20040390.pdfI
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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAME/ OF BUSIIESS -1 L;
MAILING ADDRESS
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CITY (J'ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE I Cl[JECKED BY
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PROPERTY TAX ACCOUNT PARCEL NO
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NEW
RESIDENTIAL
ADDITION
COMMERCIAL
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MULTIFAMILY
REPAIR
GRADING CynS
D(DEMOLISH
TANK
1 GARAGE
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RETAINING WALL
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CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACAVITY) EXPLAIN:
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NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
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CHANGE OF USE
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OTHER
FIRE SPRINKLER
FIRE ALARM
�PERMIT EXPIRES
USE PERMIT
ZONE NUMBERI��/Z_,/?,�/_z�13cm
JOB SUITE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO FL6T --No LID NO.
LID FEE $
I ESCP Approved 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP HW Permit Required 0
Street Use Pound Roq'd E3
EXISTING P 'PROPOSED Inspection Required 13
10 ljt iri'l. );uJowalk Required C3
REQUIRED DWICAS�N -- Underground
FT: 77,
METER SIZE, IS LINE SIZE NO. OFFIXTURgs WAHAIRED
I D E S E- W F[IZ M UST 13 E CA IPEO RT NO 13
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REMARKS
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J?A Wl��ONTROL/DRAINAGE
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HOSE BIB wITH AVB INSTALLEp
Dump AT ApppovEa) Dump SrM n2,1,x
SEE DEMOLIT1014 INSPEMoij
ENGINEERINMREV"I!&W"-15 I ON BACK OF JO]YACARD
FOR INSPECT70N REQUIREMENTS
FIRE REVIEWED BY DATE
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INSPECTION
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SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP I
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LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/RSIDE REAR
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PLANNING REVIEWED BY DATE
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REMARKS
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CHECKED
TYPE OF CONSTRUCTION
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AREAS
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SPECIAL INSPE I
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NUMBER
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PROGRESS INSPECTIONS PER UBC 108/FINAL
INSPECTION REQ'D
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HE6T ISOURCE 1GtAZING % OT SLOPE
PLAN dFfECK NO: VESIED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
L_ BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 1110DAYS
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PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 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 I HIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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I HEREBY ACKN G THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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GIVE IS 4 RECTC,\�ND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
SC R
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O� Tjl%LABOR CODE
NE I AGRkq TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
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TI N; DOING PiE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
I VI OF THE STATE OF WASHINGTON RELATING TO
IN R Ohl1PENS TION INSURANCE AND RCW 18.27.
DATE SIGNED
C�f>— - Z ( -
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
FEE Description
State Surcharge
I City Surcharge
FEE
Fire Review Plan Chk. Deposit
Fire Inspection Receipt #
Landscapelnsp. Total Amt. Due
Recording Fee Receipt # L�7
APPLICATION APPROVALO
This application is not a perinit until signed by the
CALL Building Official or his/her Deputy; and Fees are paid, and
FOR INSPECTION1 .. receipt is acknowledged in space provided.
F IALS S ATURE - DATE
(425) Ozall,
771-0220 BY D/<TE
ATY4NTION - `\`1, ___ 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 - OWNER GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING
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FINAL PROJECT APPROVAL FORM.
To:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE- DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE tt /0
PLEASE SIGN
PLANNING DIVISION DATE
PLE,"Ll SIGN
PROJECT J
SITE ADDRESS
310 _DATEINSPECTED
PERMIT ADB#
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
PERIF ORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
F� 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 ISS I UES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tenip:b1dg:f6rms:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
V')
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0
Retaining Wall ...........
0
M
Slab Insulation ...........
PLUMBING:
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Underground .............
0 M
C
M 0
Rough -In ...................
0
0
Commercial Final ......
C
-4
X M
HEATING,
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Gas Test ....................
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Gas Piping .................
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Equipment .................
0 _n
Commercial Final .......
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M M
EXTERIOR SHEATHING
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0 r-
NAILING ..........................
0 M
C Cn
FRAMING ........................
9 Cn
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FIRST FLOOR FRAMING...
-A
INSULATION ...................
Floor Insulation .........
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Wall Insulation ...........
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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