20040643.pdfI
DATE RECEIVED
PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONIE j-
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CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
OWNER NAME/NAME OF BUSINESS Av
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'�C6,7"r 14�3TA PLAT NAME/SUBDIVISION NO, LOT NO. LID NO.
MAILING ADDRESS I
I LID FEE S
PUBLIC RIG1iT OF WAY PER OFFICIAL STREET MAP I ESCP Approved
--:5:12 6
0 MAj&/ S) RW Permit Required 0
CITY Street U50 Permit Roq'd C3
ZIP TELEPHONE EXISTING - PROPOSED Inspection Required 0
1
sidewalk Required
REQUIRED DEDICATION� FT Underground
Dolo L-��- I Wiring required E3
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I I YES13 NO 0
ADDRE3S REMARKS
3C
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP ITELEPHONE
NAME
cc ADDRESS
0
CITY zip TELEPHONE
0
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STATE LICENSE NUMBER EXPIRATION DATE
PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
RESIDENTIAL
ADDITION
21SMMERCIAL
AEMODEL
MULTIFAMILY
REPAIR
GRADING CYDs
DEMOLISH
TANK
GARAGE
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COMPLIANCE OR
CHANGE OF USE
SIGN
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FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
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PLAN CHECK Nor, VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
It 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
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
MU) '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 INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS 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 AGENr OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE qF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COW-E�QJ`VINSURANVE AND RCW 18.27.
lllt--75IGN�TURE ER OR VN DATE SIGNED
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DATE
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VARIANCE OR CU SHORELINE Oil ADBI I INSPECTION BOND
1 1; — REO'D POSTED
146"' ) ') YES ONO IS �
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
EXP X �s 4(.-;. Q-S
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY
REO'D I PROVIDED
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CHECKED BY ITYPE
SPECIAL INSPECTION JAREA
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OCCUPANT
GROUP
OCCUPANT
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REMARKS a
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REQ'D
VALUATION
Description
Plan Check
Building Permit_
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE Description
State Surcharge
City Surcharge
Base Fee
I*
14,
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/tier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
FFICIALS SIGNATURE DAT E
ATTENTION E)ff 1333
IT IS UNLAWFULTO USE OR OCCUPYA BUI LDI NG OR STRUCTURE UNTILA FINAL 14
INSPECTION HAS BEEN MADE AND APPROVAL ORA 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 - ASSESSOH
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE- DEPARTMENT DATE
PLEMESIGN
ENGINEERING DIVISION DATE
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PLANNING DIVISION D ATE ozo-s
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DESCREPTION OF WORK TO BE INSPECTED
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A field inspection was conducted to determine compliance with -approved plans. Final approval
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denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the grant ing of:
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 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 inpectoi
2.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signative
1: tenip: b Idg: forms: ocap M 3/25/04
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
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Retaining Wall ........... .0
Slab Insulation ..........
0
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PLUMBING:
Underground .............
Rough -In ................... M
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0
Commercial Final ...... __40
0
HEATING: --I
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GasTest ....................
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Gas Piping ................. >
Equipment.................
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Commercial Final ....... v
EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ........................ 0 M
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FIRST FLOOR FRAMING ... C/)
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INSULATION ...................
Floor Insulation .........
Wall Insulation ........... >
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Ceiling Insulation .......
SHEETROCK NAILING ...
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SPECIAL INSPECTION ... —i
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................