20040415.pdfI
DATE RECEIVED
USE
CITY OF EDMONDS ZONE
JOB
CONSTRUCTION PERMIT APPLICATION ADDRESS Ivy)
OWNER NAMENAME OF BUSINESS U f I
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ADDITION
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MULTIFAMILY
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REPAIR
El GRADING CYDS
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DEMOLISH
D�-<ANK
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GARAGE
CARPORT
RETAINING WALL
ROCKFRY
(TYPE OF USE. BUSINESS OR ACTIVITY) EX�Kft
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PERMIT EXPIRES
PERMIT
NUMBER
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1VDdj
SUITE/APT#
LOT NO. LID NO.
I LID FEE $
TESCP Approved I
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Pormit Fi0quired 13
Straot Llso Parrilit Roq'd 13
EXISTING — PROPOSED
Inspoction Roquired C3
Sidewalk Floquand
REQUIRE[) DEDICATION� Fi
Undaigrotind
WiringfocImfud C3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 11 NO 13
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RACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE uj
VARIANCE OR CU
SHORELINE Oil ADBI INSPECTION BOND
FION E CHECKED) BY
REO'D POSTED
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70
OYES ONO S
SEPA REVIEW
SIGN AREA HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED ALLOWED PROPOSED
EXP I
, ,
PLUMBING / MECH
LOT COVERAGE
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED
FRONT SIDE REAR FRONT LJR SIDE HEAR
COMPLIANCE OR
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CHANGE OF USE
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PARKING
LOT AREA PLANNING REVIEWED BY DATE
E3 SIGN
REO'D I PROVIDED
FIRE-1 MARrNHAL.
FENCE
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REMARKS
HE PRESENT FOR
OTHER
ANK
t7l.- REMOVAL, OR CAP
FIRE SPRINKLER
1 3 FIRE ALARM
NUMBER�,V NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK -TO BE DONE �, \ I
11
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HEAT SOURCE 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
SEPARATE PERMISSION.
PERMIT APPLICATION: 100 DAYS
PERMIT LIMIT., 1 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 THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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 AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR COD�_4f` THE STATE OF WASHINGTON RELATING TO
WORKMEN),��NSATIONJNS22NC) AND FIC Ill 27.
qIGNATOk-LOWNERIOR kGENT1,e1-%X DATE SIGNr1r
OCCUPANTu
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D F3
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CHECKED BY
FQIL- -
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
CALL
FOR INSPECTION
(42.15)
771-0220
A17ENTION F 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
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt 0
Total Amt. Due
Receipt It
APPLICATION APPROVAL
I hisapplication is not a permit until signed by the
Building Oflicial or his/tier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
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09iO3 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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PO B= 31228
SaUde WA 98-103
206-547-2347
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FINAL PROJECT APPROVAL FORM
RECE IVED
TO:
J U N 0 4 2004 DATE:
DEVELOPMENT SERVICES GTR,
MEMO TO: PERMIT COORDINATOR, bbffl5MTbivisioN
FROM: FIRE DEPARTMENT DATE 5J
PLEASESIGN
ENGINEERING DIVISION DATE -
PLEASE SIGN
PLANNING DIVISION DATE--,
PLEASE SIGN
PROJEC
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SITEADDRESS-
PERMIT ADB# -DATE INSPECTED_Zq��() c�f.
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DESCRIPTION OF WORK TO BE INSPECTED-U -Sr
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
01 -
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 .
2.
0
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fom1s:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
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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