20040383.pdfI
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SE PERMIT
CITY OF EDMONDS ZONE NUMBER
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CONSTRUCTION PERMIT APPLICAT107N TADDRESS
OWNER NAMEINAME OF BUSINESS
PLAT NAME/SUBDIVISION 110 LOT NO, LID NO.
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z TESCP Approved 13
3- Pro. Box 3 -1- POFILIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Hotrulted 13
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CITY ZIP 1 ELEPHONE EXISII;� PROPOSED InGpectlen RoquIrod E3
Sidowalk Hequired
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NAME ..i_Trr1 SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 11 NO 13 E
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OWNER/CONTRACIOH RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 6
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VARIANCE OR CU SHORELINE OR ADS# INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE REQO POSTED
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PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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1:1 NEW lEg:RESIDENTIAL E] PLUMBING i MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL z
CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEZED BY DATE :5
REMODEL MULTIFAMILY SIGN REQ'D I PROVIDED a.
REPAIR GRADING FENCE
CYDS ( X FT) REMARKS
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DEMOLISH TANK
GARAGE o RETAINING WALL FIRE SPRINKLER
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REMARKS
Um PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
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VALUATION
i4m.75e 0-1o() $
Description FEE Description FEE
State Surcharge
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HEAISOURCIf GLAZING % LOT SLOPE % Building Per mit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
Uj PERMIT APPLICATION: 100 DAYS
CL PERMIT LIMIT., I 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
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ui IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON, I rs OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
M ALL CLAIMS FOR DAMAGES OF WHATEVER NAT URE, ARISING DIREC TLY OR INDIREC I LY
X FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
a DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due
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0 NOR LIMIT IN ANY WAY THE CITYs ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
xI . Recording Fee Receipt 0
1 HEREBY ACKNOWLEDGE THAT I HAVE READ TIIIS APPLICATION; THAT THE INFORMATION 2-. Z�
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC I hisapplication is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official 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 5PMffNSATION INSURANCE AND RCW 10 27.
OFF
jCIAI_S/SIGtjATURE DATE
SIGN E �WNEZ DATE SIGNED (425)
771 -0220
RFj EASED 13Y DAYE
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 O�VNER GOLD -ASSESSOR
09j03 PRESS HARD -YOU ARE MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
pLWE SIGN
GINEERING DIVISION DAT
_—PLANNING DIVISION DATE
pLEASS SIGN
PROJEC 7,n!L- ro;jay-
SITEADDRESS 20-- .!2 _L) 4L -
PERMIT #AbO4 - &��k3 ADB# DATE INSPECTED jl_0!2�
DESCRIPTION OF WORK TO BE INSPECTED 0_cL2�,;V A`S4J, L:144�)!f
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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
PERFORAIANCE _BONDS and the granting of:
,V GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date
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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 ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR AL>
OCCUPANCY ..................
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