20040542.pdfPERMIT EXPIRES
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CITY OF EDMONDS NUMBER
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CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAME/NAME OF BUSINESS /Do
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SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE , E'K ALLOWED PROPOSED ALLOWED PROPOSED
-2 7,9 6) 3
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NEW RESIDENTIAL PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT� SIDE REAR FR04T yRSIDE;, REAR.,
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ADDITION CHANGE OF USE
PARKING LOT AREA PLAKINING REVIEW Y DATE
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REPAIR GRADING Ei FENCE
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GROUP
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DESCRIBE WORK TO BE DONE
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PLAN CHEC�� 1 0- VESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 100DAYS
PERMIT LIMIT., 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 rHE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPI OYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHAT -EVER NATURE, ARISING DIRECTLY OR INDIREC ILY
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHAi L. NOT 13F
DEEMED ro MODIFY, WAIVE OR REDUCE ANY REQUIREMENT'OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY's ABILITY 10 ENFORCE ANY ORDINANCE PROVISION *
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAV I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONsrRuc-
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 COMPENSATION INSURANCE AND RCW 18 27
R AGENT) I DATE SIGNED
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VALUATION
Description FEE
Plan Check //;z 4�
Building Pcrmit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
ATTENTION \11 tX 1 1 J;3j
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
............. A�
APPLICATION APPROVAL
I his application is not a permit until signed by the
Building 011iciril or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided
-FT 4- SIG DATE
-I FAS" BY [DATEj
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL. FILE YELLOW JNSPWTO
PINK OWNER GOLD -ASSESSOR
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IT IS DUE TO THE QUALITY OF THE DOCUMENT.
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION '
FROM: FIRE DEPARTMENT DATE
FLFAU SM
C�old ENGINEERING DIVISION DATE_:!���5_
PLEASESIGN
PLANNING DIVISION DATE
MXASP SM
PROJECT 6 g�_-_rn Ls�._
SITE AD
PERMIT #20a,, el —
ADB# DATE INSPECTED 412 7 /40��
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine final compliance with approved plans. Fi nal approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
2,,�Z GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
1 .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
I .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
ocaprv1.doc.1:tenip:b1dg:fbrnis 10/0 1
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing
......................
Wall
VYI 1\
Cl—
..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final ......
HEATING:
vr
CI,
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
A,
NAILING ..........................
M�
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING
...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
The initials MT are Milton
Thompson, a temporary contract
ilispectoi or the City.
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