20040458.pdfV
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NUMBER
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PLAT NAME/SUBDIVISION NO.
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LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
I IESCP Approved 13
RW Permit Required 13
Street Use Permit Req'd 13
EXISTING - PROPOSED
Inspection Required 13
Sidewalk Required E3
REQUIRED DEDICATION- FT
Underground
Wiring required 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PAV REQUIRED
YES 13 NO 13
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINCILAW NEIV*&D V I PH Gt DATE
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INSPECTION
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YES ONO
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SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
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LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/RSIDE REAR
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PLANNING REVIEWED BY DATE
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PROGRESS -INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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VALUATION
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Description
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Plan Check
HEAT SOURCE GLAZING % LOT SLOPE %
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Building Permit
ECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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HE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
cc PERMIT APPLICATION: ISO DAYS
W
IL PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Cn 'APPLICANI, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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Fire Review
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY ANO
Fire Inspection
a: ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLYOR INDIREcrIY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscape Insp.
DEEMED ro MODIF'� WAIVE OR REDUCE ANY REQUIREMFN I OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYs ABILITY TO ENFORCE ANY ORDINANCE PROVISION.4
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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 VI'61LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTH
WORKMEN;��OMPENSAI 10
,kV�I�ANCE ANn RCW 1827.
ORIL
(425)
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771-2022
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION API
This application is not a permit until signed by the
[3uilding 011icial or his/her Deputy: and Fees are paid, and
N receipt is ackMwledged it) space provic�cl.
FAFA S SJIGNAI 1)
F�S Ely
EASED BY
ATTFKITIr)fJ V I=VT 1111
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 ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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MEMO TO:
FROM:
FINAL PROJECT APPROVAL FORM
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.)UN 2 2 2004 TO: —
DEVELOPMENT SEFIViCES CTH DATE:
CITY OF EDMOND�
PERMIT COORDINATOR, BUILDING DIVISION
PROJECT_L_�
-FIRE DEPARTMENT DATE-22 '—'- _Z_0
.1P PLEASE SIGN
-ENGMERING DIVISION DATE,
PLEASE SIGN
PLEASE SIGN
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PLANNING DIVISION DATE--,
SITE ADDRESS --
PERMIT # '1- 00 L( -'5—K ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
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 :
,K GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
1 .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
El Copy of CORRECTION NOTICE given to owner/contractor by inpector
1 .
2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbrms:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall ..........................
Pier/Porch .................
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Retaining Wall ........... 0
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0
Slab Insulation ..........
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PLUMBING:
Underground ............. -j
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Rough -in ................... C
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0
Commercial Final ...... -40
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'HEATING: M M
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Gas Test ....................
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Gas Piping .................
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Equipment .... ............. 0 -n
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Commercial, Final ....... --I
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EXTERIOR SHEATHING
NAILING ..........................
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FRAMING ........................ Cn
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FIRST FLOOR FRAMING ... Q 0
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INSULATION ...................
Floor Insulation .........
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Wall Insulation ........... z
Ceiling Insulation .......
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SHEETROCK NAILING ... 0
SPECIAL INSPECTION ... 0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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