20040420.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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Cc MAILING ADDRESS
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CITY ZIP , ITELEPHONE Y_
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NAME
I CITY
NAME
ADDRESS
CITY
STATE LICENSE NUMBER
ZIP I TELEPHONE
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ZIP
90-3-3
TELEPHONE
— 1-125-96
EXPIRATION DATE
31 / re )(')10
El
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
CBL # 1(09-5
WA
PLUMBING I MECH
COMPLIANCE OR
OF USE
CHANGE
SIGN
FENCE
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OTHER
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FIRE SPRINKLER
FIRE ALARM
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NUMBER
NUMBER OF
CRITICAL
OF
DWELLING
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AREAS
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0
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
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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
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: IBODAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
4APPLICANT, 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 INDIRECILY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 'I HIS PERMIT SHALL NOT BE
DEEMED TO MODIFY� WAIVE OR REDUCE ANY REQUIREMEN1 OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION
I
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 PEHSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27.
SIGNAI�t" (OWNER OR . ENT) DATE SIGNED
41
USE
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ADDRESS
PLA1 NAME/SUBDIVISION NO
V
IPERMIT EXPIRES
PERMIT
NUMBER
SUITE/ PT#
L L
OT NO. f )LID NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
LID FEE $
TESCP Approved
RW Permit Required
13
Street Use Permit Rorl'd
E3
Inspection Raq irod
[3
Sidewalk Aoqu�;Od
C3
Underground
Wtnng required
13
PRV REQUIRED
YES 0 NO C3
REMARKS
OWN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE Im
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VARIANCE OR CU SHORELINE OR ADBI I INSPECTION BOND
REO'D POSTED
OYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED I PROPOSED ALLOWED , PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT IJR SIDE REAR
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REO'D I PROVIDED in A L CL
REMARKS OPIEZISWLEINFF IFE)ff
CHECKED BY ITO CONSTR N OCCUPANT4
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SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED 11 YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D a
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
FEE Description
State Surcharge
I City Surcharge
FEE
Fire Review Plan Chk. Deposit
Fire Inspection Receipt #
Landscapelnsp. Total Amt. Due
Receipt N
Recording Fee
APPLICATION APPROVAL
I his application is not a perinit until signed by the
CALL Building ofliciii or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowILdged in space provided;
-_^,CIAL,,S )SIGNAT U RV/ TE
(425)
771-0220 A.EASED BY DATt
ATTENTION MA I I
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD ASSESSOR
04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNIING
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FINAL PROJECT APPROVAL FORM
/(�00 mr—C-EIVED TO:
JUN 0 3 9"004
DEVELOPMENT SERVICES CTP, DATE: 00/0�"
CITY OF ED1.10,NDS,
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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FROM: FIRE DEPARTMENT DATE
N
ENGINEERING DIVISION DATE—.
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT
SITE ADDRESS- , I
PERMIT #_qoo q,-_Q Lf t_o ADB#____________PATE INSPECTED
A-Lp, 4:t,
DESCRIPTION OF WORK TO BE INSPECTED 1—
A field inspection was conducted to determine compliance with -approved plans. Final approval
denotes that there are no objections from the above signed Departm I ent to the release of
PERFORMANCE BONDS and the granting of:
-GRANT FINAL PROJECT APPROVAL /��tq
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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
1 .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:forms:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch ................. z
0
Retaining Wall ...........
Slab Insulation ..........
PLUMBING: --I -n
Underground ............. 0 M
C 0
Rough -In ................... M
0
Commercial Final ...... 0 C:
M
HEATING: M Z
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Ga's Test .................... C:
GasPiping .................
Equipment................. 0
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Commercial Final .......
m m
EXTERIOR SHEATHING
NAILING .......................... 0
0 M
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FRAMING ........................ Cn
Q 0
FIRST FLOOR FRAMING ... Z r
INSULATION ................... ;U
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Floor Insulation .........
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Wall Insulation ...........
Ceiling Insulation ....... Cn
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SHEETROCK NAILING ... 0
0
SPECIAL INSPECTION ... 171
MISCELLANEOUS ..........
FINAL APPROVAL-Feftl-
. ..................
0