20040315.pdfDATE RECEIVED�,---?
C1W OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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REQUIRED DEDICATION— FT
METER SIZE I LINE SIZE I NO, OF FIXTURES
TESCP Approved
HW Permit Requvad
Street use Permit Reqd
Impection Heqmted
Sidewalk Required
underground
Wiring TricIevad
PRV REQUIRED
YES 13 NO 13
REMARKS
OWNER/CONrRACTOR RESPONSIBLE FOR EROSION CONIROL/DRAINAGE
ENGINEERING REVIEWED BY
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D I
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Description_
Plan Check
Building Permit
FEE Description FEE
State Surcharge
- IPLAN CHECK NO: VESTED DATE Plumbing
Mechanical 1-7 0
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
2 Engr. Review
cc PERMIT APPLICATION: 180 DAYS
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PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
City Surcharge
Base Fee
U) 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
uJ IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE Landscapelnsp. Total Amt. Due
0 DEEMED TO MODIFY� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY 1 HE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
=1 — Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ 1111S 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 WITH CITY AND STATE LAWS REGULATING CONSTRUC CALL This application is not a permit until signed by life
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or hisilier Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
OFFICI 3 SIGNATURE
FFI
DATE SIGNED � I .
SIGNATURE (OWNER (425) T 4)
xor 1 7. --- M C
771-022
0 [ilFI.FASFD 11
T I ON 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 YELLOVIV - INACTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - O�NE �- GOLD - ASSESSOR
0903 PRESS HARD -YOU ARE MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM
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DATE:
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MEMO TO: PERMIT COORDINATOR, B 'D]NdDIVIS'10�q
FROM: GN FIRE DEPARTMENT DATE446_�__
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-ENGINEERING DIVISION DATE,
PLEASESIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT
SITEADDRESS
IT# 6 ADB# DATE INSPECTED
PERM
DESCRIPTION OF WORK TO BE INSPECTED
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
_AJ:-K -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
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
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PA
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbm-is: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:
GasTest ....................
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 APPROVAL FOR
OCCUPANCY ..................
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