20040134.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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I PERMIT EXPIRES 1211
USE
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PERMIT
NUMBER
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ADDRESS
SUITE/APT#
PLAT NAME/SUBDTVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
IESCP Apotoved
RW Ptirmil Rocitmed
Street Use Permit Roq'd
EXISTING - PROPOSED
inspection Floquifed
Sidewalk Required
REQUIRED DEDICATION-
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Uode(ground
Wiring requirud
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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CITY ZIP TELEPHONE
1. VARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY POSTED
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'ROPERT)�TAX ACCOUNT PARCEL NO.
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DATE
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El NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FW
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DEMOLISH
TANK
OTHER
GARAGE
RETAINING WALL
FIRE SPRINKLER
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ROCKERY
FIRE ALARM
(TYPE OF USE. BUSINESS QR)ACTIVITY)
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NUMBER
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NUMBER OF
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CRITICAL
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NUMBER(!�)/
DESCRIBE WORK TO BE DONE
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PLAN CHECK NO:
I VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
L_ BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
:3
SEPARATE PERMISSION.
Ui PERMIT APPLICATION: 180DAYS
PERMIT LIMIT'. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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W IN INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREC RY OR INDIREc rI.Y
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CHYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION
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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
THEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
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SIGN AREA
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ALLOWED PROPOSED
ALLOWED PROPOSED
EXP I
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LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LJR SIDE REAR
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PARKING
LOT AREA
PLANNING REVIEWED 13Y DATE
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REMARKS
CHECKED BY
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CONSTRUCTION
CODE
OCCUPANT
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GROUP
SPECIAL INSPECTION
OCCUPANT
REQUIRED [] YES
JAREA
LOAD
REMARKS
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PROGRESS INSPECTIONS PER UBC I 08/11FINAL INSPECTION REOID
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VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapeinsp.
Total Amt. Due
Recording Fee
Receipt #
CALV
APPLICATION APPROVAL
I his application is riot a permit until signed by the
Building Official or hisitier Deputy: and Foos are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S CAjf,�,� �SqN INSURANCE AND RCW W 27.
FOR INSPECTION
receipt is aclinowledged in spacu provided
QFFICIALS SIGNATURE
BAT E
T) DATE SIGNED
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771-0220
Fj:IFAFfD BY
DATE'
A17ENTICIN EXT 1333
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IT IS UNLAWFUL TO USE OR OCCUPY A BU!LDING OR STRUCTURE U14TIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
09/03 PRESSHARD-YOUAR MZAKIZ4COPIES
ORIGINAL - FILE YELLOW - IOSPEC*O
PINK - OWNER GOLD - ASSESSOR
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NOTICE: IF THE DOCUMENT IN THIS FRAME IS LESS CLEAR THAN THIS NOTICE
IT IS DUE TO THE QUALITY OF THE DOCUMENT.
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NOTICE: IF THE DOCUMENT IN THIS FRAME IS LESS CLEAR THAN THIS NOTICE
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FIN AY, PROJECT APPROVAL FORM.
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE---------
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PLANNING DIVISION DATE-------�
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A field inspection was conducted to determine nnal compliance with.approved plans. Final approval
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denotes that there are no objections from the above signed Departm ent to the release of
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PERFORMANCE BONDS and the granting of:,.
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a copy of CONDITIONS given to owner/contractor by inspector
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FINAL INSPECTION - OUTSTANDING ISSUES
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a Copy of CORRECTION NOTICE given to owner/contractor by inspector.
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R.E_]NSpF - GRANT FINAL PROJECT APPROVAL
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Date D OUTSTANDING ISSUES Si
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pier/Porch .................
Retaining Wall ........... Z,
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Slab Insulation ..........
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PLUMBING:
Underground .............
Rough -in ................... M
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Commercial Final ...... 0
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HEATING: --j
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Gas Test ....................
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Gas Piping .................
Equipment .................
Commercial Final ....... 0 -n
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EXTERIOR SHEATHING 3:9
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NAILING..........................
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FRAMING ........................ 0
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FIRST FLOOR FRAMING ... (n
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INSULATION ...................
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Floor Insulation .........
Wall Insulation ........... >
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Ceiling Insulation .......
SHEETROCK NAILING ... Fn
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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