20040416.pdfFDATE -RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSIN
MAILINU ADDRESS
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NAME
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S,aATE LICENSE NUMBER EXPIRATION DATE I CHECK BY
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PROPERTY TAX ACCOUNT PA RCEL NO.
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PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
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MULTIFAMILY
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GRADING
CYDS
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GARAGE
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HEAT SOURCE GLAZING % I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
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
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
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PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) OAPPLICANI ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
W IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPiOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECHY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALT. NOT 13E
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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01 NOR LIMIT IN ANY WAY -THE CITYS A131LITY 10 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 CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSAT
�QN IYURANCE^ RCW 18 27.
SIGNAT'"�NER :0� WGE SI NEI/
DATE
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PLAT NAME/SUBDIVISION NO.
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LOT NO.
LID NO.
LID FEE S
I ESCP Approved
13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
hW Permit Required
13
Street Use Permit Req'd
13
EXISTING — PROPOSED
inspection Required
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Sidewalk Ronirnred
C3
REQUIRED DEDICATION— FI
Underground
Wiring required
E3
METER SIZE
LINE SIZE
NO. OF FIXTURES
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PRV REQUIRED
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YES 13 NO 13
REMARKS
OWNER/CONTRACIOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
REVIEWED BY DATE
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FIRE REVIEWED BY DATE
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VARIANCE OR CU
SHORELINE ORADB11
INSPECTION
BOND
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POSTED
IS
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SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP I
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LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (Ff.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LJRSIDE REAR
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REMARKS
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CHECKED BY
IPE F CONSTRUCTION
CODE:
OCCUPANT
GROUP
SPECIAL INSPECTION OCCUPANT
REQUIRED [:] YES LOAD
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D F3
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VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
FEE Description FEE
State Surcharge
15 City Surcharge Z.__>
Base Fee
CALL
FOR INSPECTION
(425)
771-0220
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
ClAt�S SIGNATURE DAJrE
ATTENTION LA I 1;jjJ
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
09103 PRESS HARD -YOU ARE MAKING 4 COPIES
BY D
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
JUN 13 4 2004 DATE:
DEVELOPMENT SERVICES CTR.
MEMO TO: PERMIT COORDINATO9,1TME-bM DIVISION
FROM: FIRE DEPARTMENT DATE. __0 ct
PLEASE SIGN
ENGINEERING DIVISION DATE z
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PLANNING DIVISION DATE
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PERMIT # B# DATE INSPECTED L(— Y -A K
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DESCRIPTION OF WORK TO BE INSPECTED _P,
A field inspection was conducted to determine compliance with -approved plans. Final approval Cn
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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
0 Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:foimu: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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