20040437.pdfI
DATE RECEIVED.
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OULISINESS
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MAILING ADDRESS
C � I n� � / t � - A' 7
CITY ZIP I TELEPHONE
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NAME
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ADDRESS
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CITY ZIP
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TELEPHONE
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STATE LICENSE NUMBER EXPIRATION)ATE
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PROPERTY TAX AL:CO.UNT Pf L NO. F
NEW RESIDENTIAL
PLUMBING MECH
ADDITION COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL MULTIFAMILY
SIGN
GRADING
REPAIR CYDS
FENCE
( X FT)
El DEMOLISH TANK
OTHER
GARAGE o RETAINING WALL
El CARPORT ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE q
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HEAT SOURCE I 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: 180 DAYS
IL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
In 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
In
!I IN INTERESL AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, ANDAGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECT LY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMI1 SHALL NOT BE
1
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY OR )INANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,*
PERMIT EXPIRES
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PERMIT
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NUMBER
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AD DRESS
SUITE/Ptq�l
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PLAT NAME/SUBDIVISION NO
P
LOT NO.
LID NO,
LID FEE S
TESCP APPMVO�,_
13
13
P PUBLIC RIGHI OF WAY PER OFFICIAL STREET MAP
RW Permit HOW1110d
[3
Street Use Permit Fjocrd
EXISTING — PROPOSED
I - rispeci,on Required
S,dewalk f1equifod
13
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REQUIRED DEDICATION—
Ft
FT
underground
Winng requ2��
METER SIZE
LINE SIZE
NO, OF FIXTURES
PRV REQUIRED
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� YES 0 NO 13
REMARKS
OWNER/CONmACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWE�6 DATE
PRE SENT FOR
IV 1� t D -� CAHIDAT
7RE REV�qVO#Y!'ILL, A
VARIANCE OR CU
SEPA REVIEW
COMPLETE , EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
SHORELINE OR ADIII I INSPECTION BOND
REO'D POSTED
OYES ONO S
F—SIGN AREA HEIGHT
I ALLOWED . PROPOSED I ALLOWED , PROPOSED
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REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR FRONT LJR SIDE REAR 0
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PARKING LOT AREA I PLANNING REVIEWED BY DATE a.
REO'D I PROVIDED I
REMARKS
CHECKED By
OCCUPANT
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED E] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REO'D 6
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VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
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Recording Fee
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- CALL
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL. BE EMPLOYED
IN V;6LATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN' MPENSATI ANCE AND RCW I B.27.
SIGIIIIISfUk (OWN�_R OR DATE S19NED (425)
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P 6 771-0220
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
I his 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.
OFFICIALS SIGNATURE -..I OATE
ATTENTION t7k I I dili
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
091/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ED BY DATE
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
TE,/'/— �'Q C�
FIRE DEPARTMENT DA
FROM. , �_, ��z
PLEASE SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECTA4,Sz A �_L
SITE ADDRESS-- 4 0
PERMIT #_2NOay - __Q �'LZ_—AD13# DATE INSPECTED ZLZ6.— ()If
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DESCRIPTION OF WORK TO BE INSPECTED Z�VJ Dq-
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
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
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2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signaturc
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
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Slab Insulation ..........
PLUMBING:
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Underground .............
Rough -In ...................
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Commercial Final ......
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0
C:
HEATING:
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Gas Test ....................
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Gas Piping .................
Equipment .................
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Commercial Final .......
EXTERIOR SHEATHING
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NAILING ..........................
0 W
0
FRAMING ........................
0 M
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FIRST FLOOR FRAMING...
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INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
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Ceiling Insulation .......
SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................