20040180.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
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CCOUNT PARqEL NO.
El NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
El REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER
NUMBER OF
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STORIES
UNITS
DESCRIBE WORK TO BE DONE
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HEAT SOURCE
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COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
FIRE SPRINKLER
FIRE ALARM
USE
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JOB
ADDRESS
PIAT NAME/SUBDIVISION NO
PERMIT EXPIRES f/
7
PERMIT
NUMBER
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE LINE SIZE NO. OF FIXTURES
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LID NO
LID FEE S
IESCP Approved
RW Permit Required
street use Permit Fioq.d
Inspection Required
Sidowalk Requirod
Undoirground
Wiring required
PRV REQUIRED
YES El NO IJ
REMARKS
OWNER/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED
DATE
FIRE REVIEWED BY DATE W
VARIANCE OR CU SHORELINE OR AD1171 INSPECTION BOND
REO'D POSTED
OYES Is
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP I I
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
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PARKING LOT A PLANNING REVIEWED BY DATE 5
REO'D I PROVIDED I I I a.
FO I REMARKS
CHECKED BY ITYPE OF CQNST�MCTION CODE OCCUPANT A
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CRITICAL fi-.5
AREAS SPECIAL INSPECTION JAREA OCCUPANT
NUMBER REQUIRED [] N S LOAD
[REMARKS a
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 2i
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THIS PERMIT AUTHORIZES ONI�Y 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: 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
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTIY 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 Limi r IN ANY WAY [HE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
' ' 'ERE BY ACKN
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
kGiVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
IV IS Co
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HE OWNER. I AGREE TO COMPLY WITI I CITY AND STATE LAWS REGULATING CONSTRUC-
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ION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
I I L T 10 ,
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
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WORKMEN'S COMPENSATION INSURANCE AND FICW 18 27.
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SIGNATURE (OWNER DKGEWD)"��j DATE SIGNED
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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 #
Landscapelnsp.
Total Amt, Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
(425)
771-0220
APPLICATION APPROVAL
This application is not a perinit until signed by the
Building Official or his/tier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFFICIALS SIGNATURE DATE
A, , 2-1
,-R F I al r6ut X.�/
� P 1 1, DATE
ATTENTION EXT 1 '3
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
09;03 PRESS HARD -YOU ARE MAKING 4 COPIES
0111GINAL - FILE YELLOW - IN)(PECTOR
PINK - OWNER GOLD - ASSESSOR
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RECEIvED
FINAL PROJECT APPROVAL FORM MAR 16 2004
DEVELOPMENT SERVICES'GIR
TO: cITY OF EDMONDF'
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLZASE SIGN
ENGINEERING DIVISION DATE
PIXASF SIGN
PLANNING DIVISION DATE
PLEASE SIGN
0 _(_
PROJECT
SITE ADDRESS '/ 1—b
PERMIT #
DATE INSPECTED-3 —/6,- '__C) L/
DESCRIPTION OF WORK TO BE INSPECTED ��eO41_�IiFtC --� L,)12 L./'j K-7�- _t
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
a 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
1 .
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
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..................
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