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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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CITY ZIP TTELEPHONE
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NAME
CITY 0 >11' ZIP I TELEPHONE
PERMIT EXPIRES
USE E R M IT
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JOB SUITE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
TIESCIP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL
STREET MAP
RW Permit Required
Street Use permit Roq*d
EXISTING PROPOSED
inspection Required
Sidewalk Required
REQUIRED DEDICATION�
Fr
Undergiound
wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
P V EQUIRED
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YES NO 13
REMARKS
OWN E RICON TRACTOR RESPONSIBLE FOR EROSION CONTROLJDRAINAGE
NAME
ENGINEERING REVIEWED BY
ADDRESS
FIRE REVIEWED BY
CITYI� ZIP TELEPHONE
1=,17 770 VARIANCE OR CU SHORELINE OR ADB#
STATE I IPEKISE NUMBER EXPIRATION DATE ED BY
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SEPA REVIEW
COMPLETE EXEMPT
PROPERTY TAX ACCOUNT PARCEL NO.
_575
EXP I
NEW
RESIDENTIAL
PLUMBING/ MECH
LOT COVERAGE
ALLOWED PROPOSED
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
PARKING
REO'D I PROVIDED
REPAIR
GRADING
CYOS
FENCE
( x Fr)
REMARKS
DEMOLISH
TANK
OTHER
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GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
CrYPE OF USE, BUSIN PS_ A T�ITY) EXPLAIN:
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CHECKED BY
NUM13ER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS I NUMBER
DESCRIBE WORK TO BE DONE
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IF
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO, VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
It BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
cc PERMIT APPLICATION: 100DAYS
W
CL PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
I SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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 OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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_j DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
2 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
DATE
DATE
INSPECTION BOND
REO'D POSTED
OYES ONO I S
SIGNAREA ISED I HEIGHT
ALLOWED . PROPOSED ALLOWED . PROPOSED
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
FRONT SIDE REAR I FRONT LJR SIDE REAR
LOT AREA I PLANNING REVIEWED BY
SPECIAL INSPECTION JAREA
REQUIRED YES
407
DATE
OCCUPANT
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
VALUATION
Description
FEE
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to
Description
State Surcharge
City Surcharge
FEE
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Plan Chk. Deposit
Receipt #
Total Amt. Due
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APPI ICATION APPROVAI
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees art, paid, and
receipt is acknowledged in space provided.
FFIC15LS SIGNATPRE DAT
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.E DATE
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IT IS UNLAWFUL. TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 4
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YELLCIA - INSPE TOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER - GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DU& 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 RCW 18.27.
E SIGNED
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
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GARY HAAKENSON
CITY OF EDMONDS MAYOR
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 FAX (425) 771-0221
Website: wwwdedmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning Building Engineering
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June 21, 2004
Attn: Paul& Donna Sorenson
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1045 3rd Ave S
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Edmonds, WA 98020
Buildin Permit: 2004-0448
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Site Address: 1045 3rd Ave S
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Expiration Date: 12/10/04
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Dear Paul & Donna Sorenson:
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The purpose of this letter is to inform you that the last remaining inspection on your
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project is a final inspection(s). The final inspection(s) determines that there are no
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outstanding life -safety issues and approval allows the City to close your permit file.
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The City considers the final inspection to be one of the most important inspections
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conducted on a project. In order to grant final approval the following must be complete:
smoke detectors, house numbers, guardrails, handrails, self -close doors between garage
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and residence, egress from sleeping rooms, safety glazing, weather-stripping, any
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Engineering department requirements etc. Of course not all of these things may
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specifically apply to your project but it does give you an idea about the kinds of things
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that must be complete as well as some items that do not need to be installed such as:
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paint, carpet, moldings, wallpaper, etc. Please be advised pen -nits expire one year from
the date of issuance. if you will need more time to complete the work, permits can be
renewed prior to expiration for one half fees. If the permit expires without a final
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approval granted by the Building Inspector, full fees are required in order to renew the
permit. This can be very costly to you and we strongly encourage you to check your
permit expiration date and call for the required final inspection(s). Note: If more than
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one department is required to final your project, this is noted on your Job Card.
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Please feel free to contact me at 425-771-0220 if you have any questions.
Sincerely,
Pen -nit Coordinator
Incorporated August 11, 1890
Sister City - Hekinan, Japan
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall.......................... z
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Pier/Porch ................. _q
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Retaining Wall ...........
Slab Insulation ..........
PLUMBING: 3:
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Underground ............. 0
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Rough -In ................... C
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Commercial Final ...... M Z
HEATING: C
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Gas Test .................... fv-\
Gas Piping ................. urn. o -n
Equipment ................. 3:9
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Commercial Final ....... 0
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EXTERIOR SHEATHING 0 M
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NAILING .......................... 9 co
FRAMING ........................
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FIRST FLOOR FRAMING ...
INSULATION ................... >
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Floor Insulation .........
Wall Insulation ........... C/)
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Ceiling Insulation ....... 0
SHEETROCK NAILING ... M
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR 6
OCCUPANCY ..........
Milton
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inspector for tile City -
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