20040659.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINEfiS
MAILING ADDRESS
NAME
ADDRESS
CITY
NAME
ADDRESS
IPA
ZIP
ZI
MW
STATE LICENSE NUMBER
)ROPERTY-TAX ACCOUNT PARCEL NO.
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TELEPHON
TELEPHONE
CBL #
TELEPHONE
No 6,*� —�9( q � F3 &17
EXPIRA,ION DATE CqCKED Ia
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1:1 NEW
R;--rESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
aj�-�NK
oGARAGE
RETAINING WALL
CARPORT
ROCKERY
PLAI
(TYPE C�F USE, BUSINESS OR ACTIV! X N
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NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS
DESCRI13E WORK TO BE DONE /'-). � � ,
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
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ADDRESS
PLAT NAME/SUBDIVISION NO.
PERMIT EXPIRES
PERMIT
NUMBER -4MWZ1—A1V5V
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE I LINE SIZE I NO. OF: FIX
SUITE/APT#
liv
x .
LID NO,
LID FEE $
TEscP 4p,,,,d
13
pw Permit Required
0
Street Use Permit Req'd
[3
inspection Requited
0
Sidewalk Required
E3
Underground
W .. ngoquvrid
13
JRES
PFIV REQUIRED
Y YES E3
ES 13 NO
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
"I'ANK F11 I BE-1110VX OB CA
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE ui
VARIANCE OR CU SHORELINE OR ADBI I INSPECTION BOND
REQO POSTED
OYES ONO IS
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP I ---
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR 0
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PARKING LOT AREA I PLANNING REVIEWED BY DATE 5
REO'D I PROVIDED I CIL
REMARKS
CHECKED BY ITYF'F,-W.PONSTPUCTION PAN�
P
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SPECIAL INSPECTION JAREA PANT
REQUIRED [] YEc
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/IBC109/[RC109 FINAL INSPECTION REOID
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
I
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. I Engr. Review
PERMIT APPLICATION: 180DAYS
IL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'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
M 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 Landscapelnsp. Total Amt. Due .4
DEEMED TO MODIF'� WAIVE OR REDUCE ANY REOUIREMENI OF ANY CITY ORDINANCE 05
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
X1 Recording Fee Receipt # 7V) 7
1 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 APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN�S Co
>p�N INSURANCE,�"W 18.27
S G�NA U DATE
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E SI NED
S NER 0 DATE (425: n
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771-0220 RELEA Y AT
xrfENTIOW - EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK - OWNER - GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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R C:, rz, I V F_ D FINAL PROJECT APPROVAL FORM
SEP -- q. 2004 TO:
DEVELOPMENT SERIJICFS CTR.
City OF EDMONDS DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: ""�'071 C_ F IRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT TZ- 2, 4�!f
SITE ADDRESS- J(-7
PERMIT #(2-W 61 (05-1 ADB# -DATE INSPECTED -
DESCRIPTION OF WORK TO BE INSPECTED
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
3.
RE -INSPECTED OUTSTANDING ISSUE, S - GRANT FINAL PROJECT APPROVAL
Date Signature
1:ten1p:b1dg:fonns: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 APPROVA"u-ri
OCCjAvx8NL ..................
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