20040512.pdfDATE
CITY OF EDMONDS '(
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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CITY ZIP TELEP IONE
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NAME
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ADDRESS
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NAME
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TELEP IONE
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ZIP
T�LEPHONE
STATE LICENSE NUMBER
�XPIRATION DATE
CHECKED BY
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
_;��ESIC ENTIAL
PLUM13ING / MECH
ADDITION
COMMERCIAL
F
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
El
SIGN
REPAIR
GRADING
4�zv CYDS 1:1
FENCE
( X FT)
DEMOLISH
TANI�
OTHER
_1f3E
,GO�A
RETAINING WALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE. BUSINESS TIVITY) EXPLAIN:
NUMBER
NUMBER OF
CRITIC !AL
OF
DWELLING
/L
AREAS
STORIES
I INITS
N11
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DESCRIBE WORK TO BE DONE
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO A — I VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 1BO DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS ANO SUCCESORS
En
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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4 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTIY OR INDIRECTLY
Mi FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF IHIS PERMIT SHALT NOT BE
13
_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION
x
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 VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COWENSATION INSYNANCE AND RCW 18.27.
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DATE SIGNED
/1
I PERMIT EXPIRES
C RA
1-6'N' F- rl I I
N U M B E R
JOB SUITE/APT#
ADDRESS
NAME/SUBDIVISION NO LOT NO LID NO.
LID FEE $
I ESCP Approven
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street Use Permit Roq'd
EXISTING PROPOSED inspection Required
Sidow.11k Required
REQUIRED DEDICATION FT Underground
Wiring required
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 0 NO
REMARKS
OWNER/CONTRACIOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
�01 - -110 1
b
FIRE REVIEWED BY DATE W
VARIANCE OR CU SHORELINE OR ADB# _I INSPECTION I BOND
REq'or POSTED
OYES )kNO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEYT ALLOWED PROPOSED ALLOWED PROYOSED
EXP I x - I 11; 11 y 1Y
LOT COVERAGE 4�- REQUIRED SET13ACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT QRSIDE, REAR
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PARKING LOT AREA I G REVIEW�D 4Y DATE
REO'D I PROVICED
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REMARKS�f
ILS11,_ (� ark 'Illddo dl'acA�J 5K
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CHECKED BY ITYPE OF CONSTRI.19TION COQE I OCCUPANT
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SPECIAL INSPECTION JAR 405 OCCUPANT
REQUIRED rk I WoMrig LOAD
YES J</jo 10
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
VALUATION
$ J J/- /--
Description
FEE Description
A State Surcharge
City Surcharge
Base Fee
FEE
'6 -
Plan Chk. Deposit ' '
,:2A 2
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/tier Deputy: and Fees are Paid, and
receipt is acknowledged in space provided.
:FICIALS SIGNATURE DATE
or
ATTENTION EXT 1333 A)
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 TtLLI-M-INSPECt
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD�ASSESSOR
09�03 PRESS HARD -YOU ARE MAKING 4 COPIES
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: PLEASE. SIGN FIRE DEPARTMENT DATE
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ZPLEASES ENGINEERING DIVISION DATE_4ZZ44Z6Z5-
PLANNING DIVISION DATE
PIXASE SIGN
PROJECT -----
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SITE ADDRESS 2, 7 /01'/ 04 Y'C
PERMIT # _ADB#_ DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED t
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A field inspection was conducted to determine compliance with -approved plans. Final ap&oval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
fx1 --GRANT FINAL PROJECT APPROVAL
. N,
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDrNG ISSUES
Copy ofCORRECTION NOTICE given to owner/con tractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANTFINAL PROJECT APPROVAL
Date Signature
1:tem1):b1dg:f6rnis:ocaprv1 3/25/04
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: -FIRE DEPARTMENT DATE
PLEASESIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
A� PLANNING DIVISION DATE 7/ (91v5-
M& SIGN
'PROJECT 4 P, P-_
SITE ADDRESS- P" 1- 33
PERMIT # 6 -70 ADB# DATE INSPECTED
DESCRIPTIO14 OF WORK TO BE INSPECTED
A field inspection was conducted to determine compliance wi th -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
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:ten11):b1dg:fon1is:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
2- 1 �0�
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
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Gas Test ....................
A
Gas Piping .................
A777 _6S
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
-A
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ....................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR Im T
OCCUPANCY ..................
The initials Ware Milton
Thompson, a Icniporary contract
inspector for tile City.
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