20040368.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
MAILING ADDRESS
CITY ZIP IELEP14ONE
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NAME
CITY
NAME
ADDRESS
CITY
STATE LICENSE NUMBER
ZIP ITELEPHONE
ZIP I TELEPHONE
EXPIRATION DATE
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CHECKED 13Y
PROPE51_� TAX ACCOUNT PARCEL NO.
4V ii�7,7
NEW
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PLUMBING / MECH
ADDITION
nRESIDENTIAL
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
F-1
MULTIFAMILY
SIGN
REPAIR
13
GRADING
CYDS
FE�L X L/
e FT)
( /,g
DEMOLISH
El
TANK
OTHER
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GARAGE
CARPORT
RETAINING WALL
ROCKERY
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FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE. BUSINESS
'I 9R ACTIVITY) EXPLAIN:.
JOB
ADDRESS
I
PERMIT EXPIRES —1 1 j
PERMIT
NUMBER,�
SUITE/APT#
PLAT NAME/SUBDIVISION NO.
LOT NO..
LID NO.
LID FE11 $
IESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
Rw Permit Required
street Use Permit Aoq'd
EXISTING PROPOSED
inspection Required
Sidewalk Required
REQUIRED DEDICATION FT
underground
wiring required
METER SIZE
LINE SIZE
I
NO. OF FIXTURES
PRV REQUIRED
YES 0 NO 13
[REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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BY
DATE
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INSPECTION
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COMPLETE EXEMPT
MPL
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ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
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REQUIRED SETBACKS (Fr.)
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PROPOSED SETBACKS (Fr
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ALLOWED PROPOSED
LLOW P 0 r
FRONT SIDE REAR
LJR SIDE REAR
FRONT U
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES z UNITS L NUMBERO�
DESCRIBE WORK TO BE DONE I
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO- VESTED DATE
T THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (cunes, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
3 SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
W
CL PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) "APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
U) S
W IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
0
2 EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
S
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
c3 M To f4
0 NY CITY ORDINANCE
DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF A
OR
LIMIT
0 NOR LIMIT IN ANY WAY THE CITYS 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 VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S C��ErATION INSURANCE AND RCW 18.27.
SIGNED
SI NATURE OWN AGENT) DATE
tfid' t , / h., -1-n �i /
PARKING LOT AREA PLANNING REVIEWED BY D E CL
REQ'D I PROVIDED I
REMARKS
CHECKED BY ITYPE OF CONST�UCTIOON ICO OCCUPANT
GROUP
SPECIAL INSPEcTi6lN �AREA U��U!7�14 I
LOAD
REQUIRED [3 YES
REMARKS z
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
Jul 11
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
FOR INSPECTION
(425)
771-0220
CVY -4120312 /1
ATTENTION
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 CC
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt # ICA
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
Pr/I�LS SIGNXTURE DATE
11L-1
ORIGINAL - FILE YELLOW - INSFIECTC
PINK - OWNER GOLD - ASSESSOR
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NOTICE: IF THE DOCUMENT IN THIS FRAME IS LESS CLEAR THAN THIS NOTICE
IT IS DUE TO THE QUALITY OF THE DOCUMENT.
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DATE—___�
..FR0M:. MXAWSW
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ENGINEERING DIVISION DATE 012-
PLANNING DIVISION DATEL—__�
PROJECT
SITE A*DDRESS_-V1 _�3 Yd )9ve
DATRINSPECTED
P E R MIrT w4 .,kDB#—
DESCRIPTION OF WORK TO -BE INSPECTED
A field inspection was conduicted to determine final compliance with.approved plans. Final approval
rtment to the release of
denotes that there are no objections from the above signed Depa
CE BONDS and the granting of.:
PERF—ORMAN
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS N01M
C, Copy of CONIDMONS given to. owner/contractor by inspector
FAILED FINAL INSPECTION OUTSTANDING ISSUES
C1 Copy of'CORRECTION NOTICE given to owner/contractor by inspector.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL.
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall ..........................
Pier/Porch ................. z
0
Retaining Wall ...........
0
ITI
Slab Insulation ..........
PLUMBING:
Underground ............. M
C:
M
Rough -in ................... 0
0
Commercial Final ...... 0 C
M
HEATING: M Z
C
Gas Test .................... >
Gas Piping .................
0 -n
Equipment .............. -n
Commercial Final .......
M M
EXTERIOR SHEATHING 0
NAILING .......................... 0
0 M
C:
FRAMING ........................ U)
M 0
Z
FIRST, FLOOR FRAMING ...
INSULATION ................... ;U
—4
Floor Insulation ......... >
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Wall Insulation ........... —1
Ceiling Insulation ....... U)
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0
SHEETROCK NAILING ... --I
0
SPECIAL INSPECTION M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
Tile jilitials NIT are Milt011
T110111PSon, a temporary contract
inspector for tile CitY-
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