20040506.pdfDATE RECEIVED
ERMIT EXPIRES
FP_1_
USE
PERMIT
CITY OF EDMONDS ZONE NU T "T
CONSTRUCTION PERMIT APPLICATION JOB RESS MBER,
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ADD g SUITE/APTO
OWNER NAME/NAME OF BUSINESS rr, o
LPLAT NAME/SUBDIVISION NO, LOT NO. LID NO,
MAILING ADDRESS LID FEE $
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3� TESCP Approved 13
0 01 PUBLIC RIGI IT OF WAY PER OFFICIAL STREET MAP HW Permit Required 13
ully street use Permit Roq.d E3
ZIP jELEPHQNE EXISTING - PROPOSED Inspection Raquired 13
Sidewalk Required E3
Underground
REQUIRED DEDICATION- FT
Wiring required E3
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO 13 K
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cc OWNER/CONIRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE S
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CITY zip TELEPHONE UJI
NAME CBLO
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ADDRESS
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FIRE REVIEWED BY DATE W
CITY ZIP TELEPHqNE,
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VARIANCE OR CU SHOREUI _ORADB# INSPECTION BOND
STATE LICENSE NUMBER 9XPIRATION DATE I�pc
1, 5r"-1B1\ REQ'D POSTED
vf SEPA REVIEW SIGN AREA OYES ONO s HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO, COMPLETE , EXEMPT ALLOWED POSED ALLOWED PROPOSED
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EXP
NEW RESIDENTIAL PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
29 ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
ADDITION COMMERCIAL COMPLIANCE OR z
CHANGE OF USE E
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REMODEL MULTIFAMILY PARKING T, 6REM VR4E44AEVIEWED BY DATE 5
REO'D
F� SIGN PROVIDED
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GRADING FENCE r
REPAIR IiESENT FOB
CYDS X FT) REMARKS
OTHER
El DEMOLISH TANK
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF USE. BUSINESS OR ACTIVI?,.EXPLAIN:
CHECKED BY TYPE-GF- F�,. OCCUPANT
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uj NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
cr STORIES UNITS
I I NUMBER REQUIRED [] YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D Fa
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$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit 1! cl City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU13LIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
UJI PERMIT APPLICATION: IGO DAYS
IL PERMIT LIMIT., 1 YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Plan Chk. Deposit
U) Fire Review
W
_j IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
* EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
M Fire Inspection Receipt #
* ALL CLAIMS FOR DAMAGES OF WHASEVER NATURE, ARISING DIRECTLY OR INDIRECTLY Z
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT 13E
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENI OF ANY CITY ORDINANCE Landscapelnsp.
_j Total Amt. Due
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NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
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- I his application is not 11 Perinit Until Signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Olficial or his/tier Deputy: and Fees are paid, and
IN VIOLATION OF THE LAB `l__G DE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATI ORANGE AND RCW 18.27.
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___ - I OFFICIALS.SIGJNATURE ATE
SIGITURE (OWNER OR INT) DATE SIGNED I
(425)
771-022 ED 134
0 RELEAS
ATTENTION E)ff 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
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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TANKS BY DALLAS BED ANn TnVATW- WnIDX40
NAME: 64 TE:
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PHONE: - 2 FAX:
ADDRESS:
REFSOURCE:
TOTAL:--
DL&METER r/777-, OIL. U/ _'WAUR: 77-
IAY.- ELECSOURCE:
GROffM COVER
07 NOTES:
AMOUNT OF TIME:
POSSIBLE 71MCVS OF NEED OR TO TAKE NOTE OF:
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FINAL PR03ECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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FROM: FIRE DEPARTMENT ATE
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ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE'
PLEASE SIGN
PROJECT, AI
SITE ADDRESS
PERMIT #e2-Q0q_—_63'2) G ADB# DATEINSPECTE
DESCRIPTION OF WORK TO BE INSPECTED W 4n2�c c egz_-
A field inspection was conducted to determine compliance witli -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
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE-lNSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tenip:b1dg:fornis:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing...................... z
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Wall..........................
0
1711
Pier/Porch .................
Retaining Wall ......
Slab Insulation .......... 0 ITI
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PLUMBING:
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Underground ............. C
3: 1711
Rough -In ......... M z
Commercial Final ...... C z
HEATING:
Gas Test .................... 0 -n
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Gas Piping .................
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Equipment ................. 00)
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Commercial Final ....... C CD
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EXTERIOR SHEATHING Q 0
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NAILING ..........................
FRAMING ........................
3:
FIRST FLOOR FRAMING...
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INSULATION ...................
Floor Insulation ......... 0)
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0
Wall Insulation ...........
0
Ceiling Insulation ....... M
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR /6)
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OCCUPANCY ..................
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