20040374.pdf15
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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
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CITY
FbAwDs
NAME
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ZIP
94?vao
ZIP
TELEPHONE
77*-'
TELEPHONE
NAME CBLH
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CITY .4 1 j ZIP TELEPHON
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STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARPEL NO.
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NEW
RESIDENTIAL
F� PLUMBING MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
r_1 CHANGE OF USE
REMODEL
MULTIFAMILY
F-1 SIGN
REPAIR
D FENCE
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GRADING
CYDS
DEMOLISH
;:<TANK
F-1 OTHER
EGARAGE
l CARPORT
RETAINING WALL
El ROCKERY
FIRE SPRINKLER
El FIRE ALARM
(TYPE OF USF. BUSINESS OR ACT
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USE
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ADDR
PLAT NAMEISUBDIVISION NO.
PERMIT EXPIRES
PERMIT
NUMBER
SUITE/APT#
LID NO.
LID FEE-$----.
TESCP App(OVOU
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW permit peqLpred
Use permit Raq'd
Street
inspection Required
13
EXISTING — PROPOSED
Sidewalk ReqU110d
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REQUIRED DEDICATION— FT
underground
METER SIZE LINE SIZE NO. OF FIXTURES
PRV REQUIRED
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YES NO C3
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REMARKS
RESPONSIBLE FOR EROSION CONI`ROL/DRAINAGE
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OWNER/CONTRACTOR
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE tu
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VARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND
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LEO 0 POSTED
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DYES 08NO S
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SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
EXP .. . . F, % t:f 7
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NUMBER [NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS I NUM13ER
'I DESCRIBE WORK TO BE DONE
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HEAT SOURCE
PLAN CHECK NO:
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GLAZING % LOT SLOPE %
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 JCURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
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PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND 1101-D HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECIVY OR INDIRECI LY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
= 0 NOR LIMIT IN ANY WAY THE CITY'S ABIL11Y TO ENFORCE ANY ORDINANCE PROVISION.
I
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 11AE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION,!NSURANCE AND RCW 18,27.
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DAI E SIG
LOT COVERAGE — lif
ALLOWED PROPOSED P%N'RTC
PARKING "
REO'D I PROVI
REMARKS
PROPOSED SETBACKS (FT.)
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UR SIDE REAR
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ED BY DATE :1
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OCCUPANT
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GROUP
SPECIAL INSPECTION
OCCUPANT
REQUIRED [3 YES
JAREA
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
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VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
FEE Descrintion FEE
State Surcharge
City Surcharge
Base Fee
CALL
FOR INSPECTION
(425)
771-0220
ATTENTION Cl& I
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
091'03 PRESS HARD -YOU ARE MAKING 4 COPIES
Plan Chk. Deposit
Receipt #
Total Amt. Due t' 4.
Receipt #
APPLICATION A VAL
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,
OFFICIALS SIGNATURE
PATE
RELEASED BY DATE
ORIGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER GOLD -ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLWE SIGN
-ENGINEERING DIVISION DATE
PMASE SIGN
PLANNING DIVISION DATE
PLWESIGN
PROJECT—U-3-E
SITE ADDRESS 7 o �i el 6,
pF # ADB# Y
,RMIT ?.oaH DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED_C,,�,S f:zP_0A'__P =4= 0—roazft.
A field inspection was conducted to determine compliance with -approved plans. Final approval
e above signed Department to the release of
denotes that there are no objections from th
PERFORMANCE BONDS and the granting of
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fonns:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall .......................... z
0
1
Pier/Porch .................
0
171
Retaining Wall ...........
Slab Insulation ..........
3:
PLUMBING: 0 M
1711
Underground ............. 0
--10
0 C
R6ugh-ln .................... --I r.
3: M
M Z
Commercial Final ......
HEATING:
Gas Test ....................
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0 -n
Gas Piping ................. -n
Equipment .................
M M
Commercial Final ....... 0)
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EXTERIOR SHEATHING cn
Cn
NAILING ..........................
Q C-)
Z
FRAMING ........................ -I
FIRST FLOOR FRAMING ...
INSULATION ................... >
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Floor Insulation .........
Wall Insulation ........... z
0
Ceiling Insulation ....... --q
0
SHEETROCK NAILING ... M
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL.F'"-
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