20040223.pdfI
DATE RECEIVED
PERMIT EXPIRES
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USE PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
OWNE NAM
/NAME OF BUSINESS
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
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lu MAILING ADDRESS
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3: 7ESCP Approved
PUBLIC RIGIIT OF WAY PER OFFICIAL STREET MAP RW Permit Required
0 / 2 / '—/ 0 —
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Street use Permit Roq'd [3
ully ZIP TELEPHONE EXISTING - PROPOSED inspection Required 13
Sidewalk Required 0
REQUIRED DEDICATION- FT 1 underground
iting required [3
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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YES13 z
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li'- ADDRESS REMARKS z
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L) OWNER/CONTRACTOn RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 5
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ATE LICENSE NUMBER EXPIRATION DATE VARIANCE OR CU SHORELINE OR AD1111 INSPECTION BOND
REO'D POSTED
YES ONO S
SEPA REVIEW SIGN AREA HEIGHT
PROPE AV L NO. I I
XTY TVqCCO NT PARCE COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
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NEW M-��RESIDENTIAL PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (IT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR C3
COMPLIANCE OR z
ADDITION COMMERCIAL E
CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE 5
REMODEL MULTIFAMILY SIGN REQ'D I PROVII ED 112.
GRADING FENCE
REPAIR CYDS ( X FO REMARKS
DEMOLISH 1ANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE BUSINE�S OR AC PLAIN:
--t—A Al XP CHECKED BY JTYPEOFCONSTRU�TION CO94 OCCUPANT
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OF DWELLING AREAS SPECIAL INSPECTION AREA OCCUPANT
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DESCRIBE WOfiK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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4910-�v i�7j-,j L4 Description FEE Description FEE
Plan Check State Surcharge
HEAT SO 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
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
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SEPARATE PERMISSION.
2 Engr. Review
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LU PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE C11-Y OF
2 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
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_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Total Amt. Due
0 615
NOR LIMIT IN ANY WAY THE CITYS ABIL11-Y TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt III
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 APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- I his application is not a per mit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED CALL 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 COMPENSATION INSURANCE AND RCW 18 27.
Or, I IS SIVUE DATE
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SIGNA� ol ARE T,
DATE��GNE
(425)
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771-0220 RELEASF13 BY DATE
ATTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM
RECEIVED TO:
MAR 3 0 2004 DATE:
DEVELOPMENT SERVICES CTR.
MEMO TO: PERMIT COORDINATOR, BUILDR�UDIVMN
WOM: FIRE DEPARTMENT DATE
PLEASESIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT Q&LIL�l AOLrZ UJ -'7
SITE ADDRESS
PERMIT —ADB#---------PATE INSPECTED—?-- 6 �y
DESCRIPTION OF WORK TO BE INSPECTED C-4P
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:
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___X_GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
c3 Copy of CORRECTION NOTICE given to owner/contractor by inspector
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3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
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Pier/Porch .................
Retaining Wall ...........
Slab insulation ..........
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PLUMBING: —1
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Underground ............. C:
M 0
0
Rough -In ................... 0
0 C
Commercial Final ...... --I
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HEATING:
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Gas Test .................... >
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Gas Piping .................
0 _n
Equipment ................. n
Commercial Final ....... M ITI
0
EXTERIOR SHEATHING 0
NAILING .......................... 0 M
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FRAMING ........................ Q 0
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FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation ......... z
Wall Insulation ...........
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Ceiling Insulation ....... z
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SHEETROCK NAILING ... 5
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SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR ff- IF ffff__1§IPF!M0
OCCUPANCY ..................
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