20040434.pdf�� FDATE _RECEIVED_
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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CITY zip TELEPHONE
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NAME
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CITY
NAME
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ADDRESS
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STATE LICENSE NUMBER t:XPIHATIUN DAIE CjCKED RY
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60 .15 3�0 5/
PROPERTY TAX ACCOUNT PARCEL NO.
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NEW 11 RESIDENTIAL El PLUMBING / MECH
ADDITION F] COMMERCIAL COMPLIANCE OR
CHANGE OF USE
REMODEL _�KMULTIFAMILY SIGN
REPAIR GRADING FENCE
CYDS ( X FT)
DEMOLISH TANK
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN-
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NUMBER NUMBER OF CRITICAL
OF .3? 1 DWELLING AREAS f
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
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HEAT SOURCE I GLAZING %
PLAN CHECK NO:
a
LOT SLOPE %
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= HE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT'. I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HFIRS. ASSIGNS AND SUCCFSORS
U)
IN INTEREST, AGREES to INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OFWHATEVER NATURE, ARISING DIRECIIYOR INDIRECILY
FROM THE ISSUANCE OF I HIS PERMIT. ISSUANCE OF THIS PERMIT SHALL N01 HE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIIIEMENT*OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY 1 HE CIM ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. 111AT THE INFORMAIION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR IHE 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 COMPENSATION INSURANCE AND HCW 1&27.
SIG F b DATE,,SIC�N�D
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PERMIT EXPIRES
USE PERMIT
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NUMBER
JOB PUITE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO, LOT NO. LID NO.
LID FEE
I ESCP Approved 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required El
Street use Permit Roq'd 0
EXISTING - PROPOSED inspection Required 11
Sidewalk Required 13
REQUIRED DEDICATION� FT onrlinground
Viaing required 0
METER SIZE LINE SIZE 0. OF FIXTURES PRV REQUIRED
I YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVI EW
COMPLETE EXEMPT
EXP I
LOT COVERAGE
ALLOWED PROPOSED
DATE
DATE
SHORELINE OR ADIII I INSPECTION BOND
REO'D POSTED
OYES ONO S
I HEIGHT
ALL C )SED ALLOWED , PROPOSED
REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT UR SIDE REAR
PARKING LOT AREA I PLANNING REVIEWED BY
REO'D I PROVIDED I
REMARKS
DATE
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CHECKED BY IT7Yyk ONISTRUCTION OCCUPANT
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SPECIAL INSPECTIO14 rREA OCCUPANT
REQUIRED [:] YES LOAD
REMARKS
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PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REQ1D Ei
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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 EXT 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 FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt 4
Total Amt. Due
Receipt #
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APPLICATION APPROVAL
I his application is not a pennit tintil signed by the
Building Official or his/her Deputy. and Fees are paid, and
receipt isacknowledged in space piovided
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rr�CIAIIS SIGN TURE DATE
RFI.rASFD BY
091/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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ORIGINAL - FiLE YELLOW - INSPECTOR
PNK-OWNER GOLD -ASSESSOR
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FINAiL PRQJECT APPROVAL FORM
TO:
DATE:
MEMO TO. PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
P—LEAsr SIGN
ENGINEERING DIVISION DATE
PLEASESIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT PQZ/V�7777
SITE ADDRESS—
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PERM A B#
IT _______�DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
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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
El Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANIDING ISSUES
El Copy of CORRECTION NOTICE given to owner/contractor by inpector
I .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fonns: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 ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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