20040602.pdfUJI
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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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CITY ZIP TELEPHONE
NAME
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ADDRESS
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PLAT NAME/SUBDIVISION NO
PERMIT EXPIRES 1 19/ L
PERMIT
NUMBER, &04-0U)2,
SUITE/APT�.,
LOT NO. LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 13
RW Permit Required E3
Street Use Permit Heq*d 13
EXISTING .1�
PROPOSED
inspection Required
Sidewalk Required 13
REQUIRED DEDICATION FT
Underground
Winng required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO 11
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONIROL/DRAINAGE
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STATE LICENSE NUMBER
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PROPERTY TAX ACCOUNT PARCEL NO.
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REQUIRED [:] YES
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
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HEAT SOURCE GLAZING % LOT SLOPE,%
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PPLAN CHECK..NO: 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
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
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SEPARATE PERMISSION.
UJI PERMIT APPLICATION: 180DAYS
a. 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
N INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMi ESS THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
< ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE C"S ABILITY TO ENFORCE ANY ORDINANCE PROVISION
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 VI'6LATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 10.27.
VALUATION
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Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr, Review
Engr. Inspection
FEE Description
State Surcharge
City Surcharge
FEE
Fire Review Plan Chk. Deposit
Fire Inspection Receipt # 7
Ato Y_
2 � �. � I
Landscapeinsp. Total Amt. Due
Recording Fee Receipt #
1 1 -, 7
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building Official or hisiher Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
OFFI A IGNAT I F DATE
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771-0220 R61 FfSE?�PY E
ATTENTION EXT 1333 jo�j
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 6/ 1_1(L IIZ611
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ORIGINAL FILE YELLOW - INSPECTOR
PINK OWNER GOLD -ASSESSOR
041;02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING
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FINAL PROJECT AP1PRnVAL FORM.
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DATE
'FROM:
PLEASESIGN
ENGINE ERING DIVISION DATE
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LEASE SI NY
-PLANNING DIVISION DATE
PIXASE SIGN
PROJECT
SITE ADDRESS
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,RMIT # &10 ADB#_.DATEIN
DESCRIPTION OF WORK TO BE INSPECTED
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
F1 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 -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:f6rnis:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
N)S
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
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OCCUPANCY ..................
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