20040373.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
PERMIT EXPIRES
USE PERMIT
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NUMBER
JOB SUITE/APT#
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JADDRESS J,
PLAT NAME/SUBDIVISION NO LOT NO. LID NO.
NEW
1?--RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
1:1
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
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REPAIR
GRADING
CYDS
FENCE
X FT,
El
DEMOLISH
TANK
OTHER
GARAGE
RETAININGWALL
FIRE SPRINKLER
FIRE ALARM
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CARPORT
ROCKERY
(TYPE OkUSE. BUSINESS OU ACTIVITY) EXPLAIN:
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NUMBER
NUM BIfR OF
CRITICAL
OF
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AREAS
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STORIES
UNITS
NUMBER
I DESCRIBEARK TO BE DONE
F,r
LID FEE $
PUBLIC RIGH1 OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
U
13
Street Use Permit Roq'd
EXISTING - PROPOSED
inspection Required
Sidewalk Required
C3
REQUIRED DEDICATION- F-1
Underground
wiring inquired
CI
METER SIZE LINE SIZE NO. OF FIXTURES I PRV REQUIRED
I I YES 11 NO 13
REMARKS
OWNER/CONfRACIOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED
FIRE REVIEWED BY
VARIANCEORCU
SEPA REVIEW
COMPLETE _, EXEMPT
EXP
LOT COVERAGE
DATE
DATE
SHORELINEORADBAl I.INSPECTION BOND
REO'D No POSTED
YES S
SIGN AREA HEIGHT
ALLOWED PROPOSEP LLOWED PROPOSED
FIR
ALLOWED PROPOSED Nfh6�T.SOE'..�Aili 'I I,FRO
PARKING LOT AREA PLANNING REVIEWED BY
REO'D I PROVIDED I
REMARKS
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DATE 5
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CHECKED BY 17PE OF.CON UISTION E_. OCCUPANTk,-__
GROUP
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SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [:] YES LOAD
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D FS
S
VALUATION
D
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURC
E!!!
'CLAZING %
LOT SLOPE %
Building Permit
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City Surcharge
Plumbing
Base Fee
PLAN CHECK 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.
Mechanical
Grading
Engr. Review
PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
Fire Review
Plan Chk. Deposit
'APPLICANI, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES 10 INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIREC-1 IY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERM11 SHALL NOT BE
DEEMED -To MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CIrYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Fire Inspection
Receipt 4
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
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'�,�AJ�ENSATION INSU��CE AND RCW 18,27.
CALL
FOR INSPECTION
(425)
771-0220
TPPLICATION APPROVAL
This application is riot a permit until signed by the
Building Olficial or his/tier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFFICIALS SIGNATURE DATE
ST, T (Owt4;E1 q1 AIG
DATE SIGNEY
r�FtFAS171) BY DATE
ATTENTION Ex 1 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-ASSESSon
W03 PRESS HARD -YOU ARE MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: PLEASE SIGN FIRE DEPARTMENT DATE—C:17- 2 _-_6Y
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE —
PLEASE SIGN
PROJECT 2-1 1�
SITE ADDRESS Pr(14�, LA-,l
PERMIT #_-2,00 ADB# DATE INSPECTED
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
0 Copy of CONDITIONS given to owner/contractor by inspector
1 .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
1 .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbrms:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
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0
Pier/Porch .................
--I
0
Retaining Wall ...........
M
Slab Insulation ..........
PLUMBING:
M
C
Underground .............
M 0
0
0
Rough -In ...................
C:
Commercial Final
M
M Z
HEATING:
C
Gas Test ....................
x
Gas Piping .................
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Equipment .................
M M
Commercial Final .......
0
EXTERIOR SHEATHING
0 M
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NAILING ..........................
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FRAMING ........................
Q 0
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FIRST FLOOR FRAMING ...
;U
INSULATION ...................
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Floor Insulation .........
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Wall Insulation ...........
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Ceiling Insulation .......
0
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SHEETROCK NAILING ...
0
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SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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