20040706.pdf9
9
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSJNESS
cc MAILING ADDRESS
0
CITY ZIP TELEPHONE
NAME
ADDRESS
CITY
ZIP
TELEPHONE
NAME
CBL
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0
ADDRESS
0
CITY
ZIP
TELEPHONE
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STATE LICENSE
PROPERTY TAX ACCOUNT PARCEL NO.
NEW
ESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
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DEMOLISH
TANK
OTH&�'L
I
GARAGE
RETAINING WALL
FIRE SPRINKLER
ALARM
CARPORT
ROCKERY
FIRE
(TYPE OF USE, BUSINESS�7
ACTIVITY) EXPLAIN:
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NUMBER OF
CRITICAL
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DWELLING
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AREAS
A/
2/
01 STORIES
UNITS
NUMBER
DESCRIBE WORK'TO 13E DONE
I
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: VESTED DATE
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.
PERMIT APPLICATION: 180 DAYS
IL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) OAPPLICANI ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTERE�T. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Ir
< ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF I'HIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED TO MODIFN� WAIVE OR REDUCE ANY REOUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
ZONE
I PERMIT EXPIRES,
PERMIT
NUMBER
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ADDRESVS
SUITE/APT#
PLAT NAME/SUBDIVISION NO,
LOT NO.
LID NO.
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VARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND
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YE
10 - S ONO IS
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP I
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT ')
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
PARKING I LOT AREA PLANNING REVIEWED BY DATE
REQ'D I PROVIDED :4 bill: Ila URC 61 is
REMARKS APR&9,SIJREREGIJIATORVALVF,(PRV)
SlIALLBEINSIALLEDNEAR -
CHECKED By TYPE OF, 0 RqTION DE OCCUPANT
GROUP
SPECIAL INSPECTION AREA OCCUPANT
In D 0 LOAD
REQUIRED [] YES
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REMARKS z
PROGRESS INSPECTIONS PER Ufk*NWRC109 FINAL INSPECTION REO'D
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A WATER SERVICR J Enn OFF
SHALL BE INSTALLED ON THE
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VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
4-1:400
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
LandscapeInsp.
Total Amt. Due
Recording Fee
--rRec6ipt
#
I HEREBY ACKNOWLEDGE TIIAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPR FAI
GIVEN IS CORRECT. AND THAT I AM TliE OWNER, OR THE DULY AUTIIORIZED AGENT OF I
ST C This application is not a permit until signed by the
STATE LAWS REGULATING CONSTRUC-
THE OWNER. I AGREE TO COMPLY WITIl CITY AND MPL Y CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Olficial or his/hot Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION IN-aURANCE AND RCW 18.27. 'At Q QirztjAri inF: DATE
SIGNATURE (OWNER R AGENT) DATE SIGNED (4125)
�20
771-102 RELEAS
ATT ENTION E)ff 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL L
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110-
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
M
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASESIGN
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MFIM [WU—ENGINEERING DIVISION DATE z
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PLANNING DIVISION DATE M
PLEASESIGN
PROJECT U5
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SITE ADDRESS— Vzs-za V, V I VNI 0
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PERMIT # ADB# DATE INSPECTED -i
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DESCRIPTION OF WORK TO BE INSPECTED C: -2
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
CE BONDS and the granting of
PE"O RMAN
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
I .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3
R-E-INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:rbrnis:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch ................. z
0
Retaining Wall ...........
0
Slab Insulation ..........
PLUMBING:
Underground ............. M
C
M
Rough -In ................... 0
--1 0
Commercial Final ...... 0 C
-4 K
X M
HEATING: M z
Gas Test- .................... C:
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Piping.................
Equipment ................. 0 -n
n ;0
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commercial Final ....... x
M M
ATHING
EXTERIOR SHE 055
0 r-
NAILING .......................... 0 M
C: CD
FRAMING ........................ 0),
M 0
Z
FIRST FLOOR FRAMING ...
z
Wall Insulation ........... --I
x
Ceiling Insulation .......
z
AILING ... 0
SHEETROCK N
SPECIAL INSPECTION ... ITI
MISCELLANEOUS ..........
FINAL APPROVAL70fir
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