20040389.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
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CITY ZIP TELEPHONE
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NAME CBL #
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ADDRESS
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CITY ZIP
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STATE LICENSE NUMBER
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TELEPHONE
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EXPIRATION DATE I CHECH
04101/0 AA,
PROPERTY TAX ACCOUNT PARCEL NO.
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
oGARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS
OR ACTIVITY) EXPLAI.V.-
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NUMBER
OF I
NUMBER OF
I DWELLING
STORIES
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DESCRIBE WORK TO BE DONE
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PLAN CHECK NO:
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
oFENCE
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OTHER
FIRE SPRINKLER
FIRE ALARM
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PLAT NAME/SUBDIVISION NO
PERMIT EXPIRES --�i
PERMIT
NUMBER
SUITE/APT#
PU13LIC RIGHT A W/VWj-6Pj[j
EXISTING ____"qRp0p
REQUIRED DEjDjjAT11,j�N_
METER SIZE
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LOT NO.
LID NO.
LID FEE S
011%DNIVIREQUIR
CP Approved E3
NPormitRaquired E3
Street Use Porrinit Raq'd 13
HE etftANED
uirod E3
=1151WRIS 13
FT
Underground
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vtZILnusquired E3
LyftF FIXTURES '
"'W RRUIRED
YES 0 NO 11
REMARKS Au its
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ENGINEERING REVIEWED BY
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FIRE REVIEWED BY DATE W
VARIANCE OR CU SHORELINE OR ADB# IN
SPECTION BOND
REO'D POSTED
YES ONO $
SEPA REVIEW SIGN AREA HEIGHT
CN E R U SHI
41E
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EPA REV W
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED OSED
EXP I PROP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/Fl SIDE REAR
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REO'D I PROVID
PARKING ED I LOT AREA I PLANNING REVIEWED BY DATE
REMARKS
CTION OCCUPANT
�4 132 GROUP
AREAS SPECIAL INSPECTION— AREA' OCCUPANT
NUMBER 1VV REQUIRED [] YES I LOAD I
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 (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES To 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 INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF IHIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN AqY WAY,THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HERiBY,,ACK,NOW EDGE\T`HAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IP C RR AND,VHAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
I
THE OWNE A R E TO qOMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
T104;OA,D 1 1) THE �ORK AUTI iORIZED THEREBY. NO PERSON WILL 13E EMPLOYED
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IN vi ? , n CODE OF THE STATE OF WASHINGTON RELATING TO
WORKIMIN Ski F1 I? AkTlt�NSORANCE AND RCW 18.27.
DATE SIGNED
CHECKED BY
R iARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapeinsp,
Total Amt. Due
Recording Fee
Receipt #
2,17
CALL
FOR INSPECTION
(425)
771-0220
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/tier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
11", 1 S SIGN fURE DATE
0�11 /,;,s,,
RELEASED BY
ATTkNTjON_ v \� ' EX7 1333
IT IS UNtA*FUL 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
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER COLD - ASSESSOR
GREEN - ACCOUNTING
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PER -MIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
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ENGINEERING DIVISION DATE
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PUA.,m SIGN
PLANNING DIVISION DATE
PIXASE SIGN
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PROJECT 5-
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PERMIT ADB# DATE INSPECTED—
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DESCRIPTION OF WORK TO BE INSPECTED ni d
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On:
A field inspection was conducted to determine compliance with -approved plans. Final approval
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denotes that there are no objections from the above signed Department to the release of
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PERFORMANCE BONDS and the granting of:
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A-' GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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0 Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractoi- by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signattire
1: te mp: b Idg: forms: ocaprvi 3/25/04
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
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Retaining Wall ...........
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Slab Insulation ..........
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PLUMBING:
Underground .............
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\Pq0,7 Rough -In ................... .
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Commercial Final
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HEATING:
Gas Test ....................
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Gas Piping .................
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Equipment .................
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Commercial Final .......
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EXTERIOR SHEATHING
0
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NAILING ..........................
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FRAMING ........................
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FIRST FLOOR FRAMING ...
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INSULATION ...................
Floor Insulation .........
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Wall Insulation ...........
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Ceiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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