20040334.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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PROPERTY TAX ACCOUNT PARCEL NO.
F-1 NEW .17-2-01 PLUMBING / MECH
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El ADDITION COMMERCIAL COMPLIANCE OR
E] El CHANGE OF USE
REMODEL MULTIFAMILY SIGN
GRADING FENCEv
REPAIR CYDS ( () X Fr)
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GARAGE RETAINING WALL FIRE SPRINKLER
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OF ;�� DWELLING AREA�
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DESCRIBE WORK TO BE DONE
HEAT SOURCE GLAZING % LOT SLOPE %
CK NO: 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.
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W PERMIT APPLICATION: 180DAYS
CL PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
En 'APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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UJI IN INIERE�T. 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
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ALI- CLAIMS FOR DAMAGES OFWHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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V NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
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
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN Vi6LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27.
DATE SIGNED
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PERMIT EXPIRES IIZZ
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/S F PERMIT
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SUITE/APT#
PLAT NAME/SUB
LOT NO,
LID NO,
LID FEE S'
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCIR Approved
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AW Permit Required
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Street use permit Roq'd
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EXISTING PROPOSED
inspection Required
Sidewalk Required
REQUIRED DEDICATION
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Undringround
Waing required
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METER SIZE
LINE SIZE
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NO, OF FIXTURES
PRV REQUIRED
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YES 11 NO 13
REMARKS
OWNER/CONIRACIOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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REVIEWE
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REVIEWED BY
DATE
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DATE
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VARIANCE OR CU SHORELINE OR ADB11 I INSPECTION I BOND
REO'D POSTED
OYES ONO IS
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
EXP I I
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJRSIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE
REQ'D I PROVIDED
REMARKS
CHECKEDBY ITYPE QF CONSTRUCTION
OCCUPANT
GROUP P,
SPECIAL INSPECTION IAREA7 OCCUPANT/
REQUIRED [] YE LOAD
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ-11.11 6
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
C717
FEE Description F Lz E
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit �5a
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
1 his application is riot a permit until signed by the
Building Official or his/tier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
'71ALS SIGNA1URF DATE
:1141b BVi DAE
ATTENTION EXT 1333 Lf
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 YELLON -
PINK - OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM.
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: -FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
K4VASIGN4
PLE SI:
PLANNING DIVISION DATE
PI.E.ASESIGN
PROJECT f3d��O�,
SITEADDRESS—
PERMIT# -20()A-n36 _ADB4 DATE INSPECTED 14(1'3
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:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
1:1 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of CORRECTION NOTICE given to owner/contractor by itipcctor
2.
3.
RE —INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:ten1p:b1dg:fornis: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 APPROVAL FOR
OCCUPANCY ..................
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