20040218.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME,NAME OF BUSINESS
MAILANG ADDRESS
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CITY ZIP TELEPHONE
NAME
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ADDRESS
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CITY ZIP TELEPHONE
NAME CBL#
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PITY ZIP TE LEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE L4;HECKED,-PY
b W 10 EW S 9 7 0 1"'l 55
PROPERTY TAX ACCOUNT PARCEL NO.
S -7 00tTYNX7
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NEW RESIDENTIAL PLUMBING/ MECH
COMPLIANCE OR
11 ADDITION a-ICOMMERCIAL
CHANGE OF USE
E3"OREMODEL 1-1 MULTIFAMILY
SIGN
GRADING
ED REPAIR 0 nync;
FENCE
( X FT)
E] DEMOLISH 0 TANK
OTHER
GARAGE RETAINING WALL
FIRE SPRINKLER
FIRE ALARM
CARPORT ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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En
NUMBER
OF
NUM BER OF
DWELLING
CRITICAL
AREAS
al
0
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
Y
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
C
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
cc PERMIT APPLICATION: 180DAYS
PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
" cn 'APPLICANI. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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W IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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cc ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREC LAY OR INDIRECTLY
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FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF I HIS PERMI SHALL N01
DEEMED TO MODIFY� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY 10 ENFORCE ANY ORDINANCE PROVISION.*
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
BY ACKNO'
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GIVEN ISJQ4.IIE
WG.CT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
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E OW I., G
I I E OW , EE TO COMPLY Willi CITY AND STATE LAWS REGULATING CONSTRUC
WORPI . 6 IN Djl�NG THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
TION; I
IN VI T 1 0 IN THE LAE30R CODE OF THE STATE OF WASHINGTON RELATING TO
EN'S CO PENSATION INSURANCE AND RCW 18 27.
GN ER DA STNED
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PERMITEXPIRES
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USE PERMIT
ZONE 2
NUMBER Vqe'01j- 03 1 4�
JOB SUITE/APT#
ADDRESS - . j
PLAT NAME/SUBDIVISION NO.
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE LINE SIZE NO. OF FIXTURES
LID NO.
LID FEE $
fESCP Approved
13
RW Permit Required
E3
street Use Permit Rdq'd
13
Inspection Required
13
Sidewalk Required
13
Underground
Wiring requirod
0
PRV REQUIRED
YES 11 NO 13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU
SEPA REVIEW
COMPLETE , EXEMPT
EXP V/
LOT COVERAGE
ALLOWED PROPOSED
'qi�_
PARKING
REO'D I PROVIDED
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REMARKS
SHORELINE OR ADB11
INSPECTION
BOND
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,,,REO'D
I M�ES ONO
POSTED
I S
SIGN AREA
HEIGHT
ALLOWED PROPOSED
S aik_
ALLOWE D ROPOSED
/512
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR
FRONT LIR SIDE REAR
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LOT AREA I
—
PLANNING REVIEWED BY DATE
CHECKED BY ITYPE OF CONSTRUCTA10/4 CODE OCCUPANT
GROUP
L -7
SPECIAL INSPECTION rA OCCUPANT
REQUIRED [] YES LOAD
0
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
VALUATIO"
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
ATTENTION )ff 133�
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 CC
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
rhis application is riot a pennit unlit signed by the
Building Official or his/her Deputy and Fees are paid, and
receipt is acknowledged in space ptovided.
7
ZVI / CIAL S .S1IGNArURF __7 / DATE
FL[FD 13 DATE/
IES
ORIGINAL - FILE YELLOW � INSPECTC
PINK - OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO: kto'&'
DATE: ;
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: --FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
PUASE SIGN
11� PLUSE SIGN -PLANNING DIVISION DAT
PROJECT
2LIL)() t&�)
SITE ADDRESS q.-I
PERMIT ADB# DATE INSPECTED
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
El Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbnns: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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