20040405.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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CITY ZIP ITELEPHONE
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PERMITEXPIRES
USE PERMIT
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ILIMBER3V4
657
JOB
ADDRESS QR�l
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PLAT NAME/SUBDIVISION NO.
OT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
ILSCP Approved
RW Pofind Stiquilod
EXISTING — PROPOSED
Street Use Famn Hoq'd
Inspection Required
REQUIRED DEDICATION� FT
sidewalk Required
underground
Winng required
METER SIZE
LINE SIZE
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NO. OF FIXTURES
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PRV REQUIRED
YES 13 NO 0
REMARKS
OWNER/CONTRAC1OR RESPONSIBLE FOR EROSION CONIFIOL/DRAINAGE
NAME CBL#
1; ) )_ \y" Vk- C Lj -I ENGINEERING REVIEWED BY DATE
ADDRESS
FIRE REVIEWED BY DATE
CITY ZIP TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO,
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0 NEW
RESIDENTIAL
1:1 ADDITION
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COMMERCIAL
1:1 REMODEL
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MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
FLOCKERY
(ryP 0 USE, BUSINESS OR &CTIVITY) EXPLAIN:
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NUMBER NUMBER OF
OF DWELLING
STORIES 01 UNITS
DESCRIBE WaK TO BE DONE
VARIANCE OR CU HORELINE OR ADB# I INSPECTION
j��YES ONO S 30 D
BY
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PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
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OTHER
EFIRE
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SPRINKLER
FIRE ALARM
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SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEM PT
ALLOWED PROPOSED
ALLOWED PROPOSED
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EXP
LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LJR SIDE REAR
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PARKING
REO'D I PROVIDED
LOT AREA
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NNING REVIEWED BY DAT?
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REMARKS
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CRITICAL M
AREAS j)1)'0_E)j0 SPECIAL INSPECTION JAREA
NUMBER "711 REQUIRED [] YES
REMARKS
JPIPQG13ESS INSPFECTIONS PER.0
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HEAT SOURCE I GLAZING %
PLAN CHECK NO:
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 (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
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SEPARATE PERMISSION.
LU PERMIT APPLICATION: 180 DAYS
CL 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 SUCCFSORS
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W IN INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD IIARM[ESS THE CITY OF
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2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY Oil INDIRFCTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF 1111S PERMIT SIIAi I NOT BE
_j DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY 10 ENFORCE ANY ORDINANCE PROVISION'
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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 AUTIIORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSAl ION INSURANCE AND RCW 18 27,
DATE SIGNED
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VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE
OCCUPANT
GROUP
OCCUPANT
LOAD
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Ty 1 17" _+7_1 1 M
Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
LP -
APPLICATION APPROVAL
I his application is not a perinit until signed by the
Building official or his/hor Deputy: and Fees are paid, and
- receipt Is acknowledged in space provided.
:F IGNAIU1 ATE
1C 111,TP ly') /I_ -
A17ENTION \, 'I \\,), I 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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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ORIGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER GOLD�ASSESSOR
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FINAL PROJECT APPROVAL FORM Z' 02 r
TO:
DATE:- 2_3 LW
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: -FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PROJECT
SITE ADI
PERMIT4,�,00-L/- NOS- ADB# DATEINSPECTED
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
PERFORMANCE BONDS and the granting of:
YL GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
1 .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
1 .
04
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbnns:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pier/Porch ................. z
0
Retaining Wall ...........
0
Slab Insulation ..........
PLUMBING:
C/)
Underground ............. 0 M
0
M
0
Rough -In ................... 0
0 C
Commercial Final ......
-4
M M
HEATING: M Z
Gas Test .................... > z
Gas Piping .................
C/)
0 _n
Equipment ................. -n
Commercial Final .......
M
M
EXTERIOR SHEATHING 0
0
NAILING .......................... 0 M
C Cn
FRAMING ........................ Cn
ITIO
FRAMING ...
FIRST FLOOR
INSULATION ................... ;0
Floor Insulation ......... >
z
Wall Insulation ...........
:E
Ceiling Insulation ....... U5
z
0
SHEETROCK NAILING ... _11
0
SPECIAL INSPECTION ... M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................