20040702.pdfFDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
CITY ZIP TELEPHONE
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NAME
ADDRESS
PERMIT EXPIRES
7
USE PERMIT
ZONE N U M B E R
JOB SU�E/APT#
fADDRE"SS 140 � I
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
7ESCP Approved 0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Paimil Roquifed C3
street use Parmi " oq'd
EXISTING .�� PROPOSED
a
InspoctionR quit�ld
Sidewalk Recililld
REQUIRED DEDICATION 40'� Fr
underground
wiring required E3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YES [J NO 0
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP TELEPHONE
NAME C13L #
/ R) S &Aj DATE
,04 ENGINEERING FIEVIEWEb BY
ADDRESS 8`/z3 1,?&)4
_rlo9k_�w FIRE REVIEWED BY DATE tu
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CITY ZIP TELEPHONE
VARIANCE OR CU SHORELINE ORADBI INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY REO'D POSTED
I OYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED
7/9, C�2 4�leon,42 e�� 4�/ e051 V) EXP I
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
NEW RESIDENTIAL PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
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COMPLIANCE OR z
E] ADDITION COMMERCIAL CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE :5
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED IL
REPAIR El GRADING CYDS FENCE � I
X FT) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUS SS OR ACTIVITY) EXPLAIN: CHECKED BY ITYPE OF CONSTRUCTION DE OCCUPANT
/a 4fzLL,)A I I j, I I? GROUP
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
I UNITA NUMBER REQUIRED LOAD
STORIES I
YES
DESCRIBE WORK TO BE DONE
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/IBC109/lRC109 FINAL INSPECTION REO'D
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11 (JQ- V_ -li INNJ \0 '�N
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
I
LOT SLOPE %
Building Permit
City Surcharge
—
Plumbing
Base Fee
PLAN CHE7 NO, VESTED DATE
WA
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
Engr. Review
ul PERMIT APPLICATION: 180 DAYS
IL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
Fire Review
Plan Chk. Deposit
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
'5 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
X FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
X1
Fire Inspection
Receipt #
Al? /Z
Landscapeinsp.
Total Amt. Due
Recording Fee
Receipt #
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 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 RELATING TO
WORKMEN'S COMPgNSATION INSURANCE AND RCW 18.27.
CALL
FOR INSPECTION
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Olficial or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OF CIALS SIGNATURE 11 DATE
SIG DATE SIGNED (425)
i�ATURE N OR JIGENT)
J . - . \,� /
771-0220 RU9, t
`7/��
ATTENTION EXT 1333 6111
ITIS UNLAWFULTO USEOR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/iSC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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ORIGINAL - FILE YELLOW - INSPECTC
PINK - OWNER GOLD - ASSESSOR
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CITY OF EDMOND&
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(,�PDROVE DATE, APPROVED '-AS: NOTED
8Y ENGINEERING
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Wence must be located on private property.,
*Property owner responsible for determining
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property lines.
Fence shall not enclose or prevent access to any IV 2��00(
city maintained utilities.
R CIEEIVED
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'AUG 18:2004
'BUILDING DEPT.
CITY COPP17
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE_V'4
�77fv�-A - JZ�a��
PEEASECIDAIK-
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT
SITE ADDRESS
PERMIT# 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:
\&RANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
.3.
RE-fNSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:roni1s: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:
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 ...
Lk - as
MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................
The Initials MT are Miltoll
Thompson, a temporary contract
ilispector fortlic CitY.
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