t 5_71 - I I OYES ONO IS
ei>xAmS Co'k-A cls SEPA REVIEW SIGN AREA HEIGHT
PROPE,9TY TAiX, ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED I PROPOSED ALLOWED I PROPOSED
Z)'CLI�ZIV Z2 Z�I*ZVI EXP I —
NEW RESIDENTIAL PLUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE HEAR FRONT LJR SIDE REAR
COMPLIANCE OR z
ADDITION COMMERCIAL z
CHANGE OF USE z
PARKING LOT AREA PLANNING REVIE ED BY DATE :5
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REMODEL MULTIFAMILY SIGN REO'D I PROVIDED
GRADING FENCE
REPAIR r. Y Dq ( x Fr) REMARKS
OTHER
DEMOLISH TANK
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY VFIREALARM
(TYPE OF USE, BUSINESS 0 CTFVU EXP;LtAl�
CHECKEDBY ITYEF.OF CONSTRUCTION C�� OCCUPANT
it U GROUP
I CRIACAL IW' 'a
NUM13ER NUMBER OF NT
OF DWELLING AREAS SPECIAL INSPECTION JA�REA OCCUPANT
STORIE§�� UNITS NUMBER REQUIRED [:] YES LOAD
DESCRIBE WqbTOBEDONE r1p I
..' I� _ _G REMARKS z
LOW _A FKUUKtbbINSPECTI0NS PER UBC 108/IBC109/IRC109 FINALINSPECTION REO'D
P�SDCI AT -Eh LEDO I PME)i4l_� I
VALUATION
$ .:��
I Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
L52 Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
Uj PERMIT APPLICATION: ISO DAYS
116 PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERM17 FOR MORE INFORMATION
(n 'APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTERE�T, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt #
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapeinsp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
MI Recording Fee Receipt #
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 APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VIOLAT191,4 OF THE LA ODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WO KMEY' ICOMPENSAWI'Nt NANCYND RCW 18 27. -14 D�TE
9tFF CIALS SIG
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_(S VIN TU OWNER 0! DATE SIGNED (425) J
5 C6 2M
A A I m� 771-0220 RritFA_�ED BY DATE
xrTq#Tf04 ( U/ EXT 1333 V// / /I '
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILARNAL L /9 , k-11LI 21 - I //I �
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INSPECTION HAS BEEN MADEANDAPPROVAL OR ACERTIFICATE OF OCCU- ORIGINAL - FILE - YELLOW - IN911
PANCY HAS BEEN GRANTED. UBC1091IBC110/iRC110. PiNK-OWNER -
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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FIN L PROJECT APPROVAL -)RNI
TO:
DATE:
MEMO TO: PE 00 LDING DIVISION
FROM: FIRE DEPARTMENT DATE -3
PLEASE SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PL17ASI: SIGN
PROJECT C-pf
SITE ADDRESS- M�L S
PERMIT # QZf o -7 -4 -Z---ADB# DATE INSPECTED 3 -
DESCRIPTION OF WORK TO BE INSPECTED A-t-A-eA-Ik,
A field inspection was conducted to determine compliance with -approved plaits. 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
0 Copy of CONDITIONS given to owner/contractor by inspector
I
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:fom1s:ocapr%,1 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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