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CONSTRUCTION PERMIT APPLICATION ADDRESS -b i
OWNER NAME/NAME OF BUSINESS
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NAME
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PERMIT
NUMBER
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LID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP fjW pte, it Fjecj.:;6,d1
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EXISTING — PROPOSED -------- S,dowillk nequinid
ZIP TELEPHONE undelgTound
REQUIRED DEDICAHON. rT wiring raquirad
PRV REQUIRED
=L METER SIZE LINE SIZE NO. OF FIXTURES YES NO 13
ZIP I TELEPHONE
CBL # 41
ADDRESS E,
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LA�C- AD fESt 9A I
STATE LICENSE NUMBER I EXPIRAT19N DATE
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PROPERTY TAX ACCOUNT PARCEL NO. - - — � _f
NEW
2e--RESIDENTIAL
ADDITION
F-1 COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
[2'-T-ANK
GARAGE
CARPORT
FIETAININGWALL
ROCKERY
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER NUMBER OF
OF DWELLING
STORIES I UNITS
DESCRIBE WORK TO BE DONE
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HEAT SOURCE i GLAZING %
PLAN CHECK NO:
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
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OTHER
FIRE SPRINKLER
FIRE ALARM
DATE
DATE
BOND
SHORELINEORADB# I INSPE�"UN I
RE1QD POSTED
20YES ONO S
HEIGHT
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EXP I
LOT COVERAGE
ALLOWED PR6�OW,
REMARKS
OWNER/CONIRACTOR RESPONSISt.E FOR EROSION CONIROLIDRAINAGE
EERING
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
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REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 5
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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
W
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CL PERMIT LIMIT1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
( U) 'APPLICANT, ON BEHAI.F OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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YEES, AND AGENTS FROM ANY AND
2 EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLO
A L CL MS I E, ARISING DIRECTIY OR INDIRECTLY
LL CLAIMS FOR DAMAGES OF WHATEVER NATUR
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x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERM11 SHALL NOT BE
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0 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENI Of-' ANY CITY ORDINANCE
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OR THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,'
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0 NOR I-IMIr IN ANY WAY
CHECKED BY ITYPE
VALUATION
Description
Plan Check
Building Permit
plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
I HEREBY ACK14OWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
RMAT 'ON
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GIVEN IS CORRECI; AND T14AI 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 WIt_L BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSA�JON 1�61URANCE AND RCW 18,2T
DATE SIGNED
SIG�N7ATJE (OWNER O,�AGE
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Recording Fee
: F E
E.l Description FEE
State Surcharge
/LL— City Surcharge
Base Fee
77r=t
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CALL
FOR INSPECTION
(425)
771 -02r..%A
C: NZT -1 11 11 *1
Plan Chk. Deposit
Receipt #
Total Amt. Due 1!
Receipt #
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.
OFFICIAI-I VS11, NATURE DAT E
RELEASED' 13Y ------ 7—DiTE
ATTEN-FIL)N
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 COPIES
ORIGINAL -FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
RECEIVECj TO:
APR 2 8 20"A DATE:
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MEMO TO: PERMIT COORDINATOR, BUILDING DIMMM".,
FROM: z�� FIRE DEPARTMENT DAT
PLZASE SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEME SIGN
PROJEC
SITEADDRESS L7 2-0 -7
PERMIT —ADB# -DATEINSPECTED
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
PERFORMANCE BONDS and the granting of:
L-_,1__GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
M 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:fbrrns:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pier/Porch .................
Retaining Wall ........... 0
M
Slab Insulation ..........
PLUMBING:
M
Underground ............. C
M
0
Rough -in ................... 0
0 C
Commercial Final ...... --I
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HEATING: g) 11 .1
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Gas Test .................... > z
Gas Piping .................
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Equipment ................. n
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Commercial Final ....... 171
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0
EXTERIOR SHEATHING 0
NAILING .......................... 0 M
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FRAMING ........................ Q 0
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FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation ......... >
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Wall Insulation ........... Z
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Ceiling Insulation ....... z
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SHEETROCK NAILING ... --I
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SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOTI�
42CCIMANO-V ..................
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