20040629 (2).pdfDATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
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STATE LICENSE NUMBEA EXPIRATION DATE 91ECKED 13Y
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qx PHUPERTY TAX ACCOUNT PARCEL NO.
NEW
M RESIDENTIAL
ADDITION
>e-C,,OMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
G CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS UR AGTIVITY]l EXPLAIN:
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NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNI
DESCRIBE WORK TO BE DONE
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71
HEAT SOURCE
PLAN CH
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COMPLIANCE OR
CHANGE OF USE
SIGN
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FENCE
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OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
PERMIT EXPIRES
L& PERMIT
ZONE
NUMBER
JOB SUITE/APT'#
ADDRES,��
PLAT NAME/SUBDIVISION NO,
LOT NO
LID NO
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
I ESCP Approved
RW Permit Required
Street Use Permit 1`10it'd
EXIST ING __� PROPOSED
inspection Required
it
Sidewalk HaquaLl 3
REQUIRED DEDICATION FT
Undfirgrotind
Winno required C3
METER SIZE
LINE SIZ7.
OF FIXTURES
PRV REQUIRED
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YES 13 NO C3
REMARKS
OWNEFIXONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
I . 4 - -1— - ..AA �
EI�GINEERING REVIEWED 6Y
FIRE REVIEWED 13Y
DATE
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VARIANCE OR C U
SHORELINE OR ADB#
INSPEC ION
BOND
Rl
POSTED
OYES gNo
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE , EXEMPTTALLOWED
LL , PROPOSED
I ALLOWED .
PROPOSED
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EXPX4jC.,L
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LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
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PARKINP-'
LOT AREA
I PLANNING REVIEWED 13Y DATE
REO'D._ PA VIDED
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FT) I REM4RKS
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CHECKED BY
SPECIAL INSPECTION JAREA
REQUIRED [
REMARKS
INSPECTIONS PER UBC I 08/FINAL INSPECTI12� REO
DN_ �a'D
L� Pill, VALUATION
I $
GLAZING % I LOT SLOPE %
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
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
W PERMIT APPLICATION: 180 DAYS
IL PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 1BO DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
W
UJI IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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M EDMONDS, WASHINGTON, I I'S OFFICIA[S, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIREC rLY
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
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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SiRUCTION COIIE OCCUPANT
GROUP
OCCUPANT
LOAD
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Description
FEE
Description
FEE
Plan Check
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State Surcharge
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspecti0,.)t,,
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due 116/T
Recording Fee
Receipt #
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 APPLICATION APPROVA__L7
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. This application is not a perflut 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 V61LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION It4
RANCE AND RCW 18.27.
0 -NAT, It DATE
SIGN�TYRE (OWNER OR GENT) DATE SIG
NED (425)
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ATTENTION
EXT -1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING
OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS
BEEN MADE AND APPROVAL
Oil A CERTIFI-
CATE OF OCCUPANCY HAS
BEEN GRANTED. UBC
SECTION 109
09iO3
PRESS
HARD -YOU ARE
MAKING 4 COPIES
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ORIGINAL - FILE YELLOW - INSPECTO
PINK - OWNER GOLD - ASSESSOIJ
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASES GN
ENGINEERING DIVISION DATE
PLANNING DIVISION DATE
PLEAS11 SIGN
PROJEC
,All
SITE ADDRESS qq
PERMIT ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
-approved plans. Final approval
A field inspection was conducted to determine compliance with
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of
GRANT FINAL PROKCT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
1.
04
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RE-fNSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date SignatUre
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FINAL - ROJECT APPROVAL FOI-,-,,l
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
nXASE SM
LaIUz 11'�71,462&4 ENGINEERING DIVISION DATE
n"SF SIGN
PLANNING DIVISION DATE
nEA.SF SIGN
PROJECT, Al
SITE ADDRESS Z 4-5 2-6- X11 i� 20 W -93
PERMIT (OA 2 -9 —ADB# 'DATE INSPECTED_!V-q/(01i
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine final 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
o Copy of CONDITIONS given to owner/contractor by inspector
I .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
o Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date— Sign_
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
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0
Retaining Wall ........... --I
0
Slab Insulation ..........
PLUMBING: =i
Underground ............. CD 3:
M
C
Rough -in ................... 0
M 0
Commercial Final ....... 0 C
3: M
HEATING:
M Z
ID --I
Gas Test .................... C _Z
Gas Piping .................
65
Equipment ................. 0 -n
-n
Commercial Final .......
M M
EXTERIOR SHEATHING 0 —
Cn
NAILING .......................... 0 r-
0 M
C: Cn
FRAMING ........................ Cn
FIRST FLOOR FRAMING ... M 0
Z
INSULATION ................... ;0
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Floor Insulation ......... :E
Wall Insulation ........... z
Ceiling Insulation ....... C/)
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SHEETROCK NAILING ... 0
4
SPECIAL INSPECTION ... 0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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