20040567.pdfDATE RECEIVED
NUMMMMMMMMMMMM�
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OuWVVNER NA E/NAME OF BUSINESS
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STATE LICENSE NUMBER
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TAX ACCOUNT PARCEL NO.
_L�ERMITEXPIRES
USE
ZONE PERMIT
NUMBER
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SUITE/APT#
ADDRESS.','2
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PLAT NAME/SUBDIVISION NO, LOT NO. LID NO.
I LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved 13
13W Pernill Required 0
Street Use Permit Roq'd 0
EXISTING __4&___P_RLp4hqf; inspection Required 0
Sidewalk Required E3
RE-OUIRED 1601CSIM ergiound
I t F I 77T-b 1� ?Tf �pj 0
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
0 1 MUST BE CAPOMiltr NO 13
f in
EXPIRATION DATE CHECKED BY
1:1 NEW
RESIDENTIAL
1:1
PLUMBING / MECH
0 ADDITION
COMMERCIAL
1:1
COMPLIANCE OR
CHANGE OF USE
E] REMODEL
MULTIFAMILY
1:1
SIGN
REPAIR
GRACING
CYDS
0
FENCE
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M V DEMOLISH
TANK
OTHER
GARAGE
CARPORT
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RETAINING WALL
ROCKERY
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FIRE SPRINKLER
FIRE ALARM
E . PES 0
(TYPE 2f US , qLt6 S R APTIVITY) EXPLAIN:
A
NUMBER
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NUMBER OF
DWE
'LLING
CRITICAL
AREAS -2/_
STORIES
UNITS
NUM13ER
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DESCRIBE WORK TO 13E DONE
HEAT SOURCE
PLAN CHECK NO:
GLAZING %
LOT SLOPE %
VESTED DATE
REMARKS
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HOSE BIB WITH AV9 I-N'sTALLED
DUMP AT APPROVBD IDMp SrM am
SEP, DEMOLITION INSPECMON
ENGINEERINIWEV%WMfa1&LIS_1 ON BACK OF JOB)AUAiFD
FOR INSPECTION REQUIREMENTS
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FIRE REVIEWED BY DATE Lu
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VARIANCE OR CU SHORELINE OR ADBI I INSPECTION BOND
REO'D POSTED
13YES ONO S
SERA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (IT) PROPOSED SET13ACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIFISIDE REAR
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PARKING LOT AREA PLANNING REVIEWED BY DATE
REO'D I PROVIDED I I f.— - IL
REMARKS
CHECKED BY [TYPE
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GROUP
SPECIAL INSPECTION
_J�LOAD
OCCUPAIW
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REQUIREDE]
JARE4
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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VALUATION
Description FEE
Plan Check
Building Permit
Plumbing
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO MuClidillUal
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU13LIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Grading
SEPARATE PERMISSION.
cc Engr. Review
Lu PERMIT APPLICATION: IBODAYS
CL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
U) 4APPLICANT ON BCLIA 1 0 �
Description FEE
State Surcharge
City Surcharge L5
Base Fee
(11 F 1-110 Un Hun SPOUSE. HEIRS, ASSIGNS AND SUCCESOMS I -Ire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS rHE CITY OF
EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Ir R I R Fire Inspection Receipt N
ALL CLAIMS FOR DAMAGES OFWHATEVER NATURE, ARISING DIRECTLY 0 Not ECRY
FROM THE ISSUANCE OF THIS PERMIL ISSUANCE OF THIS PERMIT SHALL NOT BE
A
DEEMED TO MODIFI� WAIVE OR REDUCE ANY REQUIREMENr OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABIL11Y 10 ENFORCE ANY ORDINANCE PROVISIO
Recording Fee Receipt #
I . 'Az/ .00-5
1 HEREBY ACKNOWLEDGE THAT I IIAVE READ THIS APPLICATION; THAT THE INFORMATION 21
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 REGULANNG CONSTRUC. This application is riot 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 TiIE STATE OF WASIIINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27
F 1)
SIGNAT RE (OWNER OR AGENT) DATE SIGNE
(425)
771-0220
.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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
0.9/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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BY
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL VORM.
TO:
DATE:
MEMO TO:
PERMIT COORDINATOR, BUILDING DIVISION
FROM:
FIRE DEPARTMENT DATE
PLrASESIGN
ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE
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PLEASE SIGN
PROJECT
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PERMIT #
104-050 ADB# DATE INSPECTED 091( 311,66 4
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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
FAILED FINAL INSPECTION - OUTSTANDING ISSUE, S
1:1 Copy of CORRECTION NOTICE given to owner/contractor by inpector
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:ten1p:b1dg:forms: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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