20040727.pdfX,
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED
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(?11316451
PROPERTY TAX ACCOUNT PARCE� No.
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
ID REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
oGARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE PF USE, BUSINESS OR ACTIVIM EXPLAIN:
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NUMBER OF
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DESCRIBE WORK TO BE DONE
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COMPLIANCE OR
OF USE
CHANGE
SIGN
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OTHER
FIRE SPRINKLER
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LID NO.
LID FEE $
TESCP Approved
0
RW Permit Required
0
Street Use Permit Roq'd
0
Inspection Required
0
Sidewalk Required
13
Underground
Wiring required
13
PRV REQUIRED
YES 1:1 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY
DATE
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FIRE REVIEWED BY DATE U.1
VARIANCE OR CU SHORELINE OR ADBI I INSPECTION BOND
REO'D POSTED
OYES EINO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE (L
REO'D I PROVIDED I I
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CRITICAL
AREAS,
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SPECIAL INSPECTION
CCU PANT
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NUMBE
JAREA
REQUIRED E
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PROGRESS INSPECTIONS PER UBC
108/FINAL INSPECTION REQ'D
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LOT SLOPE %
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.
ui PERMIT APPLICATION: 180 DAYS
EL PERMIT LIMIT., 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF 141S OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESOH8
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LU IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON. I rS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY ANT
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDILIECHY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF 1111S PERMIT SHALL NOT BE
DEEMED TO MODIFY� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CI 1Y ORDINANCE
01 NOR LIMIT IN ANY WAY THE CITY'S 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 WITH CITY AND STATE LAWS REGULATING CONSTRUC
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIbLATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING 10
WORKMEN'S COMPFJJSATION 114SURANCE AND RCW 18.27,
SIGN E A OR'AGENT)' DATE SIGNED
I
VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
Building Permit City Surcharge
Plumbing Base Fee f
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review Plan Chk. Deposit
Fire Inspection Receipt #
Landscapelnsp. Total Amt. Due
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Recording Fee Receipt # z -2
7PPLICATION APPROVAL /
I his application is riot a permit Until signed by the
CALL Building otticial or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
rFIG L.StiHGNAI RE DATE
(425)
MW
771-0220 iir) ,1- 1) yj DATE
ATTENTION EXI 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL
FILE
YELLOW INSWCTO
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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
PL IWE SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
0
PROJECT P / (
SITE ADDRESS- (01 A,"
PERMIT ADB# DATEINSPECTED
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
PERF ORMANCE 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
El Copy of CORRECTION NOTICE given to owner/contractor by inpector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1: tenip: bidg: forms: ocaprvl 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
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Retaining Wall ...........
171
Slab Insulation ..........
PLUMBING:
0
Underground .............
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Rough -In ...................
0
0
0
Commercial Final ......
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HEATING:
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Gas Test ....................
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Gas Piping .................
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Equipment .................
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Commercial Final .......
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EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ........................
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FIRST FLOOR FRAMING ...
INSULATION ...................
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Floor Insulation .........
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Wall Insulation ...........
Ceiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
171
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................