20040243 (2).pdfi
FDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
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CITY Zip TELEPHONE
NAME
W
tRESS
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NAME
ADDRESS
1011 V4
STATE LICENSE NUMBER
PROPERTY
NEW
ADDITION
REMODEL
REPAIR
El
DEMOLISH
GARAGE
CARPORT
(TYPE OF USE,
ZIP ITELEPHONE
CBL 4
C:
ZIP I TELEPHONE
EXPIRATION DATE I CHECKED BY
PARCEL NO.
ARESIDENTIAL
El
COMMERCIAL
El
MULTIFAMILY
GRADING CYD
TANK
RETAINING WALL
ROCKERY
OR ACTIVITY) EXPI
I uj NUMBER NUMBER OF
a OF DWELLING
to UNITS
o STORIES I
DESCRIBE WORK TO BE DONE
x
HEAT SOURCE
GLAZING %
El PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X. FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
AREAS
N U M B E Wel)19
LOT SLOPE %
PLAN CHEC VESTED DATE
_�1140'
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
gr PERMIT APPLICATION: 180DAYS
PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) OAPPLICANI ON BEHALF OF [Its Oil HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
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�j IN INTERE�T, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON. 11-S OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Im ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
4
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
a DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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01 NOR LIMIT IN ANY WAY THE CIT-Y'S A131LITY TO ENFORCE ANY ORDINANCE PROVISION
USE
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JOB
ADDRESS
PLAT NAME/SUBDIVISION NO.
I PERMIT EXPIRES
PERMIT
NUMBER
SUITE/APT#
�W' C;7
LOT NO LID NU.
LID FEE $
TESCP 0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW permit R q vrod
street use Permit Roq'd
inspection Required 10�
EXISTING PROPOSED Sidealk Requited
Underground
REQUIRED DEDICATION FT witingiriquirod
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I-- I- YES NO E3
Ef:=
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLiDRAINAGE
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ENG114EERING REVIEWED BY DATE
NJ va�LL.�-
FIRE REVIEWED BY DATE Lu
C U
VARIANCE OR CU
SHORE �I'NE —OR ADEN
INS PECTION
BOND
POSTED
REQ'D
: S
IYE WO
s
V IEW
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
EXP
LOT COVEIRAGEREQUIRED
SETBACKS (Fr.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE RE:AAR
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0,
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PARKING
LOT AREA
REVIEWED BY D'e4
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REO'D i PROVIDED
:P�LANNING
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REMARKS
CHECKED BY TYPE 0 RUCTION C0j)E OCCUPANT
GROUP
SPECIAL 14NSPECTION AREA OCCUPANT
REQUIRED [] YES LOAD
[REMARKS a
P SPECTION REQ'D 1 'F3
PROGRESS INSPECTIONS PER UBC 108/171NAL IN
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
LandscapeInsp.
Recording Fee
FdEE Description FEE
State Surcharge
City Surcharge_
Base Fee
CALL
FOR INSPECTION
(425)
771-0220
-1 r3 03 12
ATTENTION j L;A I
IT IS UNLAWFUL TO USE OR OCCU13Y 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 C(
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND T14AT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
lION AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN Vicil-ATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S Co��ATION INSURANCE AND RCW 18 27.
SIGNATIMWNER ) R AGENT) DATE SIGNED
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt # 0
APPLICATION APPRdVAL
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.
OFFICIALS SIGNATURE DATE
.r�) r- -1 1
- . ----I ('\� - 114-111k
4RFl EASED BY 7 / FATV A
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ORIGINAL -FILE YELLOW."INSVECT6
PINK -OWNER GOLD -ASSESSOR
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GUTTERS/DoWNSPOUTS
SYST.
TO CONNECT TO EXIST
/ACGEP"l'fiB%LE TIGHTLINIE
MATERIAL
SDR 35
SCH 40
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RECE IVED
DRIVEt','AY S,A-,
MAR 2 3 2004
PERMIT �OUNTER
Dat(
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APPl`i0VcD AS NOTED
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SETBACKS:--",---.—.
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FRONT,---/
SID E
REAR
14 OTHER
APPROVED BY PLANNING
,�N_lca A pl.
IN'*PFC701 Prruipm
FINAL PROACT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
MY" SIGN
role, ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT SL)A(G
Pe
SITE ADDRESS,?/ 3/_ 7- s
PERMIT —ADB# *.DATE INSPECTED —
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine final compliance with approved plans. Fi nal approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
/I GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
I .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
I .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
ZQ
Footing ......................
Wall ..........................
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0
Pier/Porch .................
0
Retaining Wall ........... M
Slab Insulation ..........
PLUMBING: 3:
0 M
C
Underground ............. M 0
__4 0
Rough -in ................... 0 0
C
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Commercial Final ...... 3: M
M Z
HEATING: C —Z
Gas Test ....................
Gas Piping .................
Equipment ................. —4
x
M ITI
Commercial Final .......
EXTERIOR SHEATHING
0 M
NAILING..........................
Cn
Q 0
FRAMING ........................ Z
FIRST FLOOR FRAMING ...
INSULATION ...................
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Floor Insulation .........
Wall Insulation ........... 0)
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Ceiling Insulation ....... 0
SHEETROCK NAILING ...
M
SPECIAL INSPECTION ...
?Y)S
MISCELLANEOUS ..........
FINAL APPROVAL FOR 9 -d
OCCUPANCY ..................