20040631.pdfI
DATE RECEIVED ?
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
7
CITY ZIP I TELEPHONE
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NAME
ADDRESS
CITY ZIP TELEPHONE
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Cc Al' 1370
ADDRESS
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CITY ZIP TELEPHONE 9_76 7�
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STATE LICENSE NUMBER EXPIRATION DAIE CMEQKED
T / IqlV
au A Z:,A� )(- 6114)1, �'/j I WA
PROPERTY TAX ACCOUNT PARCEL NO
NEW
x
RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING CYDS
FENCE
t X FT)
DEMOLISH
TANK
OTH&
GARAGE
RETAINING WALL
FIRE SPRINKLER
ALARM
CARPORT
ROCKERY
FIRE
(TYPE OF USE, BUSINE§S-�DFI ACTIVITY) EXPLAIN
U
ch
ull NUMBER NUMBER OF CRITICAL
a OF DWELLING AREAS
M I
0 STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
.1p"9
Ahc I-10a X-C.
HEAT SOURCE
PLAN CHECK NO:
GLAZING %
LOT SLOPE %
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
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
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
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
CROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
PERMIT EXPIRES
USE PERMIT
ZONE
NUMBER
JOB SUITE/API #
ADDRESS 7 A ItVe
PLAT NAME/SUBDIVISION NO. LOT NO, LID NO.
LID FEE $
IESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Rectijiled
Street Use permit Roq'd
VATEr E RV W. a I " T IN
fi
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OtANAEW/29ANPOR IV5PONW0FFD EFIESO&ONBLErNTaICAL
, R-FLPLACEMENT
INSPECTION IS REQUIRED EF ELFC3R=
(RftCFU4MNG IS ALTERED RMOVED
L
I FtEU�EiWQF LABOR& 1NDUSTRLESELEMwCAL_Hu
DIVIMON AT425-290-1309
I I [1YES EINO IS
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
EXP I -
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LjRSIDE REAR
PARKING LOT A�E PLANNING REVIEWED BY DATE
4:
RE D PROV, iED
Q' c PURSU�NT TO UPC 605.2
J�tAijr4'g dififtuif —
[REM:ARKS . G 13 - S I HAUFT e6r i L I L
SHALL BE INSTALLED ON THE
LINE AS IT 13RMS THE BUILDING
CHECKED BY ITMY '�7
Or THIJU UN V��UrAlvr
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
I REQUIRED F] YES I LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REQ'D
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
-7 / -'
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
LandscapeInsp.
Total Amt. Due
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT., AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
E LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STAT CALL Building Official or his/tier Deputy: and Fees. are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
KF
WORKMEN'S COMPENSATION INSURANCE AND RCW 18,27. 911C ALS sirNA URE DATE
DATE SIGNPD
SIGNATU;U rEINP (425)
ff771-0220 RFLEA-SED BY DATE
A17ENTION r EXT 'laN
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
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE.
PLEASE SIGN
'EMEM232el/t ENGINEERING DIVISION DATE
PdASESIGtr_'
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT Pi4p d'�M
I yv2a
SITE ADDRESS- 11%Y t1c)
PERMIT ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED WSL
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:
XGRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
I .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
1 .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS . ......................
FOUNDATION:
Footing .................
Wall..........................
Pier/Porch .................
R "'ing
etain .........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
E A
v
_MT S
T�. .1 N. - T: ........... .
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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