20040652.pdfI
DATE RECEIVED ///
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY
NAME
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ZIP TELEPHONE
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ZIP TELEPHONE
I I PERMIT EXPIRES i-�
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USE - PERMIT
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JOB SUITE/APT#
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PLAT NAME/SUBDIVISION NO. LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 0
RW Permit Required 13
Street Use Permit Roq'd 13
EXISTING — PROPOSED
Inspection Required E3
Sidewalk Required E3
REQUIRED DEDICATION- FT
Underground
Winng required
METER SIZE
LINE SIZE
NO. OF FIXTU13ES
PRV REQUIRED
YES 11 NO 13
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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-NGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE
VARIANCE OR CU HORELINE OF INSPECTION BOND
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STATE LICENSE NUMBER EXPIRATION DATE ll,,CHECKED By REO&, 0 IS POSTED
14d,,411 OYES AN
bASEPA REVIEW SIGNIAREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE , E EMIT ALL PROPOSED ALLOWED , PROPOSED
100 lft�
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT)
NEW RESIDENTIAL PLUMBING/ MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
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COMPLIANCE OR ---------- F
ADDITION COMMERCIAL CHANGE OF USE z
X PARKING LOT AREA P"ING R WED Y e ATE 911.
REMODEL MULTIFAMILY IGN REO'D PROVIDED
13 GRADING AEFENCE ___+_ I 6"'L
E] REPAIR CYDS ( X FT) REMARKS
OTHER
DEMOLISH TANK
EiGARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
GYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: CHECKED BY TYPE Of�ZPNEjTRUCTION CODE OCCUPANT
,�AzeiV 4!5��X_ GROUP
NUMBER OF RITICAL
OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
NUMBER LOAD
NUMBER UNITS C [] YES
STORIES REQUIRED
DESCRIBE WORK TO BE DONE
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REO'D 9
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VALUATION
FEE Description FEE
V Description —
Plan Check State Surcharge
HEAT SOURCE T GLAZING % LOT SLOPE % City Surcharge
Building Permit lx2L) ;2
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical AbInliv 4�2
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO -
It BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
i DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
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PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
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 Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.0
x Recording Fee Receipt # '42
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND T14AT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
ING CONSTRUC- This application is not a permit until signed by tire
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULAT CALL Building Official or his/her 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.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. 1 " . FFF I-S SIGNAYURE 77DFE
RE( W DATE NED �� L /I
0 'NrER7,Aa (425) (0 d (t) �1 �Ll ')
7f DATY
71 771-0220 E EQ BY,
ATTENTIOW EXT 1333 1'/
ITIS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL g
INSPECTION HASBEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW ./INSR -CTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK -OWNER rnIr)-ASSPSeS(OR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
DIVISION DATE
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-ENGR--TEERING
PLEA9ESIGN
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PLANNING DIVISION DATE
PLEASE SIGN
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SITE ADDRESS- ti—)
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PERMIT# ZAN-VI-0 �2- 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
PERFORMANCE BONDS and the granting of:
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V GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El 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:fon-ns:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
GasTest ....................
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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