20040479.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERWTAPP CATION
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OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS j _-j , , -
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CITY TELEPHONE
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NAME
ADDRESS
CITY
ZIP ITELEPHONE
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STATE LICENSE NUMBER
EXPIRATION DATE
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ADDITION
COMMERCIAL
COMPL ANCE OR
CHANGIE OF USE
REMODEL
MULTIFAMILY
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REPAIR
GRADING FENCE
CYDS 0 ( - X-FT)
1:3 DEMOLISH
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13 TANK
E] OTHER
GARAGE
CARPORT
[] RETAINING WALL F RE SPRINKLER
ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY)i EXPLAIN:
PERMITEXPIRES
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PERMIT - 4:�
NUMBER.
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SUITEIAPT#
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PLAT NAME/SUBDIVISION NO.
LOT IN 0.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
IESCP Approved [3
RW Permit R ad 0
Street Use P:rqr1U1:; Roq'd 0
EXISTING PROPOSED
Inspection Required [3
Sidewalk Required E3
REQUIRED DEDICATION-
Fr
Underground
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YESM NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
REVIEWED BY DATE
FIRE REVIEWED BY DATE W
VARIANCE OR CU
SHORELINE OR ADB#
I INSPECTION
BOND
REO'D
10-YES ONO
POSTED
1$
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSE
ALLOWED PROPOSED
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LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIRSIDE REAR
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DATE
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PARKING
REO'D I PROVIDED
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LOT AREA
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REMARKS
CHECKED BY
OCCUPANT
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GROUP
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NUMBER
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STORIES
NUMBER OF
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UNITS
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SPECIAL INSPECTION
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AREA Z-2 I
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DESCRIBE WORK TO BE DONE
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ROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REO'D
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PLAN CHECK NO:— -11 VESTED YATE_ _&�C
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMWCOVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPUCATION: ISO DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 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
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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 VIOLAT ON OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WOR�YEN!S COMP6N I CE ANDACW 18.27.
qIrh"1RR`-10"I11B.9K AG1100 /z5r" I DA=TES NED
Desladption
Plan Check
'Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
t CALL '
RINSPECTII
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(425)
.—l-0220
FEE Description FEE
State Surcharge
0 City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt # q-
APPLICATION APPROVAL
This application Is not a permit until signed by the
Building official or his/her Deputy: and Fees are paid, and
receipt Is acknowledged In space provided.
FICI LS SIGNATURE E
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL I YELLOW - ASPEAO
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK n.6. - rnin ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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FINAL PROJ . ECT APPROVAL FORM
TO: R/5
DATE: _�/_/ —
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE,
PLEASE SIGN
G� �;�z -PLANNING DIVISION DATE__���Q
PLEASE SIGN (
PRO
JECT
SITE ADDRESS Z7 Y
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PERMIT _ADB#____L_�DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED—
-approved plans. Final approval
A field inspection was conducted to determine compliance with
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denotes that there are no objections from the above signed Depa ment to the release of
PERFORMANCE BONDS and the granting of:
1// GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
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2.
3.
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..........................
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Pier/Porch .................
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M.
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
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Underground .............
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Rough -In ...................
Commercial Final ......
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HEATING:
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GasTest ....................
Gas Piping .................
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Equipment .................
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Commercial Final .......
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EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
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