20040635.pdfFDA7TE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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CITY
NAME
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STATE LICENSE NUMBER EXPIRATION DATE PHEdC�ED)4
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jx PROPERTY TAX ACCOUNT PARCEL NCT
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NEW Y��RRESIDENTIAL
ADDITION COMMERCIAL
REMODEL MULTIFAMILY
GRADING
REPAIR CYDS
D DEMOLISH TANK
GARAGE RETAINING WALL
CARPORT ROCKERY
(TYPE OF USE. BUSVqSS OR ACTIVITY) EXPLAIN:
Nu NUMBER OF
OF;��
DWELLING
ST 2 :
0 UNITS
DESCRI13E WORK TO BE DONE
HEAT SOURCE
PLAN CHECK NO:
411
GLAZING %
p6W
PLUMBING MECH
COMPLIANCE OR
El CHANGE OF USE
SIGN
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FENCE
( X FT)
0
THEIR
ElFIRE SPRINKLER
FIRE ALARM
ICRITICAL
AREAS
NUMBER
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. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANI. 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 I [its PERMIT. ISSUANCE OF I HIS PERMIT SHALL NOT 13E
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMEN1 OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,"
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM TliE OWNER, OR THE DULY AUTHORIZED AGENT OF
TIiE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGUIATING CONSTRUC
TION AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN V6LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
wnnKJAFhX'; COMPENSATION INSURANCE AND RCW 18.27.
DATE SIGNED
PLAT NAMEISUBDIVISION NO
PERMIT EXPIRES
PERMIT
NUMBER
41 SUITEIAPT#
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LID NO,
T NO,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING � PROPOSED
REQUIRED DEDICATION- IFT
METER 31ZE LINE SIZE NO, OF FIXTURES
LID FEE $
777;;�
LSCP APPMV
0
E3
11W pe,mll Required
[3
street Use Porrelt nerl'if
inspection Flecl,prod
CI
S.d,,,iIk RnqUI(Od
underground
C3
wiring (0111tGO
pRV REQUIRED
YES NO
REMARKS
OWNER/CONTRACIOR RESPONSIBLE FOR EROSION CONTROL/ORAINAGE
N
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
EXEMPT
COMPLETE
EXP
LOT COVERAGE
ALLOWED PROPOSED
DATE
DATE
SHORELINE OR ADB# INSPECTION, BOND
REQ'D POSTED
0
OYES ONO $
HEIGHT
LOYT LLO PROPOSED
SIGN AREA $ HEIGHT
ALLOWED PROPOSED ALLOWED PROPOSED
0
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REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING LOT AREA PLANNING REVIEWED BY D
REO'D I PROVIDED
AT
REMARKS
CHECKED BY E ONST CTION jCODf OCCUPANT
ON ION E OCCUPANT
HE KED BY CDC) GROUP
OCC U PANT
C ie ST CT LOAD
SPECIAL INSPECTION AREA OCCUPANT
LOAD
REQUIRED [] YES
I REMARKS L INSPECTION RE z
FPROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REG-D
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp
"u
Recording Fee
FEE Description FEE
State Surcharge
City Surcharge
Base Fee A'If`T
CALL
FOR INSPECTION
(425)
Plan Chk. Deposit
Receipt N
Total Amt. Due
#
Receipt #
APPLICATION APPROVAL
I his application is not a perinit until signed by the
Building official or his/her Deputy: and Foes are paid, and
wceipt is acknowledged in space provided.
FIFIOWS SIGNAiTUijF DATE
771-0220
ATTENTION 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
DA
OFAIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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C E D FINAL PROJECT APPROVAL FORM
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TO:
AUG 3 2004
DEVELOPMENT SERVICES CTR
CITY OF EDMONDS DATE:.
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE 83 </
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SIGN I
ENGINEERING DIVISION DATE 0
PLEASE SIGN 0
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PLXASE SIGN PLANNING DIVISION DATE Zi =-n
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PROJECT OM
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SITE ADDRESS ag, 0 C:
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PERMIT # ADB# DATE INSPECTED M Z
DESCRIPTION OF WORK TO BE INSPECTED ei2JLt"k
-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
PERF ORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
1 .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
I .
2.
93
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbnns:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pier/Porch .................
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0
Retaining Wall ...........
0
Stab Insulation .......... 171
PLUMBING: -1 -n
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Underground .............
x
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Rough -in ................... M 0
0
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Commercial Final ...... 0 C
M
HEATING: M z
GasTest ....................
Gas Piping .................
Equipment ................. o -n
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Commercial Final ....... -4
M M
EXTERIOR SHEATHING
0 U5
NAILING .......................... 0
0 M
FRAMING........................
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FIRST FLOOR FRAMING... Z
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INSULATION ...................
Floor Insulation .........
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Wall Insulation ........... _q
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Ceiling Insulation ....... Cn
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SHEETROCK NAILING ... 0
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SPECIAL INSPECTION ... 0
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MISCELLANEOUS ..........
FINAL APPROVAL FOW
..................
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