20040410.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME/NAME SIYSS
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PLAT NAMEISUBDIVISION NO
PERMITEXPIRES
PERMIT
NUMBER
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LOT NO,
dPUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
7 REQUIRED DEDICATION- Fr
METER SIZE I LINE SIZE I NO� OF FIXTURES
LID NO.
LID FEE $
TI,SGP Approved
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8W Pornit Required
13
Street use Permit Roq'd
[3
Inspection Required
13
Sidewalk Ruquired
13
Underground
Wiring requited
[3
PRV REQUIRED
YES C3 NO 1:1
REMARKS
OWNEH/CONTRACIOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED 13Y
DATE
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STATE LIC NUMBER CHECKED BY
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SHORELINE OR ADBI INSPECTION BOND
REO'D POSTED
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SEPA REVIEW
SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL
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ALLOWED PROPOSED ALLOWED PROPOSED
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REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FF.)
FRONT SIDE REAR FRONT L/R SIDE REAR
PROPOSED
ADDITION COMMERCIAL
COMPLIANCE
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CHANGE OF USE
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LOT AREA PLANNING REVIEWED BY DATE
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REPAIR GRADING CYDS
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REMARKS
TV( DEMOLISH TANK
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OTHER
o GARAGE RETAINING WALL
FIRE SPRINKLER
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CARPORT ROCKERY
FIRE ALARM
(TYP_q OF USE. BUS114ESS OR ACTIVITY) EXPLAIN:
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JCM�N OCCUPANT
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NUMBER NUMB:ROF
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CRITICAL
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SPECIAL INSPECTION
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LOAD
DESCRIBE WORK TO BE DONE
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTI ON REQ'D
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VALUATION
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Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCET GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
1
Base Fee
PLAN CHECK NO:
VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
UJI PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V) Fire Review Plan Chk. Deposit
U) 'APPLICANI, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
LU IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NAlURE,AIIISINGDIRECrIYORINDIRFCII.Y
FROM THE ISSUANCE OF 'THIS PERMIT. ISSUANCE OF 11-11S PERMIT SHALL. NOT HE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY Cl rY ORDINANCE Landscapeinsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY 10 ENFORCE ANY ORDINANCE PROVISION.*
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Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ TIflS APPLICATION, THAT THE INFORMATION
GIVEN IS CORRECT AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
T14E OWNER. I AGRiE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. [his application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building 011icial or his/tier Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF TIIE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'��NSATION INSURANCE AND FICW 10.27. OFFICIAIS SIGNATURE D
S I G N AT 10 kQO !W JNEJ R -A G E7 - DATE SIGNE I D All (425)
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771-0220 b
11'1/ F 'A§j� B Y A
ATTENTION EXT 1333r
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL - -J1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YELLOW - INSPECTO F R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER - GOLD - ASSESSOR
09/03 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 ----
PLEASE SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNINU DIVI�dU.N VAIL
PLEASE SIGN
PROJECT 'Q
SITE ADDRESS
PERMIT # f064_0 4 0 B#-------PATE INSPECTED 00
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
__X-GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
EJ Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of CORRECTION NOTICE given to owner/contractor by inpector
1 .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbn-ns:ocapr-v1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pier/Porch ................. z
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Retaining Wall ...........
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171
Slab Insulation ..........
PLUMBING:
Underground ............. 0 M
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Rough -In ................... 0
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Commercial Final ...... K
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HEATING: M Z
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Gas Test .................... > z
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Gas Piping .................
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Equipment ................. -n
Commercial Final .......
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EXTERIOR SHEATHING
NAILING .......................... 0 r-
0 M
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FRAMING ........................
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FIRST FLOOR FRAMING...
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INSULATION ...................
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Floor Insulation ......... >
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Wall Insulation ........... --I
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Ceiling Insulation .......
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SHEETROCK NAILING ... --I
SPECIAL INSPECTION ... M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................