20040564.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY
ZIP ITELEPHONE
NAME CBLN
ADDRESS
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CITY AP ETELEPHONE
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STATE LICENSE NUMBER EXPIRAT . ION DATE 1 (060:1
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PROPERTY TAX ACCOUNT PARCEL NO._, _� � ol,01
NEW
E��ESIDENTIAL
PLUMBING if MECH
ADDITION
[] COMMERCIAJL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULT11FAMILY
SIGN
REPAIR
GRADING
El CYDS
FENCE
X
DEMOLISH 2--�TANK
OTHER
GARAGE
CARPORT
RETAININGWALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM.
(TYPE OE_t,[SE.
BUSINESS OR ACTIVIM EXPLAIN:
I I A �
— - 4.
NUM6ER OF CRITICAL
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0 OF DWELLIN AREAS 7
1
M STORIES UNITS NUMBER
NUMBER
01
2 DESCRIBE WORK TO BE DONE
d
PERMIT EXPIRES
---
USE PERMIT
ZONE NUMBER
SUITE/APT#
JOB (Dry- co nu E" L- 'jo
ADDRESS
PLAT NAMEISUBDIVISION NO LOT NO, LID NO
'D FEE $
L LID FEE $
�S P Ap "'oved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
"o qu "Od
FIW parroll Requited
Fj'le�d
Street Use permit 9,)q'd
P a no
'It
Roqti I'd
inspection Required
EXISTING � PROPOSED
it "Od
Sidewalk Requited
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Undeiground
REQUIRED DEDICATION� Ff
Wifing required
0 1 XT
METER SIZE LINE SIZE N OF F URES
D RED
PRV REQUIRED
ESO NO
Y Y 0
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE , EXEMPT
EXP
FU
LOT COVERAGE
ALLOWED PROPOSED
PARKING : I
REQ'D I PROVIDOA
-f- A I It
REMARKS
CHECKED BY
DATE
DATE
BOND
SHORELINE OR ADS# I INS�,FO�,IUN POSTED
10YES ONO S
SIGN AREA HEIGHT
ALLOWED . PROPOSED I ALLOWED I PROPOSED
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REQUIRED SETBACKS (Fr.) PROPOSED SE' IAOK, (FT1 I
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BY DATE
A PrA �Pl A R ItWED
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OCCUPANT
GROUP
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SPECIAL INSPECTION JAREA LOAD
REQUIRED 0 YE I
REMARKS
PROGRESS INSPECTIONS PER UBC108/IBC109/IRC109 FINAL INSPECTION REWDd 25:
VALUATION
Description FEE Description FEE
FHEAT
Plan Check
State Surcharge
SOURCE GLAZING % LOT SLOPE %
Building Permit City Surcharge
PLAN CHECK NO, VESTED DATE
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
BE DONE ON PRIVATE PROPERTY
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
Engr. Inspection
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PERMIT APPLICATION: 180DAYS
PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STA FITED WITHIN 180 DAYS
Plan Chk. Deposit
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
8APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
DEFEND AND HOLD HARMLESS THE CITY OF
Fire Review
Receipt ft
IN INTEREST, AGREES TO INDEMNIFY,
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ARISING DIRECTIYOR INDIRECTLY
Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NA1URE.
THE ISSUANCE OF THIS PERMIT ISSUANCE 0 F THIS PERMI1 SHALL NOT BE
Landscape Insp.
Total Amt. Due
a
i
FROM
DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
WAY THE CITY'S ABILI1Y TO ENFORCE ANY ORDINANCE PROVISION."
Receipt #
0
NOR LIMIT IN ANY
Recording Fee
ACKNOWLEDGE THAT I HAVE READTHIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
I HEREBY
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
CITY AND S1 ATE LAWS REGULATING CONSTRUC-
CALL
-this application is not a permit until signed by the
Building Olticial or his/tier Deputy: and Fees are paid, and
WITI I
THE OWNER. I AGREE TO COMPLY L BE EMPLOYED
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WIL
RELATING TO
FOR INSPECTION
receipt is acknowledged in space provided.
IN VIOLATION OF THE LA13OR CODE OF TIIE STATE OF WASHINGTON
AND RCW 18.27.
I
OFFICIAi S SIGN TURE D TE/
WORKMEN'S COMPENSATIO RANCE
DATE SIGNED
(425)
'7z 7,
WNER OR� ENT)
771 -0220
D BY DATt
"T I I rA-11
ATTENTION
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. uBC109/IBC110/iRC110. -YOU ARE MAKING 4 COPIES
09/03 PRESS HARD
ORIGINAL - FILE YELLOW - INSPECTOR
PINK OWNER GOLD � ASSESSOR
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FINAL PROJECT AFPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
I'MUSE SIGN
ENGINEERING DIVISION DATE
PLEASESIGN
PLANNING DIVISION DATE
PLEASESIGN
PROJECT 6, C)
SITE ADDRESS 16n)
PERMIT #9dA/)-4 ADB# DATE INSPECTED n
DESCRIPTION OF WORK TO BE INSPECTED 03 PC)/"g "L S�3w
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 liVe )
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRE CTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbrms: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:
Gas Test ....................
.................
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 17,
OCCUPANCY .................. vi
V0010"
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