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/ PERMIT EXPIRES
USE PERMIT
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NUMBER
JOB
ADDRESS
PLAT NAME/SUBDIVISION NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE I LINE SIZE NO, OF FIXTURES
SUITE/APT#
LID NO.
LID FEE $
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inspection Rarillned
sidewalk Floquired
underground
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PRV REQUIRED
YES [3 NO E3
REMARKS
OWNER/CONrRAcron RESPONSIBLE FOR EROSION CONTROL/DRAINAGE___�
110
FIRE REVIEWED BY
DATE
DATE
VARIANCE OR CU
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REO'D I PROVIDED
REMARKS
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LOT AREA I PLANNING REVIEWED BY DATE
SPECIAL INSPECTION JAREA
REQUIRED [:] YES I
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 15
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VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
FEE Description FEE
I State Surcharge
- L City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATII__
:)N APPrIffivi
ROVAL
This application is not a permit until signed by the
CALL Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided,
OFFICIALS SIGNAJU . RE ATE
(425)
771-0220 RELEASED BY DATk
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A I lltN I 1U tA I I jjj
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
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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LCc MAILING ADDRESS
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CITY TELEPHONE
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NAME
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NAME
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STATE LICENSE NUMBER
EXPIRATION
ATE
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PROPERTY TAX ACCOUNT PARCEL NO
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NEW
RESIDENTIAL
PLUMBING i MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
ryng
FENCE
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DEMOLISH
TANK
OTHER
F-1 GARAGE
RETAINING WALL
FIRE SPRINKLER
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FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVIM EXPLAIN:
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NUMBER
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NUMBER OF
DWELLING
CRITICAL
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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.
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W PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREC BY On INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF I HIS PERMIT SHALL NOT 13E
_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
121 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
I IJERE13Y 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 LAPJ).RCODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSAWN INSURANCE AND RCW 18 27.
DATE SIGNED
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
0111GINAL - FILE YELLOW. INSPECTOR
PINK -OWNER GOLD-ASSESSoq
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PER
(7 G DIVISION
FROM: _rRD IRE DEPARTMENT DATE
PLEASE SIGN
-ENGINEERING DIVISION DATE
PLE.ASII SIG N
PLANNING DIVISION DATE
PLEASrSIGN
PROJECT
SITE ADDRESS— Ic)6 t(
PERMIT# 04 -7 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
PERFORI%IANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
1:1 Copy of CONDITIONS givcn to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owncr/conti'actor by inpector
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
I:teiiip:bl(lg:forilis:ocal)rN,I 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
7, 5i
Underground .............
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Rough -in ................... C
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Commercial Final ...... 0
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HEATING:
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Gas Test .................... -4
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Gas Piping .................
Equipment ................. 0)
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Commercial Final ....... -n
EXTERIOR SHEATHING M M
NAILING ..........................
0
01—
FRAMING ........................ 0 rn
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FIRST FLOOR FRAMING ... rn 0
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INSULATION ...................
Floor Insulation .........
Wall Insulation ........... >
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Ceiling Insulation ....... 3:
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SHEETROCK NAILING ... z
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .................. dill- �-Inal
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