20040696.pdfDATE RECEIVED ERMIT EXPIRES
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USE --PERMIT
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CONSTRUCTION PERMIT APPLICATION ADDRESS 7 _,_�VITE/APT#
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Lj PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Aw Permit Required
0 street use Permit F100
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�1 I T TELEPHONE EXISTING — PROPOSED inspection Raqiefed
ZIP Sidewalk Floquired
REQUIRED DEDICATION— FT underground
Wiring required
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I T YES 0 NO
AD0ft__ST___T1T__ REMARKS
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OWN ER/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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NUMBER
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORIK 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' 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 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 WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF IHIS PERM11 SHALL NOT BE
DEEMED TO MODIF� 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 14AVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGRiE TO COMPLY WITH 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 RELATINJ TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
FIRE REVIEWED BY DATE
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INSPECTION
BOND
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ALLOWED PROPOSED
ALLOWED PROPOSED
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REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
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SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED btYES I I LOAD
REMARKS
PROGRESS INSPECTIONS PER UEIC 108/ IBC109 / IRC109 FINAL INSPECTION REQ'D
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
FEE Description FEE
State Surcharge
�40
City Surcharge
"::0Base Fee
Fire Review Plan Chk. Deposit
Fire Inspection Receipt #
Landscapeinsp. Total Amt. Due
Receipt #
Recording Fee
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
OFFIC GN TURE E
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A17ENTION E)ff 133kDdzo(2k&,u
ITIS UNLAWFULTO USE OROCCUPYABUILDING OR STRUCTURE UNTILA FINAL 6
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - I SPEC OR!
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
PLEASL SIGN
-ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE
PLEASESIGN
PROJECT 741J, A�144_ZZIA
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PERMIT #- .- ADB#_e��_'_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
El Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINALINSPECTION - OUTSTANDING ISSUES
El Copy of CORRECTION NOTICE given to owner/contractor by inpector
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2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:ten1p:b1dg:f6rnis:ocaprv1 3/25/04
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE—,
PLEASESIGN
ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE 0
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DESCRIPTION OF WORK TO BE INSPEC
A field inspection was conducted to determine final 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
o' Copy of CORRECTION NOTICE given to owner/contractor by inspector
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2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
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Retaining Wall ........... 0
Slab Insulation ..........
PLUMBING:
Underground .............
0 M
Rough -In ................... C
M 0
0
Commercial Final ...... 0
0 C
HEATING: x M
M Z
Gas Test ....................
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Gas Piping ................. --I
Equipment ................. 0)
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Commercial Final ....... —4
x
EXTERIOR SHEATHING M M
NAILING .......................... 0
0
FRAMING ........................ 0 M
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FIRST FLOOR FRAMING ... Q 0
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INSULATION ...................
M
Floor Insulation ......... --I
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Wall Insulation ........... z
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Ceiling Insulation ....... x
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SHEETROCK NAILING ... z
0
SPECIAL INSPECTION ...
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MISCELLANEOUS -
FINAL APPROVAL FOR
OCCUPANCY ..................