20040463.pdfI
DATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
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CITY ZIP TELEPHONE'.2Cg. -5-,3'36j:4�
NAME
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C ITY ZIP TELEPHONE
NAME CBL #
ADDRESS
CITY ZIP TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
04112711
PROPERTY TAX ACCOUNT PARCEL NO.
NEW
70 RESIDENTIAL
PLUMBING / MECH
ADDITION
—
1-1 COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
1:1 MULTIFAMILY
SIGN
REPAIR
GRADING
El CYDS
FENCE
( x FT)
DEMOLISH
TANK
OTHER
GARAGE
r.APPnRT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE,,PqINESS OR -ACTIVITY) EXPLAIN:
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
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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: IBODAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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9 IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CIry OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGES OF WHATEVER NAT URE. ARISING DIRECTLY OR INDIRECT LY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
10 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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.
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATIN� TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27.
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USE
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ADDRESS
PLAT NAME/SUBDIVISION NO
PERMIT EXPIRES
PERMIT
NUMBERi��
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
SUITE/APT#
LID NO.
LID FEE S
iESCV Approved
13
RW Permit Required
13
Street Use Porred 1100
C1
inspection Required
13
Sidowalk Required
13
Underground
Winnit required
0
PRV REQUIRED
YES13 NO 13
REMARKS
OWNER/CONIRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
PURSUANTTO ECDC 19.3
ENGINEERING REVIEWED BY THE- WATER SHUTOFFATE
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP I
LOT COVERAGE
ALLOWED PROPOSED
DATE
SHORELINE OR ADB11 I INSPECTION I BOND
REO'D POSTED
SIGN AREA OYES ONO S HEIGHT -
FALLOWED . PROPOSED I ALLOWED . PROPOSED
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REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE
REQ'D I PROVIDED I
REMARKS
CHECKED BY ITYPE
GROU
SPECIAL INSPECTION AREA OCCUPANT
REQUIRED [] YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/ IBC109 if IRC109 FINAL INSPECTION REO'D - 9
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
Description
FEE
State Surcharge
City Surcharge
Base Fee
00- el 7 (. :4
4/5
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt # �0 44.
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or hisiher Deputy. and Fees are paid. and
,_ receipt is acknowledged in space provided.
0�h*[_S SIGNATURE DATE
SIGNATUR] WNE"fi A31EN,% DATE SIG ED V
IQ02 is-
771-0220 RFL AS
A17ENTION EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL FILE YELLOW- INSPECTOR
PINK-OWNFR GOLD -ASSESSOR
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FINXL PROJECT. APPROV, AIL, FORM
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TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUH-DING DIVISION
FROM: FIRE DEPARTIVIENT DATE -------
11,IJ __�asij�k t1kz,�t_.EN.GINEERING DIVISION DATEAL�/_ /�(O�
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PLANNING DIVISION DATE------.
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PmEcT____�_Lo t
SITE ADDRESS- V) (,-- C 1, - - 2 - I In I 6---L r-r ( ) 1-/ L ) -T- rN t I
PERMIT _ADB#_________PATE.INSPECTED
DESCRIPTION OF WORK TO'BE INSPECTED
A field inspection was conducted to determine final 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 : �
zk�_GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inspector.
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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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 ...
;7� yr v 114 1 il
Floor
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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