20040317.pdfI
DATE RECEIVED [PERMIT EXPIRES 7C
USE PERMIT
CITY OF EDMONDS ZONE NUMBERd 60 q__
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CONSTRUCTION PERMIT APPLICATION AOIDRESS -S7-
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2?AMEINAME OF BUSINESS
tr I N &rj 'n PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
cc MAILING ADDRESS LID FEE $
W 71E-I;rP �Appfoved 0
z PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required [3
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0 Street Use permit Req'd [3
EXISTING — PROPOSED inspection Required 0
CITY ZIP TELEPHONE Sidewalk Required [3
REQUIRED DEDICATION— FT Underground
Wiring required 0
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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t: ADDRESS REMARKS z
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CITY IP TE;70,3 0 bTREET TO BE, CLEANED OF DEBRIS
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STATE LICENSE NUMBER EXPIRATIONPATE I CHECKED PROPE Y LINE REO'D POSTED
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COMPL E A"ffl i , 9 1 PROPOSED
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OLITION INSPECTION z
COMPLIANCE OR E
ADDITION rCOMMERCIAL 11 CHANGE OF USE 0 CHECKLIST_QN_.gAr!K oF ILIA CARD z
PARKINFOR DATE
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REMODEL MULTIFAMILY El SIGN REO'D I PROVIDED r
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REPAIR GRADING CYDS ( X F-0 REMARKS
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(TYPE OF USE, BUSINESS OR [VIM , PLAIN: CHECKED BY ITYPE OF N TI OQDE OCCUPANT
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0 STORIES UNITS YES
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ1D 5
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$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit n lCity Surcharge
ECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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
PERMIT APPLICATION: 180DAYS
PERMIT ILIMITI YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
ui 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 #
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.X ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREcrLy OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
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01 NOR LIMIT IN ANY WAY THE Cl rYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
x Recording Fee Receipt # Lk
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION AP 3ROVAL
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 pairmit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Olficial or his/her 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. F ICI SIGNATURE D E
E DATE SIGNED (425) Utk _4.
IDATE
771-0220 EASED BY
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
FROM: ___YIRE, DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE—!
LANNING DIVISION DATE
PLEASE SIGN
PROJECT 17,agn2YA�OA
SITE ADDRESS
PERMIT # �Z� 4 —0 31 2 -ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine final 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:
GRANT FINAL PROJECT APPROVAL
iT PROJECT APPROVAL WITH CONDITIONS NOTED
of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION*
Footing......................
Wall..........................
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Retaining Wall ...........
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Slab Insulation .......... ----------------
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commercial Final ......
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HEATING:
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GasTest ....................
Gas Piping .................
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Equipment .................
Commercial Final .......
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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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