20040188.pdf0
DATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF: BUSINESS ISO E W6 C�U f)17-tWI aj
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MAILING ADDRESS
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CITY ZIP EPHONE
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NAME
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CITY
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ADDRESS
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ZIP I TELEPHONE
ZIP TELEPHONE
STATE LICENSE NUMBER E P I ZRA' 1=0 � DAT E BY
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PROPERTY TAX AiCCOUNT PARCEL N
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NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
APARTMENT
REPAIR
GRADING CYDS
DEMOLISH
TANK
oGARAGE
RETAINING WALL
CARPORT
ROCKERY -
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER OF
OF
DWELLING
ol STORIES
UNITS
TO BE DONE
()/V;C-:
7� S f I CS L 5—
HEAT SOURCE I GLAZING %
E] PLUMBING / MECH
EDCOMPLIANCE OR
CHANGE OF USE
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FENCE
( — X
OTHER
RENEWAL
FT)
JOB /�j -;� �
ADDRESS
PLAT NAM EiSUBDI VISION NO
PERMITEXPIRES VA1141
PERMIT
NUMBER
SUITE,'APT#
LID NO
LID FEE S
TESCP Approved u
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Piurrut Requited 0
Street Use Permit Req d 0
EXISTING - PROPOSED
insppcl,on Required 0
Sidewalk Requlrcv 0
REOUIRED DEDICATION FT
Underground
mung reaujifed 0__1
mb I ER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRE[)
YES 0 NO 0
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING REVIEWEDtDATE
FIRE REVIEWED By DATE LU
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VARIANCE OR CU
SHORELINE OR ADBO
INSPECTION
BOND
REO'D
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OYES 0 NO
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED P RI?XL� E D
PF IPPOSED
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LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
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FIPLANNING REVIEWED BY DATE
REO'D I PROVIDED
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CHECKEDBY I TYPE OF CONSTRUJION CODE OCCUPANT
GROUP
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CRITICAL
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SPECIAL INSPECTOR
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LOAD
REMARKS
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VALUATION
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PLAN CHECK FEE
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BUILDING
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PLAN CHECK NO: 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.
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m PERMIT APPLICATION: 180 DAYS
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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
wj IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY O�
m EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
m ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIREC TLY
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FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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0 NOR LIMIT IN ANY WAY THE CITY'S 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 THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONS THLIC
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 10
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27
SIGNATU�t. (OWNER DATE Sl(.-,NLD
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At ENTIO
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T IS UL TO �USE 6'ROCCUPY 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
5�96
PLUMBING
MECHANICAL
GRADING,'FILL
4 r, I te I
��IURCHARGE
ENG REVIEW FEES
ENG INSPECTION i:EE
LANDSCAPING I
INSPECTION FEE
RECEIPT
PLAN CHECK DEPOSI1 2-
RECEIP�
TOTAL AMOUNT DUE
CALL
FOR INSPECTION
(425)
771_0220/�
EXT 333(,_
771-0221
FAX
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APPLICATION APPROVAL
This jippliccition it, not a p��tnul until signod by Ino
Building Otlici.ii or hisiher Deouty and Foos are vind. ind
r0c,,,pj t5 oiknoModged it, sp,jco ptovidod
OFFICIAI-S 9IGNATI. DATE
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ORIGINAL FILE YELLOW INSPECTOR
PINK OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE41 1'24 DL(
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: -FIRE DEPARTMENT DATE
PLEASE SIGN
PROJECT
ENGINEERING DIVISION DATE -
PLEASE SIGN
PLANNING DIVISION DATE 61111aA
PLEASVGN
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SITEADDRESS L' &P _2c:::><1 L�4
PERMIT #7,WL� 4s� ADB# U DATEINSPECTED 611(la-4
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 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
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:forms: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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