20040626.pdfI
DATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
CITY zip TELEPHONE
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NAME
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ADDRESS
91TY
ZIP
TELEPHONE
NAME CBL #
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ADDRESS
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
PROPERTY
NEW
RESIDENTIAL
PLUMBING/MECH
ADDITION
COMMERCIAL
COMPLIANCE-C*
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
( X Fr)
DEMOLISH
TANK
OTHER
GARAGE
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RETAINING WALL
FIRE SPRINKLER
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CARPORT
ROCKERY
FIRE ALARM
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER
NUMBER OF
CRITICAL
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OF
DWELLING
AREAS
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STORIES
UNITS
NUMBER
DESrRIR a BE DO�E'�
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HEAT SOURCE I GLAZING %
LOT SLOPE %
PLAN CHECK No6q, 3q-6 VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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.
W PERMIT APPLICATION: 160DAYS
IL 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 THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECILY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT 13E
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CIT'rS 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 CONSTRLIC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LAL3011 CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
SIGNATURE (/70%n'q� AGEN DATE SIGNED
0or
USE
ZONE/,),
JOB
ADDRESS
PLAT NAME/SUBDIVISION NO.
PERMIT EXPIRES
PERMIT
NUMBER
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- FT
METER SIZE LINE SIZE NO. OF FIXTURES
-oozb
SUITE/APT#
LID NO.
LID FEE $
TESCP Approved
AW Permit Required
Street Use Permit Fteri'd
E3
Inspection Required
13
Sidewalk Required
Underground
Wifing required
E3
PRV REQUIRED
YES 13 NO 0
REMARKS
OWN ER/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING
FIRE REVIEWED BY
DATE
DATE
0
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VARIANCE OR CU
HOREIINE OR ADBI
INSPECTION I BOND
REO'D POSTED
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OYES Is
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP ,
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LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT QRSIDE REAR
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PARKING
LOT AREA
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PLANNING REVIEWED BY DATE
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REO'D I PROVIDED
REMARKS
CHECKED BY ITY ONSTRUCTION OCCUPANT
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SPECIAL INSPE REA OCCUPANT
LOAD
REQUIRED [:] YES
REMARKS
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REO'D
VALUATION
$ '� /)) -- .--7- —
Description
Plan Check
Building Permit_
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
FEE Description FEE
,46 State Surcharge Z� 7171
City Surcharge
Base Fee
CALL
FOR INSPECTION
(425)
771-0220
MENTION E)ff 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU- 14
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRCI10.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
Plan Chk. Deposit
Receipt #
Total Amt. Due
,Receipt#______
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
DATE
by /ATE
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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FINAL PROJECT APPR
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: YIRE DEPARI
PLEASE SIGN
PLANNING
PLEASE SIGN
PROJEC
SITE ADDRESS_,J!L____!�-�-�!�
PERMIT ADB#__________PATE
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine compliance
denotes that there are no objections from the above i
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inE
1 .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/i
1 .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL
Date Signature
1:temp:b1dg:fonns:ocaprv1 3/25/04
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TO:
DATE:
DATE —O't -
DIVISION DATE
'ISION DATE
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approved plans. Final approval
Department to the release of
ROVAL
by inpector
APPROVAL
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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
OCCUPANCY ..................
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