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DATE RECEIVED
EIRMIT EXPIRES IL;�
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USE PERMIT
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CITY OF EDMONDS NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAWMME OF BUSINESS','� �� I _Az�I_Xl / c Alle
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
AW Permit Required
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Street Use Permit Fioni'd
CITY
ZIP TE EPHONE
EXISTING — PROPOSED
inspection flarlijaird
sidowall, Flocitered
NAME
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WNW 41d -5 71?d - -
REQUIRED DEDICATION- FT
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METER SIZE LINE SIZE NO. OF FIXTURES
underground
Wiring required
PRV REQUIRED
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ADDRESS
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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CITY
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE
F
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PROPERTY TAX ACCOUNT PARCEL NO
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NEW
2eRESIDENTIAL
1:1
ADDITION
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REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
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GARAGE
RETAINING WALL
CARPORT
ROCKERY
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DWELLING
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DESCRIBE WORK TO BE DONE
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- HEAT SOURCE— GLAZING %
PLAN CHECK NO:
FIRE REVIEWED BY
DATE
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'KED BY POSTED
REO'D
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COMPLIANCE OR
CHANGE OF USE
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FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
LOT SLOPE %
VESTED DATE
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ALLOWED PROPOSED
ALLOWED PROPOSED
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LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIR SIDE REAR
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PARKING
LOT AREA
PLANNING REVIEWED BY DATE
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REQ'D I PROVIDED
FT) REMARKS
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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 WHAT EVER NATURE, ARISING DIREc riY OR INDIRECT LY
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
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I 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
THE OWNER. I AGREE TO COMPLY WIT I I CITY AND STATE LAWS REGULATING CONSTRUC
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
WORKUENS—C—OlaPCNSATIONJNSURANCE,AND RCW 16.27.
R9)(O%VNER6RAG9N I DATE GNED
CHECKED BY I TYPE OF
CODE I OCCUP,
x9A-.4 I GROUP
SPECIAL INSPECTION AREA OCCUPAN I
LOAD
REQUIRED [] YES
REMARKS z
PROGRESS INSPECTIONS PER UBC 108 / IEICII 09 1 IRC1 09 FINAL INSPECTION REQ'D F5
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VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
ATTENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
FEE Description r-tt:
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt N
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/tier Deputy, and Fees ate paid, and
fecelpt is acknowledged inspacL provided.
0 FICI I S SIG AT R D T
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09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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FINAL PROJECT APPRQVALf�QRM
TO:
DATE: -
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE__q!���C'Y
PIXA-911. SIGN
ENGINEERING DIVISION DATE
PLEASESIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT
SITE ADDRESS—/
PERMIT d)=O��6 �e�ADB#___________�DATE JNSPECTED__!4����
DESCRIPTION OF WORK TO BE INSPECTED. 4-
. 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 tor by inpector
Copy of CORRECTION NOTICE given to owner/contrac
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2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:ten1p:b1dg:fbn1is: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 AppjtOVAT"R
..............
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