20040394.pdfI
DATE RECEIVED
4�/ CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWy3R NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
NAME
ADDRESS
CITY
ZIP I TELEPHONE
NAME CBL#
ADDRESS CBLj
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CITY Zip TELEPHONE, ZI 3
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STATE LICENSE NUMBER EXPIVATION U�fft CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO
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5q-ITESIDENTIAL
ADDITION
COMMERCIAL
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REPAIR
GRADING CYDS
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GARAGE
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RETAININGWALL
ROCKERY
(TYPE OF USE, BUSINESS OR
EXPLAIN
NUMAR OF
ac OF DWELLIN
a UNITS
0 STORIES
NUMBER
DESCRIBE WORK TO BE DONE
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HEAT SOURCE I GLAZING %
PLUMBING / MECH
COMPLIANCE OR
OF USE
CHANGE
SIGN
FENCE
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OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER 121
LOT SLOPE %
USE
ZONE
JOB
ADDRESS
PERMIT EXPIRES
PERMIT
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NUMB
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SUITE/APT#
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
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LID FEE $
1111SCIP Appiro�ed
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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REQUIRE[) DEDICATION— FT
underground
Wiring ioclurad
METER SIZE LINE SIZE
NO. OF FIXTURES
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PRV REQUIRED
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P PLAN CHECK PP* - VESTED DATE
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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: IBODAYS
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a. PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
U) B S
LU IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
_j S I G ON
2 A HN T
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANYAND
cc ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
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x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF I HIS PERMIT SHALL. NOT HE
C1 DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; TI IAT T1 IE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGEN1 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'S COMPENSATIO INSURANCE AND RCW 18.27.
SIG _E o ER� DATE SIGN -D
7,,,�T 47710V
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED
DATE
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FIRE REVIEWED BY DATE W
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BOND
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<ARIANCE OR CU SHORELINE OR ADB# I a& POSTED
R E O'D POSTED
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YES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXFEMPT ALLOWED , PROPOSE IDALLOWED PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDIE REAR FRONT UR SIDE REAR
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PARKING LOT AREA PLANNING REVIEWED BY DATE 5
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REO'D I PROVIDED
REMARKS
CHE ED BY F CON 'SIT CTION 12P
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SPECIAL INSPECTION AREA OCCUPANT
LOAD
IREQUIRED C] YES
REMARKS a:' D] z
PEROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RE, 5
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
rLandscape Insp.
Recording Fee
FEE oDescription FEE
State Surcharge
City Surcharge
Base Fee
CALL
FOR INSPECTION
('425)
f I -UZZU rRFIrAtFif 13Y DATE
0103
C;A I I
ATTENTION e/n USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL _XVMX��
IT IS UNLAWFU YELL(:AV I CO
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A FINAL INSPErTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE -'NSPE/
r%K1 Ina PINK�OWNER GOLD -ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. U111, atu 1 1
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
rPlan Chk. Deposit V,-2AI�5
Receipt 4 1
Total Amt. Due :;0
Receipt #
APPLICATION APPROVAL
This application is riot a pound until Signed by the
BUilding olficial or his/her Deputy, and Fees are paid, and
receipt is acknowledged in space provided.
OFFICIALS SIGNATURE DATE
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTM I ENT DAT41
PIXASr SIGN
ENGINEERING DIVISION DATE
PLEMSE SIGN
PLANNING DIVISION DATE
PLCASE SIGN
CT
PROJE
SITE ADDRESS —
PERMIT# ()-d ADB# DATE INSPECTED
11,71
DESC RIPTION 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
El Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
F� Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date SigilatL11-C
1:tenip:b1dg:fornis:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ............ a .............
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 ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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