20040739A.pdfUATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER �IAME/NAME OF @USINESS
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MAILING ADDRESS
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NAME
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STATE LICENSE NUMBER EXPIR
PROPERTY TAX ACCOUNT PARCEL NO.
I DATE C)ECK Illy
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NEW
RESIDENTIAL
MtfPLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
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FENCE
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GARAGE
r.ARPORT
o RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINEPR-OR ACTIVIT-Y) EXPLAIN:
Lu NUMBER NUMBER OF CRITICAL
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OF DWELLING AREAS�j
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PLAN CHECK NO:
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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
i DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
2
PERMIT APPLICATION: 180 DAYS
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CL PERMIT LIMIT 1 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 ANYAND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREc Try on INDIREC fly
M FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOI BE
DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
!02 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 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 COMPENSATION INSURANCE AND RCW I B 27.
SIGNATIA DATE �IG�El)
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PLAT NAME/SUBDIVISION NO.
PERMIT EXPIRES
PERMIT
N U M B E R _�41 A/V/ —
SUITE/A"PT#
ILOT NO� ID NO.
TLID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE LINE SIZE NO. OF FIXTURES
TESCP Approved
RW Permit Required
Street Use Permit Roq'd
inspection Required
Sidewalk Required
Underground
Witing required
PRV REQUIRED
YES 0 NO 13
REMARKS
OWNER/CONTRACIOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
FIRE REVIEWED BY
VARIANCE OR CU SHORELINE OR ADB#
SEPA REVIEW
COMPLETE , EX
,KT
EXP
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REQ'D I PROVIDED
REMARKS
DATE
DATE
-:3
INSPECTION PBOND
REqDe- OSTED
OYES LNO s -------
10 S
S!GN APIROAPO HEIGHT
SED] ALLOWED PROPOSED
ALLOWE
REQUIRED SET13ACKS (FT.) PROPOSED SETBACKS (Fr.)
FRONT SIDE,, REAR,, FRON)� LJF�SIDEJIREAR/e
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LOT AREA pr
CHECKED BY I'WPr r)F COIN
SPECIAL INSPECTIC
REQUIRED [] YES
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REMARKS
N REQ'D
PROGRESS INSPECTIONS PER UBC 108/IBC109 IRC109 FINAL INSPEC110
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
ATTENT!ION I I EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALOR ACERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
FEE Description FEE
State Surcharge
City Sul charge
'Base Fee
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Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy� and Fees are paid, and
receipt is acknowledged in space provided.
SIYNATUVE DATE
#4 4
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09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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ORIGINAL - FILE YELLOW - INSPECTOPI
PINK - OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
F? El E I E D
TO:
SIET "'! 0 2004
[)EVE, jIVICES CTR DATE:
OF
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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FROM: FIRE DEPARTMENT DATE
PIXASrSIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
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PLANNING DIVISION DATE
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PERMIT #1�00 ADB# DATE INSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED 2_
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A field inspection was conducted to determine compliance with -approved plans. Final approval
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denotes that there are no objections from the above signed Department to the release of
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PERFORMANCE BONDS and the granting of
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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1:1 Copy of CORRECTION NOTICE given to owner/contractor by inpector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tenip:b1dg:fbrms:ocaprv1 3/25/04
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 ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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