20040424.pdfDATE RECEIVED
PERMIT EXPIRES
6SE P=-IRMIT
CITY OF EDMONDS ZON E S,/74
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CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
OWNER NAME/NAME OF BUSINESS
PLAT NAMEiSUBDIVISION NO LOT NO. LID NO.
MAILING ADDRESS
LID FEE S
TESCP Approved [3
0 J�r...j PUBLIC RIGHT OF WAY PER OFFWIAL STREET MAP RW Peje�ijt Requifed
CITY Street Use Permit Roq'd E3
ZIP TELEPHONE EXISTING — PROPOSED inspection Required CI
Sidewalk Required [3
7 REQUIRED DEDICATION-- FT Undaroround
winng require 13
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
*1 0
YES 0 NO 13
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UJI L
I'- ADDRESS
REMARKS
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OWNERICONTRACTOR RESPONS11 LE FOR EROSION CONTROL/DRAINAGE E5
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CITY ZIP ITELEPHONE u
NAME
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LjENGINEERING REVIEWED BY DATE
ADDRESS
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--ITELEPHONE FIRE REVIEWED BY DATE tu
CITY ZIP
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45'rZ Z - Z i7-Z7 VARIANCE OR CU SHOREL NE OR ADS# INSP . ECTION BOND
STATE LICENSE NUMBER, EXPIRATION DATE P�IECRED BY
REO'D POSTED
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;�j PROPERTY TAX SEPA REVIEW SIGN AREA 10YES ONO S HEIGHT
ACCOUNT PARCEL NO. COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED I PROPOSED
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EXP
NEW E] RESIDENTIAL PLUMBING/MECH LOT COVERAGE RECIUMED SETBACKS (FT) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRO14T SIDE REAR FRONT LIR SIDE REAR
ADDITION COMMERCIAL COMPLIANCE OR z
OF USE
REMODEL MULTIFAMILY PARKING LOT AREA PLANNING REVIEWED BY DATE
M SIGN REQ'D I PROVIDED
GRADING FENCE
REPAIR CYDS ( � X—M REMARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF USE,,13USINESS OR ACTIVITY) EXPLAIN:
CHECKED BY ITYPE OF CONSTRUCTION CODE OCCUPANT
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NUMBER NUMBtR OF CRLTICAL U
OF G AREAS' I A3
M DWELLIN SPECIAL INSPECTION AREA OCCUPANT
0 STORIES UNITS NUMBER REQUIRED YES
7 LOAD
DE RISE WORK Ta Do�!
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UZI REMARKS
PROGRESS INSPECTIONS F ER UBC 108/FINAL INSPECTION REQ D
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VALUATION
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Description FEE
Plan Check
HEAT SOURCE GLAZING % LOT SLOPE %
I Building Permit
PLAN CHECK NO: VESTED DATE
Plumbing
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
t:
2
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Grading
SEPARATE PERMISSION.
Engr. Review
W
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE
Engr. Inspection
BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEMS, ASSIGNS AND SUCCESORS
Fire Review
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
M
Fire Inspection
4 ALL CLAIMS FOR DAMAGES OF WHATEVER NAI URE. 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
Landscapelnsp.
R LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND T14AT 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
CALL
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 COMPENSATION OSURANCE AND RCW 18.27.
FOR INSPECTION
GNA�RE �kfl OR APENT) DATE SIGNED
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771-0220
ATTtNTION
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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
04/02 PRESS HARD -YOU ARE
MAKING 5 COPI
Description FEE
State Surcharge
City Surcharge
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt ht
APPLICATION APPROVAL
this application is not a pennit until signed by the
ding Olficial or his/tier Deputy: and Foes are paid, and
receipt is acknowledged in space provided.
A�1/ I NA 9, IE DATE
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ORIGINAL - FILE YELLOW - 14SPEC&
PINK -OWNER GOLD -ASSESSOR
GREEN -ACCOUNTING
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MEMO TO:
FROM:
1:� E C E I V W8VAL FORM
FINAL I�RQJECT APP
JUN U 3 2004
DEVELOpMENT SERVICEs
CITY OF EOVMi[)�
PERMIT COORDINATOR, BUILDING DIVISION
PROJEC
SITE ADDRESS
TO:
DATE:
FUZE DEPARTMENT DATE d
PLEASE SIGN
ENGINEERING DIVISION DATE —
PLEASE SIGN
PLANNING DIVISION DATE —
PLEASE SIGN
PERMIT ADB# DATE INSPECTED—L-::1�0 �'.
DESCRIPTION OF WORK TO BE INSPECTED-hn2D— D M(1, Th 1/2-/k ty 7
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:
-A GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
Copy of CONDITIONS given to owner/contractor by inspector
1 .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of CORRECTION NOTICE given to owner/contractor by inpector
1 .
2.
93
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 .................
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Retaining Wall ...........
Slab Insulation ..........
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PLUMBING:
Underground .............
Rough -In ................... M
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Commercial Final ...... 0
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HEATING:
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Gas Test .... ...............
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Gas Piping ................. >
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Equipment ................. W
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Commercial Final .......
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EXTERIOR SHEATHING M ITI
NAILING ..........................
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FRAMING ........................ 0 ITI
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FIRST FLOOR FRAMING ... Q 0
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INSULATION ...................
Floor Insulation .....
Wall Insulation ........... >
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Ceiling Insulation .......
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SHEETROCK NAILING ... z
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR Z4.1
OCCUPANCY ..................
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