20040255.pdf3
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNEP NAME NAME OF BUSINESS
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CITY zip TELEPHONE NUMBER
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CITY
TELEPHONE NUMBER
NAME
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ADORE
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CITY zip TELEPHONE NUMBER
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STATE LICENSE NUMBER EXPIRATION DATI
Legal Description of Property - include all easements V
USE
ZONE PERMIf
NUMBER
JOB
ADDAF 55
,EGAL DESCRIPTION CHECKI SUBDIVISIOI� IjO
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SUITE APT a
LID '40
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
T'SCP App'o�ed 11
RW Per MIT Required 0
EXISTING ____ REQUIRED DEDICATION
Street Use Permit Req d 0
PROPOSED
Inspection Requited 0
Sidewalk Required 0
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METER SIZE
LINE SIZE
NO. OF.FIXTURES
PRV REQUIRED
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YES 0 NO 11
REMARKS
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Property
Tax Accoun4
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FINEW 5?S RESIDENTIAL 11 PLUMBINGIMECH
COMPLIANCE OR
FIADDITION D COMMERCIAL 1:1 CHANGE OF USE
EIREMODEL 1:1 APT. BLDG. 1-1 SIGN
FENCE
EIREPAIR (_ X _FT)
FIDEMOUSH 'I.IDSTWOVE SWIM POOL
1:1 INSERT HOT TUB/SPA
FGARAGE RETAINING WALL/
—JCARPORT 7 ROCKERY RENEWAL
(TYPE OF USE. BU�INESS OR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
CRITICAL
OF
DWELLING
AREAS
STORIES 4:::f III
UNITS
NUMBER
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DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
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HEAT
GLAZING
MEMO DATED
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP
LOT COVERAGE
ALLOWED I PROPOSED
LOT
REMARKS
BY ITYPE OF
ADB N
SIGN AREA
ALLOWED I PROPOSED
REVIEWED BY
SHORELINE It
HEIGHT
ALLOWED ]PROPOSED
Out RED SETBACKS (FT) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR I FRONT UR SIDE REAR
111:1INT IWATAffil
CODE
DATE
OCCUPANT
0
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SPECiAL INSPECTOR AHI_A OCCUPANT
REQUIRED I I I LOAD I
PROGRESS INSPECTIONS PER UBC 108
FIRE MARSHAL
MUST BE PRESEN FF
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FINAL INSPECTION REQUIRED
VALUATION
PLAN CHECK FEE
BUILDING
PLUMBING
Plan Check No. MECHANICAL
This Permit covers work to be done on private property ONLY. GRADINGIFILL
Any construction on the public domain (curbs, sidewilks, *trArE%U RCH A FIG E(4t
driveways, marquees, etc.) will require separate permission
Permit Application: 180 Days STORM DRAINAG!ZE
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days =5=
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"Applicant, on behalf of his or her spouse, heirs, assigns and E -INSPtCT71&F F
successors in interest, agrees to indemnity, defend and hold
harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE
provision." I
I H�rBb acknowledne that I have read this application; that the
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information given is correct; and that I am the owner, or the duly
ATTENTION
APPLICATION At��-'NUVAL
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
This application is not a permit until
state laws regulating construction; and in doing the work authoriz-
I
AUTHORIZES
signed by the Building Official or his/her
ed thereby, no person will be employed in violation of the Labor
ONLY THE
WORK NOTED
Deputy; and fees are paid, and receipt is
Code of the State of Washington relating to Workmen's Compensa-
acknowledged in space provided.
tion Insurance aria RCV�-T$.27.
INSPECTiOt4
ATUR DATE SIGNED
DEPARTMENT
61or/ATURE DATE
0
CITY OF
ol
EDMONDS
0
CALL FOR
RELEASED BY f 4)A I t
ATTENTION
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
HAS BEEN MADE AND APPROVAL OR
771-0220
ORIGINAL - File YELLOW - inspector
UNTIL A FINAL INSPECTION
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTION 109
PINK - Ov.ner GOLD - AS5essor
102-87
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DATE_!���O
FROM:
PLEAS&SIGN
ENGINEERING DIVISION DATE
PLFASESIGN
PLANNING DIVISION DATE
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PLEMESIGN
PROJECT Z_ U 7
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SITE ADDRESS �2_
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PERMIT # 9�60 _ADB# INSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED d= C-A—P
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A field inspection was conducted to determine final compliance with approved plans. Final approval
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denotes that there are no objections from the above signed Department to the release of
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PERFORMANCE BONDS and the granting of
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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0 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 inspector
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2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
ocaprv1.doc.1:temp:b1dg:fbnns 10/0 1
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ...................
FOUNDATION:
Footing ....................
Wall.......................
Pier/Porch ................
RetalningWall ............
Slab Insulation ............
PLUMBING:
Underground .............
Rough -In .................
Commercial Final ........
HEATING:
GasTest .................
GasPiping ................
Equipment ................
Commercial Final .........
EXTERIOR SHEATHING
NAILING ....................
FRAMING.' ....................
INSULATION:
Floor Insulation ...........
Wall Insulation ...........
Ceiling Insulation .........
SHEETROCK NAILING ......
SPECIAL INSPECTION ......
MISCELLANEOUS
FINAL APPROVAL
FOR OCCUPANCY ..........
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