20040164.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMENAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP
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NAME
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I'_ ADDRESS
TELEPHONE
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CITY ZIP TELEPHONE
NAME
ADDRESS
CITY
STATE LICENSE NUMBER
I TELEPHONE
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EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
7�,
e90
NEW
a -'RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING
CYDS
DEMOLISH
ErTANK
GARAGE
RETAININGWALL
CARPORT
ROCKERY
(TYPE OF USE. BUSIN ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
OF
DWELLING
S
STORIES
UNITS
DESCRIBE WORK TO BE
DONE
HEAT SOURCE GLAZING %
PLAN CHECK NO:
#
PLUMBING MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
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OTHER
F1
FIRE SPRINKLER
FIRE ALARM
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USE
ZONE
JOB
ADDRESS
PLAT NAMEISUBDIVISION NO,
I PERMIT EXPIRES
- -
PERMIT
NUMBER
LOT NO.
PUBLIC RIGIiT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICAfION— Fr
OF FIXTURES
METER SIZE LINE SIZE
SUITEIAPT#
LID NO.
LID FEE S
FE—SCP Approved
RW permit Requited
Street use permit Req'd
inspect an noquired
Sidewa;k Required
underground
wiring required
V REQUIRED
PR
YES 0 NO 13
REMARKS
FOR EROSION CONTROLYDRAINAGE
OWNEFIXONTRACTOR RESPONSIBLE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU
SEPA REVIEW
COMPLETE I EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D I PROVIDED
REMARKS
SHORELINE OR ADRO r INSPECTION I BOND
1REO'D POSTED
0YES EINOIS
SIGN AREA rirlun
ALLOWED . PROPOSED ALLOWED , P'ROPOSED
REQUIRED SETBACKS (FT.) PROPOSED SET13ACKS (Fr.)
FRONT SIDE REAR FRONT L/R SIDE REAR
PLANNING REVIEWED By
LOT AREA
TYPE OF CON
CHECKED BY
CRITICAL
AREAS 04 1 SPECIAL INSPECTION JAREA
NUMBER IZZAJ REQUIRED [D YES
LOT SLOPE %
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: IBODAYS
PERMIT LIMIT 1 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
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 THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,.
I IIERE13Y 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 CQNSTFILIC-
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 !1��URANCE AND RCW 18.27.
WNER ORtENT):� ATE GNED
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DATE
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GROUP
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTI�� EaD
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VALUATION
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Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
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FEE Description FEE
S
State Surcharge
City Sur rg
city Surcharge /I _It)
CALL E
FOR INSPECTION
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(425)
771 0220
T 1333
[RecePlan Chk. Deposit
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ipt #
TotEI mt
Total Amt. Due
Receipt #
1 2
APPLICATION APPROVAL
This application is not a permit until signed by the
dAOtliciil or his/her Deputy� and Fees are paid, and
eccipt is acknowledged in space provided.
-ib DATE
ATTENTION
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
04102 PRESS HARD -YOU ARE MAKING 5 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
GREEN - ACCOUNTING
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE Y
I'MASE SIGN
ENGINEERING DIVISION DATE —
PLEASE SIGN
PLANNING DIVISION DATE
PLWESIGN
PROJECT.�/)
2�
SITE ADDRESS /,A) I " — V
PERMIT AD -----------DATE INSPECTED-?
DESCRIPTION OF WORK TO BE INSPECTED- US-11 ) P (J /" Pi- f2-//L
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 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
1
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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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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