20040662.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW RESIDENTIAL
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COMPLIANCE OR
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kit, DEMOLISH TANK
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GARAGE RETAINING WALL FIRE SPRINKLER
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PLAT NAMEISUBDIVISION NO. LOT NO.
LID NO.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
7ESCP Approved 13
RW Permit Required [3
street use Permit Hoq'd
EXISTING -ff�� PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION -"f� FT
underground
Wiring required E3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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REMARKS
OWNjq,�ONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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DATE
VARIANCE OR CU SHORELINEORADIIII I INSPECTION I BOND
REO'D I POSTED
DYES ONO IS
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE I EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE
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PARKING
REGO I PROVIDED
REMARKS
CHECKED BY
LOT AREA I PLANNING REVIEWED BY DATE
CONSTRUCTION
SPECIAL INSPECTION JAR
REQUIRED [:] YES
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GROUP
OCCUPANT
LOAD
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PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REQ'D I E'i
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit City Surcharge
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PLAN CHE?c In Plumbing Base Fee
VESTED DATE 405
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU13LIC
9 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
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SEPARATE PERMISSION.
2 Engr. Review
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W PERMIT APPLICATION: 180 DAYS
IL PERMIT LIMIT'll YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS Engr. Inspection
. SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V) 'AFPLICANT, 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
Ir Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY On INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 1HIS PERMIT SHALL NOT BE
DEEMED TO MODIFI� WAIVE OR REDUCE ANY REQUIREMENI OF ANY C17Y ORDINANCE Landscapeinsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION "APPUCEATION 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 CONsrRUC- This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED ALL Building Olficial or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASIIINGrON RELATING TO F INSPECTION receipt is acknowledged in space provided.
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'9fig,MEN'S Cq$PENSATION INSURANCE AND RCW 18,27.
OFFP IALS SIGt 7 TU DATE
PE OR AGENT) DATE SIGNED (425)
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771-0220 RELEAStD HY
ATTENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINA
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - INSP�ECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/]RC110. PINK - OWNER GOLD - ASSESSOR
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
IIIXASI! SIGN
-ENGINEERING DIVISION DATE
1,IA:AqL SIGN
PLANNING DIVISION DATE
PLEASC SIGN
PROJECT J& Ida
SITE ADDRESS f- 3�e�'7 �o4,1
PERMIT # 4 -60 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 ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1Acn1p:b1dg:f6rn1s:ocaj)rv1 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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