20040622.pdfPERMIT EXPIRES
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DATE RECEIVED
USE
PERMIT
CITY
OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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OWNER NAME/NAME OF BUSINESS
PLAT NAMEISUBDIVISION NO
LOT NO. LID NO
LID FEE $
TESCP ApPrOV611
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MAILING ADDRESS
jW par it Required
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP HW Pat
Use Permit Roci'd
Street
EXISTING PROPOSED— inspertion Required
�Ildawaljk Requited
CITY ZIP
.TTELtEPHONE
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NAME
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REMARKS
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NUMBER
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HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHEbil NO',,�,//. 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 (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: ISO DAYS
PERMIT LIMITI 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 THE CITY OF
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
NOR LIMIT IN ANY WAY THE CITYS ABIL11Y TO ENFORCE ANY ORDINANCE PROVISION. -
VARIANCE OR CU
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—
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REMARKS
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SPECIAL INSPECTION JAREA OCCUPANT
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 2i
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VALUATION
$
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVEnEAD THIS APPLICATION; THAT THE INFORMATION
I I E INFO RMAT'ON
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHOR I IZED AGENT OF
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T TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
, RELATING TO
IN VIOLATION OF THE LABOR CODE OF THE STNTE OF WASHINGTON
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WORKMEN'S COMPENSATION INSURANCE AND RCW I B 27.
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Description
State Surcharge
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CALL
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771.n920
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
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APPLICATION APPR VAL
I his 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.
:F�cl AT
'? if" DATE
A / I t-t IA . /.
ATT ENTION EXT 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
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE 3(
ASESIGN z
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PLANNING DIVISION DATE
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PROJECT Z 9
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PERMIT # �Zcq4-0&2-2- ADB#_DATEfNSPECTED
DESCRIPTION OF WORK TO BE INSPECTED F- t- "� JQ
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 ownerkontractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
El Copy of CORRECTION NOTICE given to owner/contractor by inpector
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2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tenip:b1dg:Forms:ocaprv1 3/25/04
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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 .......
SHEET I ROCK NAILING ... ry)7— 2_ 41 — 0:5
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR C>
OCCUPANCY ..................
Tile Initials MT are Milton
Thompson, a temporary contract
inspector roi- tile City.
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