20040654.pdfF—DAT E
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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MAILING ADDRESS L77
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NAME
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NAME CBL
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TELEPHONE
'TAfE LICENSE NUMBER
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ROPERTY TAX ACCOUNT PARCEL NO.
20 0 4 2- V0 3
NEW
1:1 RESIDENTIAL
ADDITION
�COMMERCML
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
0 DEMOLISH
TANK
GARAGE
CARPORT
RETAININGWALL
ROCKERY
(TYPE OF USE. BUSAESS OR ACTIV" EXPLAIN:
NUMBER NUMBER OF
OF DWELLING
STORIES U1.11
DESCRIBE WORK TO BE DONE
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TI—1 Ow [PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB
SUITE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
TESCP APPrOv6d
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Required
Street Use Peffnh R8q'd
EXISTING - PROPOSED
inspection Required
Sidewalk Requited
13
REQUIRED DEDICATION— FT
Underground
13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO E3
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
3
DATE
FIRE REVIEWED BY DATE LU
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SIGN AREA
ALLOWED , PROPOSED
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HEIGHT
ALLOWED PROPOSED
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.4
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT URSIDE REAR
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PARKING
REQ`D I PROVIDED
LOT AREA
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REMARKS
OTHER
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FIRE SPRINKLER
FIRE ALARM
CHECKED BY TYPE qF PONSTRUCTION CQDE OCCUPA
C -.5 h 5_1V GROUP 2;
CRITICAL OCCUPANT
AREAS SPECIAL INSPECTION JAREA
NUMBER OL LOAD
7/k [REQUIRED 13 YES I
REMARKS I
PROGRESS INSPECTIONS PER USC 106/ 11310109/1RC109 FINALINSPECTION REO'D
Descripten FEE Descriptlon FEE
Plan Cher�. State Surcharge
GLAZING % LOT SLOPE % 1A
HEAT: it 4 — City surcharge
Building Per:.d I
PLM CHECK Nl� 4X/J VESTED DATE Plumbing Base Fee
4
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPEFrrV ONLY. ANY CONSTRUCTION ON THE PUBILIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVIEVAYS. MARQUEES, ETC.) WILL REQUIRE
Engr. Review
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review
Plan Chk. Deposit
Plan
*APPLICAK ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Fire Inspection
lReceipt
#
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 THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED I o MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt. Due
T t
Recording Fee-
Receipt #
NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This applicaflon Is not a permit until signed by the
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.
O?IFFIALS S,�Ir3t,4ATURE DATE
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1 4 .0 /
WORKME"MPENSATION INSURANCE AND RCW 18.27. %
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SIGNAT RE
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771-0220
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ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL I- �a
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL -FILE YELLOC
PANCY HAS BEEN GRANTED. UBC109/lBC110/IRC110. PINK -OWNER GOLD4
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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JUL-20-2004 12:43 P.03/03
RECEIVED
JUN 2 12004
PERMIT COUNTER
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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
PLEASESIGN
—PLANNING DIVISION DATE IOLI�t 0
PLEASE SIGN
PROJECT— 4 PIOCO,
SITE ADDRESS /4-
PERMIT # 06 5q —ADB#--------PATE INSPECTED
CTE
DESCRIPTION OF WORK TO BE INSPE D__5_4A__ _10G_REI
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
PERYORMANCE BONDS and the granting of
G'R ANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
13 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
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fomis:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pier/Porch .................
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Retaining Wall ...........
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Slab Insulation ..........
PLUMBING:
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Rough -In ...................
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�Commercial Final ......
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HEATING:
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GasTest ....................
Gas Piping .................
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Equipment
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Commercial Final .......
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EXTERIOR SHEATHING
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NAILING ..........................
FRAMING ........................
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FIRST FLOOR FRAMING...
INSULATION ............. .. ..
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................