20040426.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PLAT NAME/SUBDIVISION NO.
PERMIT EXPIRES
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REQUIRED DEDICATION- Fl
ZIP
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NUMBER
EXPIRATION DATE
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REPAIR
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CARPORT
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(TYPE OF USE, BUSINESS OR ACTjYIT'D_!E�PLAIN:
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DESCRIBE WORK TO BE DONE
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PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
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OTHER
FIRE SPRINKLER
FIRE ALARM
SUI1E/APT#
LID NO.
LID FEE $
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FjW pormit Required
Stlem use permit Req'd
Inspection Required
S,d,waik Required
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W,ing coquirod
PRV REQUIRED
YES 11 NO 13
REMARKS
OWNER1CONrRAC1OR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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DATE
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VARIANCE OR CU SHORELINE�j INSPECTION I _BOND
REO'D POSTED
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SEPA REVIEW SIGNrA HEIG T
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S
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COMPLETE EXEMR�lf EAL.... ANOSED ) .. ALLOWtEDPROPOSED
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REMARKS
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REQUIRED
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LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
LOT SLOPE %
PLAN CHECK NO: 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.
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Lu PERMIT APPLICATION: 180 DAYS
IL 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
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W IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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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 PERM11 SHALL NOT BE
_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I HEREBY ACKNOWLEDGE THAT I IiAVE READ THIS APPLICATION. THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGEN1 OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
TION AND IN DOING THE WORK AUTHORIZED 111EREBY. NO PERSON WILL BE EMPLOYED
IN V61LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COM PEN SATI��Sy RANCE AND RCW 10 27
SIGNATURE (OVjW;a.0jGE
_N;�7 ,),/ / /, I DATE SIGNEV
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
ATTENTION IF E)ff 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
State Surcharge
City Surcharge
Base Fee
FEE
14:;-
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt III
APPLICATION APPRC
This application is not a permit until signed by the
Building Official or his/tier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFFICIA.S S71G DATE
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09�03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
RECEIVED
TO:
JUNI 0 4 2004
DEVELOPMENT SERVICES CTR. DATE:
CITY OF EDMONDS
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE_L— q-0
PLEASE SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJEC
SITE ADDRESS 2-2- 1 sl� !Z6
PERMff —ADB# -DATE INSPECTED Y -_0 e(
DESCRIPTION OF WORK TO BE INSPECTED LA 1 / pult'E
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
PERF ORMANCE 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
I .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
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 .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
GasTest ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING .........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION
MISCELLANEOUS ..........
OCCUPANCY ..................
FINAL APPROVAL FOR
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