20040503.pdf13
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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
T R NAME/NAME 01 USIN ESS
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MAILING ADDRESS
CITY
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NAME
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ICENSE NUMBER
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PERMIT EXPIRES LZ7�
USE PERMIT
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ADDRESS
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
TESCP A- roved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit P Required
Street Use Permit Roq'd
EXISTING PROPOSED
REQUIRED DEDICATION FT
inspection Required
Sidewalk Required
Underground
Winng required
METER SIZE
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LINE SIZE
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NO. OF FIXTURES
PRV REQUIRED
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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CHANGE OF USE
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REPAIR
GRADING
CYDS
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DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL
FIRE SPRINKLER
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSI OR ACTIVITY) EXPLAIN:
NUMBER
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NUMBER OF
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NUMBER
DESCRIBE WORK TO BE DONE
ENGINEERING REVIE
FIRE REVIEWED BY
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REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
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PROGRESS INSPECTIONS PER UBC108/IBC109/IRC109 FINAL INSPECTION REO'D FS
to
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
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LOT SLOPE %
Building Permit
City Surcharge
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT C(!(VERS 7ORK. TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU13LIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
Engr. Review
PERMIT APPLICATION: 180 DAYS -
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
2
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'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."
Fire Review
Plan Chk. Deposit
4
Fire Inspection
Receipt #
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Landscapelnsp.
Total Amt. Due
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 permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATI�G To FOR INSPECTION receipt is acknowledged in space provided.
�CO�SATION INSURANCE AND RCW 18.27.
I - - __ . - I SIGNATjIJRE DATE
SIGNA`IA� (0 NE D E GNED (425)
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ATTE"ON EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 fM I
PRESS HARD -YOU AN MAKING 4 COPIES
DAT
ORIGINAL - FILE YELLOW - INSPEVC
PINK -OWNER GOLD,ASSESSOR
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NOTICE: IF THE DOCUMENT IN THIS FRAME IS LESS CLEAR THAN THIS NOTICE
IT IS DUE TO THE QUALITY OF THE DOCUMENT.
Y OF EDMONDS
F-110ILDING DEPARTMENT
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ADn�MiESS
APPROVED DATE*
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RECEIVED
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PERMIT COUNTER
CITY 'COPY
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE 2LZWf
PLEASE S16T
PLANNING DIVISION DATE
PLEASE SIGN
PROJEC
SITEADDRESS.
PERMIT # A"6 56-3 ADB# DATE INSPECTED ("7
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine compliance with -approved plans. Final approval
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denotes that there are no objections from the above signed Department to the re ease of
PERFORMANCE BONDS and the granting of:
YGRANT 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
0 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:fonns:ocaprv1 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 ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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