20040648.pdfu
CITY OF EDMONDS Z
CONSTRUCTION PERMIT APPLICATION i
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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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ADDRESS
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CITY ZIP
TELEPHONE
NAME
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TELEPHONE
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STjfCLICENSE NUMBER EXPIRATION DATE
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PROPERTY. -TAX ACCO NT PARCE L NO,
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NEW RESIDENTIAL PLUMBING/ MECH
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
REMODEL MULTIFAMILY SIGN
REPAIR GRADING CYDS ��F ENCE x FT)
OTHER
DEMOLISH TANK 1:1
GARAGE RETAININGWALL FIRE SPRINKLER
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CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINg_4* OR ACTIVITY) EXPLAIN:
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NUMBER
NUMBER OF
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CRITICAL
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DWI ELLING
AREAS
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STORIP
UNITS
NUMBO
DESCRIBE WORK TO BE DONE
HEAT SOURCE
GLAZING %
LOT SLOPE %
NO: .
VESTED DATE
FE�HECK
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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PERMIT APPLICATION: 180DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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'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 DIREC rLy OR INDIREC fIY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 1111S PERMIT SHALI NO] 13E
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMEN I OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
201
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
THEOWNER. 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 OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
SIGNATURE O"ER bnAGENT)
DATE SIG ED
DATE RECEIVED
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ONE
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DDRESS
PLAT NAME/SUBDIVISION NO.
PERMIT EXPIRES
PERMIT
NUMBER
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
REQUIRED DEDICATION— FT
M TER SIZ SIZE FIXTU
E E LINE I NO.OF RES
SUITE/APT#
LID NO.
LID FEE $
TESCP Approved
RW Permit Required
Street Use Permit Hoq'd
Inspection Required
Sidewalk Required
Underground
PRV REQUIRED
YES 0 NO 0
1EMARKS
)WN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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4�5- -7 16 XZ,
REVIEWED BY DATE
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ED BY DAf E
VARIANCE OR CU SHORELINE OR ADBI I INSPECTION BOND
0YE!EO'D POSTED
S ONO S
SEPA REVIEW SIGN AREA HEIGHT
3 OMPLETE . EXEMPT ALLOWED . PROPOSED "I'VED PROPOSED
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LOT COVERAGE I REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FF.)
kLLOWED PROPOSED I FRONT SIDE REAR I FRONT UR SIDE REAR
PARKING LOT AREA I PLANNING REVIEWED BY DATE
�EQ'D I PROVIDED I
3EMARKS
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,HECKED BY ITYPE OF CONSTRUCTION OCCUPANT
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SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES LOAD
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IROGRESS INSPECTIONS PER LIBC 108/ IBC109/ IRC109 FINAL INSPECTION REO'D
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VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
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City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection I I
Fire Review I I Plan Chk. Deposit
Fire Inspection Receipt #
Landscapelnsp. Total Amt. Due
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
Receipt # 19z
APPLICATION APPROVAL
I his application is not a permil until signed by the
Building Official or his/her Deputy; and Fees are paid, and
receipt is acknowledged in space provided.
:1511CIALS SIGNATURE QATE ,
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--WrttNTION ,,
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL -FILE YELLCN9
PINK -OWNER GOLD-
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J,-iPPROVED AS NOTEV
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CITY COPY
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60 JUL 2 2 2004
PERMIT COUNTER
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FINAL PROJECTAPPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT cooRDrNATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
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PLEAS[fS(bN
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PLANNING DIVISION DATE
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PLIIASUSIGN
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SITE ADDRESS
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PERMIT # ADB# DATE INSPECTED
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DESCRIPTION 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
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PERFORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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1:1 Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
El Copy of CORRECTION NOTICE given to owner/contractor by inpector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fomis:ocaprv1 3/25/04
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
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Retaining Wall ...........
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Slab Insulation ..........
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PLUMBING:
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Underground .............
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Rough -In ...................
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Commercial Final ......
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HEATING:
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Gas Test ....................
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Gas Piping .................
Equipment .................
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Commercial Final .......
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EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ........................
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FIRST FLOOR FRAMING ...
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INSULATION ...................
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Floor Insulation .........
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Wall Insulation ...........
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Ceiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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