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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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PERMIT EXPIRES
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jNUMBER::`�i�z /SUITE/APT�� ^,/SUBDIVISION NO. OT LID NO.
LID FEE $
T OF WAY PER OFFICIAL STREET MAP Rw Po rnd Rovud ❑
RW PormA Rogwred ❑Stroet Ilso Permit Hoq'd ❑ PROPOSED inspectionHoquirod ❑Sidowalk RequiredDEDICATION FI Underground
Winng requuod ❑E I LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES ❑ NO ❑
REMARKS
OWNERICON TRACTOR RESPONSIBLE FOR EROSION CONTROL./DRAINAGE
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CITY ZIP TELE HONE
EXPIRATION DATE rCVCKED �iY VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
STATERLICENSE NUMBER j Cy OYES ONO is
POSTED
If& `I Tk ) �' q - I I `� SEPA REVIEW SIGN AREA HEIGHT
Jx PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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NEW El RESIDENTIAL El PLUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR t7
COMPLIANCE OR z
❑ ADDITION COMMERCIAL ❑ CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE g
❑ REMODEL ElMULTIFAMILY ❑ SIGN REQ'D PROVIDED
GRADING FENCE
❑ REPAIR ❑ CYDS ❑ ( X. FT) REMARKS
❑ DEMOLISH ❑ TANK OTHER _
Z ❑ GARAGE CARPORT ❑ ROCKERY WALL El FIRE ALARM kIRE LER
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(TYPE OF USE, �INESS OR ACTIVITY) EXPLAIN:
CHECKED BY JTV..E�OF CONSTRUCTION C OCCUPAN
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D OF DWELLING �/ AREAS SPECIAL INSPECTION JAREA OCCUPANT
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DESCRIBE WORk TO BE DONE .y
REMARKSlPROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D a
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S• j ( /���1-y 0q 7/-f Plan Check State Surcharge
HEATS RCE GLAZING % LOT SLOPE %
Building Permit ) City Surcharge
PLAN CHECK NO• �' VESTED DATE Plumbing Base Fee
/ 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
PERMIT APPLICATION: 1 SO DAYS
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a PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
N 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESOHS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection _ Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
= FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE dsca e Ins /
DEEMED 10 MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Lanp p' Total Amt. Due
O NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
= Recording Fee Receipt # T
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
TILE OWNER. I AGREE TO COMPLY WITII 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 VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPEN N SURANCE AND RCW 18.27.
9FFJCIALS SIGN TURF. DATE
SI TURE (OWNF El") ' DATE PIGNE /425 l•
N 7714c,Qg20� HE TEAS
ATTENTI N E i1W
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
BY
ORIGINAL - FILE YELLOW - INSPECTOR
PINK OWNER GOLD - ASSESSOR
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FINAL PROJECT' APPROVAL FORM
TO:
FIE:--
DATE: - Z
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: k�W� FIRE DEPARTMENT DATE
PLEASE SIGN .
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
YI PACP CIrM
PROJECT
SITE ADDRESS G J �:2 / v LJ
PERMIT # � �- LA B# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
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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
Y 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
❑ Copy of CORRECTION NOTICE given to owner/contractor by inpector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
l:temp:bldg:forms:ocaprvl 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: 1
Gas Test
Gas Piping 01
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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