20040482.pdfDATE RECEIVED
PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUM13ER-7&?/1`//
J013 SUL E/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS% —
OWNER NAMEINAME OF BUSINESS
LPLAT NAME/SUBDIVISIO� NO. LOT NO. LID No.
01 MAILING ADDRESS
u LID FEE
Z TESCP Approved E3
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit RriqU110d 0
0 /07 Street Use Permit Rriq'd (3
CI.TY ZIP ITELEPHONE EXISTING — PROPOSED inspection Required 13
Sidewalk Required 11
REQUIRED DEDICATION. FT Undefground
Wiring inquifod 0
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
?_ YES 13 NO 1:1 z
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ADDRESS f REMARKS z
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Lill OWNER/CONIRACJOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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CITY ZIP TELEPkONE
NAME CBL#
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cc ADDRESS DATE
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5 —3 � VARIANCE OR CU SHORELINE707RADBIl INSPECTION B76
STATE u&r_:NSE NUM13ER EXPIRATION DATE JCCKED BY REO'D POSTED
5 1 _511;I110 E; , 2d SEPA REVIEW SIGN AREA OYES ONO 1$ HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED I PROPOSED ALLOWED I PROPOSED
EXP,
NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMPLIANCE OR z
ADDITION COMMERCIAL 2
CHANGE OF USE I z
PARKING LOT AREA [PLANNING REVIEWED BY DATE 5
REMODEL �54NIULTIFAMILY SIGN REaD I PROVIDED (L
GRADING FENCE
E] REPAIR CYDS X FT) REMARKS
DEMOLISH TANK T
GARAGE
RETAINING WALL FIRE SPRINKLER
z CARPORT El ROCKERY FIRE ALARM
(TYPE OF USE, j3US_1N. S OR A IVITY) EXPLAIN:
OCCUPANT
CHECKED BY z NSTRUCTION
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w NUMBER NUMBER OV CRITICAL 40 -1 177
go OF DWELLING AREAS SPECIAL INSPECTION AREA OCCUPANT
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to STORIES UNITS NUMBE REQUIRED E] YES LOAD
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DESCRIBE WORK TO BE DONE
REMARKS
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PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REO'D 5
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tit
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT GLAZING % LOT SLOPE %
Building Permit City Surcharge
ECK NO: VESTED DATE Plumbing B ase Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
D
SEPARATE PERMISSION.
2 Engr. Review
M
W PERMIT APPLICATION: ISO DAYS
CLI PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANI, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND ESORS Fire Review
Cn succ Plan Chk. Deposit
UJI ��) /I
_j IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NAT URE, ARISING DIRECTLY OR INDIRECTLY Atj
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT HE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp.. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABII I FY TO ENFORCE ANY ORDINANCE PROVISION.'
X1 Recording Fee Receipt #
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 APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC This application is not a pennit until Signed by the
TION AND IN DOING IIIE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or hisihor Deputy. and Fees are paid. and
IN ViCiLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27.
6CIALS SIGNA1UHF DATE
ENT) ?iG 91? 1
SIGN T JRE (OWPER YR DATE NVD (425)
771-Ur-e-V R
MENN-0007 f If--ASFD BY /bATE
ATTENTION EXT 1333 -----------
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
09io3 PRESS HARD -YOU ARE MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: �Z_ - / FIRE DEPARTMENT DATE_3—'�
ENGINEERING DIVISION DATE
PLEASP SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT P7
SITE ADDRESS--?
S 2� ADB# DATEINSPECTED
PERMIT it ;Z00 OY —
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:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
I
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
I .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT F INAL PROJECT APPROVAL
Date Signature
1: temp:bldg: forms: ocapnl 3/25/04
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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:
GasTest ....................
Gas Piping .................
Equipment.................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
A
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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