20040303.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PLAT NAMEISUBDIVIS:ON NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
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street use Permit Fleq'd
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EXISTING — PROPOSED
Inspection Required
Sidewalk Raquired
13
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RFOUIRED DEDICATION—
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METER SIZE
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NO. OF FIXTURES
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REMARKS
OWNER/CONTRACIOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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STATE LICENSE NUMBER EXPIRATION DATE
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OTHER
FIRE SPRINKLER
FIRE ALARM
FIRE REVIEWED BY
DATE
VARIANCE OR CU SHORELINE ORADB#_l INSPECTION BOND
REO'D POSTED
OYES DNO 1$
SEPA REVIEW
COMPLETE EXEMPT
EXP I
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D I PROVIDED
REMARKS
N AREA HEIGHT
ALLOWED . PROPOSED I ALLOWED . PROPOSED
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT UR SIDE REAR
LOT AREA I PLANNING REVIEWED BY DATE
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D I
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VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit �ZT City Surcharge_
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVEnsWORKTO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
ir PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT., 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
W IN INTERES!", AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, 11S OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt H
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREC TLY OR INDIREc rLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF -[[its PERMIT SHALL NOT 13E
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMEN1 OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due
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x 0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCIF PROVISION
I Recording Fee Receipt it �2`Ll 0
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT * AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY W1111 CITY AND STATE LAWS REGULATING CONSTRUC CALL This application is not a permit until signed by the
TION. AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building 011icial or hisihor Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTIO receipt is acknowledged in space prov I ided.
WORKY �'S COMPENS�I�RANCE AND RCW 18,27. T DATE
0 FT C -S S GNATUR
ATE SIC ED
3 BY
SIG T E (OWNE O�N� D (4251-
771-022'
F 11 :ASFD BY DAT
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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
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
-FIRE DEPARTMENT DATE_�
FROM:
PLEASE SIGN
ENGINEERING DIVISION DATE-
PLEASESIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT
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SITE ADDRESS- C,,
PERMIT # 3 __�ADB# DATE INSPECTED -
DESCRIPTION OF WORK TO BE INSPECTED. US,1_
A field inspection was conducted to determine compliance with-approv.ed 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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GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
F-1 Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES tor by inpector
0 Copy of CORRECTION NOTICE given to owner/contrac
1.
2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbnns:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROV AL
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