20040640.pdf9
I DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
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ZIP
NAME
ADDRESS
CITY Z I
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STATE LICENSE NUMBER
PROPERTY TAX ACCOUNT PARCEL NO
TELEPHONE
TELEPHONE
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RESIDENTIAL
E] ADDITION
COMMERCIAL
E] REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
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ROCKERY
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CrYPE OF USE, BUZSIN!
OR A1TIVfTY),,EXPLA,1N:
NUMBER
NUMBER OF
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OF
DWELLING
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STORIES
UNITS
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DESCRI13E WORK TO 13E DONE
CBL #
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USE
ZONE
JOB
ADDRESS
PLAT NAMEISUBDIVISION NO.
PERMIT EXPIRES
PERMIT
N U M B E R
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
r REQUIRED DEDICATION- IFT
/] METER SIZE I LINE SIZE I NO. OF FIXTURES
DATE I CHECKED BY
PLUMBING I MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
SUITE/APT#
LID NO.
LID FEE S
TESCP Approved
RW Permit Required
Street Use Permit Roq'd
Inspection Required
Sidewalk Required
Underground
Wiring loquaad
PRV REQUIRED
YES 0 NO 0
REMARKS
OWNER/CONTRAC1OR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVI
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DATE
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IS REQUIRED
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GROUP
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CRITICAL
AREAS
NUMBER &2te_�
SPECIAL INSPECTION
REQUIRED [] YES
[PRROGRESS
JAREA
OCCUPANT
LOAD
REMARKS
INSPECTIONS PER UBC 110810131109/11`1101109 FINAL INSPECTION REO'D
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HEAT SOURCE
PLAN CHECK NO:
GLAZING % I 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: 180DAYS
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, Nk�SHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIREC1 LY
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 CITYS ABILITY 10 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
A WATER SERVICE SHTJTOFF
VALUATION SHALL BE INSTALLED ON TH
$ IhfNE AS FF EN4ERIS THS BYWI-P!
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit_
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
APPLICATION APPROVAL
111L UWNLIA. I Aunciz lu COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This applicalionjs not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL 13E EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION �eccipt is acknowledged in space provided.
WORKMEN'S CO
,,�PENSATION�II,ISURANCE AND RCW 18.27,
OF�l S flp�ATYRE DATE
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SIGNjRE)6WNtR'P� A NT) DATE G
/�NEE (425)
771-0220 RF qr:n V nA F
AT/fth"TION E)ff
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE ANDAPPROVALOR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO:
PERMIT COORDINATOR, BUILDING DIVISION
FROM:
-FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
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PLEASESIGN
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-PLANNING DIVISION DATE
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PLEASE SIGN
PROJECT
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PERMIT #
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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 owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
1 .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall ..........................
Pier/Porch .................
Retaining Wall ........... z
SIO Insulation ........... 0
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PLUMBING: -
Aderground .............
,'Rougk-ln ................... 0 M
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MO
0
Commercial Final
0 C
HEATING:
M
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Gas Test ............ . .......
C
.-Gas-Piping >
Equipment .................
0 -n
Commercial Final ....... -n
EXTERIOR SHEATHING M
NAILING .......................... M M
0 C0
0 r,
FRAMING ........................ 0 171
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F. U)
-FIRST FLOOR FNAMING ...
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INSULATION
Floor Insulation ;U
Wall Insulation ........... >
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Ceiling Insulation ....... --I
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SHEETROCK NAILING ... z
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SPECIAL INSPECTION --I
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MISCELLANEOUS ..........
FINAL APPROVAL **W
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