20040682.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER EINAME OF BUSINESS
MAILING ADDRESS
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CITY ZIP TELEPHONE
C
4Z5 - 173-11
NAME
CITY
ZIP I TELEPHONE
4 U USE
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7ONE
I PERMIT EXPIRES
PERMIT �_,,,7, -
NUMBER �4
I 1 11-7
OL2 QOY?
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JOB
SUITEIAPT#
ADDRESS P1 ne
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
I ESCP Approved
0
PUBLIC A:GHT OF WAY PER OFFICIAL
STREET MAP
RW Permit Required
0
Street Use Permit Roq'd
[3
EXISTING - PROPOSED
inspection Required
13
Sidewalk Required
13
REQUIRED DEDICATION-
FT
Underground
Winnoniquired
[3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES13 NO 13
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
NAME CBL#
F ACV
loef4,77 ENGINEERINVE\IFW_INSP 12,rzn DATE
ADDRESS sa'P.HT TO 1313 CLMjjjaj) Or fia= 1
3 3 FIRE REVIEWED BY. ST Bit CAPPER'" W
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CITY ZIP TELEPHONE SIS
PROP
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STATE LICENSE NUMBER EXPIRATION DATE/X CHEC E)B) 0 1 11 1. 1 Tim POSTED
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2 06 SEPA REVIEW -_ Z sl
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE IVENMVID Y64= '77LTO ROPOSED
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EXP
LOT COVERAGE BACKS (Fr.)
NEW �arRESIDENTIAL PLUMBING MECH MAW'SIDE REAR
ALLOWED PAVO %, %ST N z
COMPLIANCE OR FO z
El ADDITION r__j COMMERCIAL CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE 5
QL
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED
FENCE
REPAIR GRADING ryps ( X FT) REMARKS
N� OTHER
DEMOLISH TANK El
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIV.TYIEXPLAIN:
CHECKED BY TYPE PO)ICMOUCTION C 0 OCCUPANT
GROUP
7 /C
NUMBER tiUMBER OF CRITICAL OCCUPANT
OF DWELLING AREA SPECIAL INSPECTION JAREA
NUMBER LOAD
STORIES UNITS REQUIRED
DESCRIBE WORK TO BE DONE
REMARKS -D z
PROGR ESS INSPECTIO NS PER UBC 108 IBC11 09 IRCI 09 FI NAL INSP ECTION REU 5
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LUATION
$
Description FEE TDescripflon FEE
E
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % C ity
Building Permit City Surcharge
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 PU13LIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. Engr. Review
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review Plan Chk. Deposit
;APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
N INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLYOR INDIIIECTIY ---
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF I HIS PERMIT SHAI L NO T BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMEN r OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION alpt 0
Recording Fee Receipt N
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMAT, ION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
ING CONSTRUC I his application is not a perinit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULAT CALL Building 011icial or his/her DOPLIty. and Fees are paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED jj,�ceipt is acknowledged in space provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 1&27. 01-1:1CIALS SyGf)�T RE A'E
Cl- ATURE (OWNEnOR AGENT) DATE SIGWED (425)
771-0220 I-ASFI) 13Y
11171 F
E)ff 1333
ATTENTION
IT IS UNLAWFULTO USE OR nocuPYABUILDING 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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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
'T ENGINEERING DIVISION DAT07-1"Z U_
PLEASO'SlhN
PLANNING DIVISION DATE
PLEASE SIGN
PRO JECT !14MWJW1WJI
-Roe
SITE ADDRESS
PERMIT #A 00 L�_ 6 (09'2'— ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED (Al"Nul AMD
-_ U_ 6 '�_ -
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
Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
El Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date — Signature
1: tenip:bldg: forms: ocaprvi 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pler/F�brch .................
Retaining Wall ...........
Slab lnsL)tation ........
PLUMBING:'
Underground ....... I ........
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
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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