20040198.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
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CITY ZIP TELEPHONE
NAME 1 _
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STATE LICENSE NUMBER
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PROPER TAX ACCOUNT PARCEL NO.
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TELEPHONE
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EXPIRATION DATE CI KED B.Y
❑ NEW RESIDENTIAL ❑ PLUMBING / MECH
❑ ADDITION ❑ COMMERCIAL ❑ COMPLIANCE OR
CHANGE OF USE
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN
❑ REPAIR ❑ GRADING CYOS ❑ FENCE X FIT)
❑ DEMOLISH TANK ❑ OTHER
❑GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ❑ ROCKERY ❑ FIRE ALARM
(TYPE OF USE, BUSINSS OR ACTIVITY) EXPLAIN
o NU R. NUMBER OF / CRITICAL
O DWELLING AREAS fJ
to UNITS NUMBER
0
DESCRIBE WORK TO BE DONE
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
F BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
F-
Iz PERMIT APPLICATION: 180 DAYS
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a PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
W 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
N
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
i EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOl 13E
of DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
x O NOR LIMIT IN ANY WAY THE CITYS 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 CONSTRUC
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 INSURANCE AND RCW 1B27.
SIGNATURE (OWNER OR G N DATE SIGNED
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USE
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JOB
ADDRESS
PERMIT EXPIRES
PERMIT /
NUMBER II
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LID NO.
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LID FEE $
OF WAY PER OFFICIAL STREET MAP
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RW Pormit Roquuea ❑
FFXISTING
Suoot Uso Point Hoq'd ❑
PROPOSED
Inspection Roquirod ❑
Sidewalk Required ❑
OICATION Fi
Underground
Wiringrequired
I LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES ❑ NO ❑
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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NGINEERING REVIEWED BY DATE
REVIEWED BY DATE w
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VARIANCE OR CU SHORELINE OR ADBtf INSPECTION BOND
REDID POSTED
❑YES ❑NO 5
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
PARKING LOT AREA PLANNING REVIEWED BY DATE
REGO PROVIDED
REMARKS FIRE MARSHAL
MUST BE PRESENT FOR
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CHECKED BY ITI CONSTRJJCTION CQ9E. OCCUPANT
GROUP
SPECIAL INSPECTION AREA OCCUPANT
REQUIRED ❑ YES I
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REMARKS c9
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D o
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VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE Description FEE
State Surcharge
City Surcharge z,
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Base Fee
Plan Chk. Deposit
Receipt N
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Total Amt. Due
Receipt N
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFFIC , LS SIGNA URE DATE
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RELEASED BY DATE
ATTENTION EXT 1333 1--- -
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL l_
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
09,iO3 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL -FILE YELLOW -INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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MEMO TO.
FROM:
PROJECT
AL P
PERMIT COORDINATOR, BUILDING DIVISION
PLEASE
RECEIVED
d FORM MAR 17 2004
--DEVELOPMENT SERVICE:
CITY OF EDMON,:
TO:
DATE.
DEPARTMENT DATE J''16
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
SITE ADDRESS
PERMIT #� - ' / l 9 ADB# DATE INSPECTED 3��// 6 `-(
DESCRIPTION OF WORK TO BE INSPECTED US
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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 so
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 inspector.
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date
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Sign,
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS
FOUNDATION:'
Footing' ..................•...
Wall
Pier/Porch Z
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Retaining Wall ........... --I
Slab Insulation M.
PLUMBING:
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Underground ............. p m
Cp
Rough -In ................... m O
On
Commercial Final ...... C
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HEATING: M Z
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_ Gas Test ...:...... D Z
Gas Piping ....... ........
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Equipment .... .......... O
Commercial Final .......
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EXTERIOR SHEATHING (n
NAILING r
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FRAMING Cl)
FIRST FLOOR FRAMING... � rmm
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INSULATION
Floor Insulation _
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Wall InsulationCn
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Ceiling Insulation,...,..
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SHEETROCK NAILING ... OMNI
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SPECIAL INSPECTION ... M
MISCELLANEOUS ......
FINAL APPROVAL FOR
OCCUPANCY
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