20040432.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
4_1 _e_11L
MAILING ADDRESS
CITY ZIP �TELEPHONE
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NAME
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t: ADDRESS
CITY ZIP
NAME
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ADDRESS
60
CITY
TELEPHONE
TELEPHONE
51 -J'(�
6�/Iyj 0 1
STATE LICENSE NUMBER EXPIRATION DATE FrEC
14C r
CBL N
Cj( PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
RESIDENTIAL
ADDITION
COMMERCIAL
El REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
F� DEMOLISH
TANK
GARAGE
o RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EWIN:
in
w NUMBER
NUMBER OF
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17
DWELLING
01 STORIES
UNITS
I DESCRIBE WORK TO BE DONE
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HEAT SOURCE I GLAZING %
PLAN CHECK NO:
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X FT,
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL %�
AREAS CK
NUMBER
PERMITEXPIRES
USE PERMIT
ZONE NUMBER
JOB
SUITE/APT#
ADDRESS
LJ
PLAT NAME/SUBDIVISION NO,
LOT NO.
LID NO,
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Appicived
FiW Poralit Required
C3
13
SUM use Permit noq.d
E3
EXISTING - PROPOSED
Instiriction Required
E3
Sidewalk Required
E3
REQUIRE[) DEDICATION- F1
undeiground
Wiring mquired
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
C3
YES 11 No E3
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REMARKS
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OWNER/CON1RACTOR RESPONSIBLE FOR EROSION CON18OL/DRAINAGE
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE Lu
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VARIANCE OR CU SHORELINE OR ADBI I INSPECTION I BOND
REO'D POSTED
IkE MARSHALOYES ONO $ —
'A HEIGHT
SEPA
C 0 M P IL E T E 04 1 %S1T`TB —EAPL(ROWTOFIEL) i ALLOWED PROPOSED
_14 . AP
EXP I -41K FILI., RWMIAL, OR 1;
LOT COVERAGE REQUIRED SETBACKS (FF.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
PARKING
REQ'D I PROVIDED
REMARKS
CHECKED BY
LOT AREA I PLANNING REVIEWED BY
SPECIAL INSPECTION AREA
REQUIRED [] YES
DATE
OCCUPANT
GROUP
OCCUPANT
LOAD
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I I PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REQ1D -
D
I L '74,jv, I I M
LOT SLOPE %
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: ISO DAYS
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PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
V)
Uj IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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4 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERM11 SHALL NOT BE
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_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Ol 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
I "
kGIVEN IS CORRECT ' AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THTHE 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
IC
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
W �C
ORKMEN' zn2 SATION INSURANCE AND RCW 18.27.
I IC NER 6R AGENT)
INAT , I -I' �,, I DATE SIGNED.
I A! i Oil
U1 C
ATTENTION
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
09/03 PRESS HARD -YOU AR
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
EXT 1333
) V�2 I T�
FEE Description FEE
State Surcharge
City Surcharge
Bage Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt # 2qz_& 7
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Olficial or hisitier Deputy; and Fees are paid. and
receipt is acknowledged in space provided
I
OFFICIALS, SIGNA)'URE
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I ORIGINAL - FILE YELLOW - INSPECTOR
-7 1 X 1-361 PINK OWNER GOLD - ASSESSOR
E MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM
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DATE: c
i-110ES OT13,
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: Y- qq CG�V'"'��o FIRE DEPARTMENT DATE
SIGN
ENGINEERING DIVISION DATE
PLEASESIGN
PLEASESIGN PLANNING DIVISION DATE —
PROJECT U 5T PL-!-f- N�� (J�� 627,�—Cle4,1
SITEADDRESS
PERMIT #,�M' —ADB#_________PATE INSPECTED
o)AS L4aC+Z-U
DESCRIPTION OF WORK TO BE INSPECTED ,t�Ajo "<) -
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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
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:fomis: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 APPROVAL4&Mmw 04—
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