20040202.pdfI
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DATE RECEIVED
C1W OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAM� OF BUSINESS
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MAILING ADDRESS
6ilow
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CITY ZIP TELEPHONE
C1� IF
NAME
ADDRESS
CITY I � ZIP
NAME
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ADDRESS
P/7' &fx Sn)?
CITY ZIP
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STATE LICENSE NUMBER
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PROPERTY TAX ACCOUNT PARCEL NO.
TELEPHONE
CBL
USE
ZONE
JOB
1
ADDRESS
-71
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TELEPHONE
10 K - 7
EXPIRAJION DATE CHECKED BY
t1loff I �11W
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NEW
EYRESIDENTIAL
ADDITION
1:1 COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYD
DEMOLISH
Eae"TANK
GARAGE
RETAINING WALL
ROCKERY
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NUMBER
NUMBER OF
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DWELL NG
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DESCRIBE WORK TO BE DONE
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
El SIGN
FENCE
( x Fr)
OTHER
oFIRE SPRINKLER
FIRE ALARM
tv
CRITICAL
AREAS
NUMBER
PLAT NAMEISUBDIVISION NO
PERMIT EXPIRES
PERMIT
NUMBER
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
SUITE/APT#
I
LID NO.
LID FEE $
TESCP Approved
13
RW Permit Required
13
Street Use Permit Hoq'd
Q
Inspection floquirod
C3
Sidewalk Required
13
Underground
Wiring required
PRV REQUIRED
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLYDRAINAGE
MAROSHAL
ENGINEERING T1PVJ9VEIyBy1_i -, z I L. I'll ��'d /"%L.,
FIRE REVIEWED BY
DATE
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VARIANCE OR CU
SHORELINE OR ADB11
INSPECTION
BOND
REO'D
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POSTED
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OYES ONO
S
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP I
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LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LJR SIDE REAR
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PARKING
LOT AREA
PLANNING REVIEWED BY DATE
REQ'D I PROVIDED I
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HEAT SOURCE
PLAN CHECK NO:
GLAZING %
: ^0
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: 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
ALI- CLAIMS FOR DAMAGES OF WHATEVER NAIURE.AIIISINGOIRECTiYORINDIRECII-Y
FROM THE ISSUANCE OF THIS PERMIL ISSUANCE OF HAS PFRMI1 SHALL NOT HE
DEEMED ro MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR Limi r IN ANY WAY THE CITYS ABILITY to ENFORCE ANY ORDINANCE PROVISION I
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION� THAT THE INFORMATION
GIVEN IS CORRECT AND THAT I AM THE OWNER, 08 THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGRLE TO COMPLY WITI I CITY AND STATE LAWS REGULATING CONSTlTUC
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 59KENSATION INSURANCE AND RCW 10 27.
SIGNAT, �NE 10�140(WT)11 DATE IGNFD
I"r . W
REMARKS
CHECKED BY jTYPE�,y,?,STfIUC ON ICO OCCUPANT
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED E] YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt 9
LandscapeInsp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
(425)
771 -0220
APPLICATION APPROVAL
I hiLi application is slot a pefillit until signed by the
Building 011icial or his/her DOPLAY. and Fees are paid, and
receipt is acknowledged in space provided
KFIr I TURF DATE
'!' I'Ijl
RFI FASFI�'F! Y E i
ATTENTION t:A I I JJJ
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
04,'02 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
RECEIVED TO:
MAR 15 2004 DATE:
ICES CTFI.
MEMO TO: PERMIT COORDINATOR, BUELD96'sMANDS
FROM: FIRE DEPARTMENT DATE S*�— 4-7
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT D CJA�W tE _2
SITE ADDRESS I ___2 1 2 e,) � �" L_ A /_')
PERMIT _ADB#_________DATE INSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED 0 317— lz__ 1 4,,, sz CA-
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 :
X_GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
c3 Copy of CONDITIONS given to owner/contractor by inspector
1 .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
c3 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
OCCUPANCY ..................
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