20040247.pdfDATE RECEIVED
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CITY OF EDMON�DS
CONSTRUCTION PERMIT APP
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OWNER NAMEINAME OF BUSINESSL�__%�,ij-4,f7d" t"fiff-I
MAILING ADDRESS
PERMIT EXPIRES
IUSF PERMIT
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NUMBER
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P PLAT NAMEISUBDIVISION NO. LOT NO.
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s TATE LICENSE NUMBER EXPIRATION DATE A \CHECK&
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
ROCKERY
(TYPE OF USP, BUSINESS OR ARIVITY). EXPLAIN:
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PLUMBING I MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( x FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS IV14- I NUMBER
DESCRIBE WUHK lu ut UUNt
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HEAT SOURCE
PLAN CHECK NO:
GLAZING %
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
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IL PERMIT LIMIT, I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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Lu IN INTERESF. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGEN1 S FROM ANY AND
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ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIr ISSUANCE OF THIS PERMIT SHAi ' L NOT BE
DEEMED TO MODIFI� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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x 01 NOR LIMIT IN ANY WAY 1 HE 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 WASIIINGTON RELATING TO
WORKMEN'S COMPEN� �rC�4
_jt4SURANCE AND RCW 18 27.
SIGNATURE (OWN DATE j SIqAED
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
62-
3UITE/APT#
LID NO.
LID FEE $
IESCP Approved
AW Permit Required
Street Use Permit Req'd
Inspection Required
Sidewalk Required
underground
Wiring f0clUirad
PRV REQUIRED
YES El NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE LU
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP I
LOT COVERAGE
ALLOWED PROPOSED
.14 il
PARKING
REO'D PROVIDED
10, 1 a -7
REMARKS
SHORELINE OR ADBII
I INSPECTION
REO'D
UK —ES ONO
I BOND
I POSTED
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SIGN AREA
HEIGHT
ALLOWED PROPOSED
ALLOWED PROPOSED
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REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR
FRONT L/R SIDE REAR
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LOT AREA
I PLANNING REVIEWED BY DATE
CHECKED BY ITYPE 0 STR CTION CODE OCOUPANT.,6
GROUP
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SPECIAL INSPECTION JAREA OCCUPANT
REQUIREDE] Y LOAD
REMARKS a
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 5
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Base ee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #.
I
LandscapeInsp.
Total Amt. Due
Recording Fee
Receipt #
---
__�9 9 * a
CALL
FOR INSPECTION
(425)
771-0220
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APPLICATION APPROVAL
I his application is not a permit until signed by the
Building Official or hisitier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
/-T-Fj 'kI Sc� S I G E DAT E
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-LEASED BY I DATf
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ATTENTIC-DN,", V / Ex 1 1333
IT IS UNLAWFUL TO USE 013 OCCUPY A BUILDING OR STRUCTURE UNTIL LLF_�V_( (t d t tt
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.
TO
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASP SIGN
-ENGINEERING DIVISION DATE
PIXASP. SIGN
PLANNING DIVISION DATE
PLEAtVGN
PROJECT PL't��Z_
SITE ADDRESS- 2_?_ 31 q- 61-C
PERMIT# ?,04.P7-47 ADB# DATEINSPECTED 91�1�o
DESCRIPTION OF WORK TO BE INSPECTED
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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
PERF, ORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
1:1 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
El Copy of CORRECTION NOTICE given to owner/contractor by inpector
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2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fonns:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall...........................
Pier/Porch ................. z
Retaining Wall ...........
Slab Insulation ..........
PLUMBING: =n-
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Underground ............. x
0 M
C 0
Rough -In ................... M
0
0
Commercial Final ...... 0 C:
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HEATING: M Z
Gas Test .................... C:
Gas Piping .................
Equipment ................. 0 -n
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Commercial Final .......
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EXTERIOR SHEATHING
NAILING .......................... 0 r-
0 M
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FRAMING ........................ Cf)
Q 0
FIRST FLOOR FRAMING... Z r-
INSULATION ................... ;U
Floor Insulation ......... >
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Wall Insulation ........... --I
Ceiling Insulation Cf)
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SHEETROCK NAILING ...
SPECIAL INSPECTION ... M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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