20040745.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS t A \ r
MAILING ADDRESS
CITY
NAME
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CITY
:GL!Td
ADDRESS
CITY
STATE LICENSE NUMBER
PROPERTY TAX
ZONE
JOB ADDRESS��••//// / L-1
PLAT NAME/SUBDIVISION NO.
.PERMIT EXPIRE
PERMIT
NUMBEROhr
r
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
ZIP TELEPHONE EXISTING PROPOSED
REQUIRED DEDICATION FT
METER SIZE LINE SIZE NO, OF FIXTURES
ZIP
E
EXPIRATION
❑ NEW ❑ RESIDENTIAL
❑ ADDITION COMMERCIAL
REMODEL ❑ MULTIFAMILY
❑ REPAIR ❑ GRADING CYDS
❑ DEMOLISH ❑ TANK
GARAGE RETAINING WALL
❑ CARPORT ❑ ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
coy- � c
NUMBER NUMBER OF
OF DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
HEAT SOURCE GLAZING %
PLAN CHECK NO:
CH 11M
CHECKED BY
❑ PLUMBING / MECH
COMPLIA14CE OR
CHANGE OF USE
❑ SIGN
❑FENCE
( X FT)
❑ OTHER
❑FIRE SPRINKLER
FIRE ALARM
LID NO.
LID FEE $
TESCP Approved ❑
RW Permit Required ❑
Street Use Permit Roq'd ❑
Inspection Required ❑
Sidewalk Required ❑
Underground
Wiring required ❑
PRV REQUIRED
YES ❑ NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING
FIRE REVIEWED BY
VARIANCE OR CU
I�
SEPA REVIEW
COMPLETE EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D I PROVIDED
REMARKS
DATE
DATE
SHORELINE OR ADBp INSPECTION BOND
REO'D POSTED
OYES ONO S
SIGN AREA HEIGHT
ALLOWED PROPOSED ALLOWED r PROPOSED
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REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT UR SIDE REAR Ly
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LOT AREA PLANNING REVIEWED BY DATE a
HECKED 8Y TYPE O O TflJJCT10N COD
OCCUPANT
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GROUP
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C TICAL
AREAS
SPECIAL INSPECTION
OCCUPANT
LOAD
NUMBER
JAREA
REQUIRED ❑ YES
REMARKS
PROGRESS INSPECTIONS PER UBC108/IBC109/IRC109
FINAL INSPECTION REO'D
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to
LOT SLOPE %
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS• DRIVEWAYS• MARQUEES• ETC.) WILL REQUIRE
H
SEPARATE PERMISSION.
¢ PERMIT APPLICATION: 180 DAYS
W
a PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
rn 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 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 THIS PERMIT SHALL. NOT BE
9 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
O 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 VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
SIGNA URE (OW ER O AGENT) ) DATE SIGNED
r r
$ i
Description FEE Description FEE
Plan Check Z� 0�
Slate Surcharge
Building Permit City Surcharge
Plumbing Base Fee
Mechanical 1 M. i,
Grading
Engr. Review
Engr. Inspection
Fire Review Plan Chk. Deposit 14ILD
Fire Inspection Receipt
Landscape Insp. Total Amt. Due �7�, J'
Recording Fee Receipt N
APPLICATION AP AL
CALL This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
OFFICIALS SIGNATURE DA E
(425) OLK
771-0220 r
ELFAS BY TE
ATTENTION EXT 133 erg �• - �.
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A 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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City of Edm®nd.sq
All persons Are Ordered to
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Property Owner (irknown) `'' `" �'
S1'�ly .f�li siht. .. r1 1•, \ , ,f i1 41ft y=.b eft,
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Id I, IW.e:_are unable .to locate a valid permit'ror the nvork being done at'thrs address A peen}it r , '
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\ 1.is reg»red for ihi project 'Work SHALL NOT• contrniie until a permit has been' obtained t J.
" _ I '1'', and ,the work ii�spccted for conroririance with applicable codes and of drnances lf;you ,+'
have already„obtained the :permit, please contact us at (425) 771=02�0,:wrth the permit
t
j VL I'd.,number so we card revise our records.
:An -application must be submitted or a response in writinbIt, y,
1 t i Y.
must be made to our office no later.than 4:00 pm on ..
, .
t A VIOLATION 1� EE EQUAL OR UP 'I'O FIVE TIIi�iES
Ad THE PERMIT FEE SHALL. BE ASSESSED.. r'
Add Ad..n'
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'Posted this day of +
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�Varnin;~: The failure to stop this wolr•k or ' -activity activity and/or 'ahe'
°R>4, resuming ` of work without permission or the removal,
>mlutilation, o><• concealment of this Notice :is punishable by fine
and imprisonment.
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City of l?dmrnuls Development Services Departmm�t Building l)ivisie�n
121 5"' Ave N • Edmonds, WA 98020 (425) 771-0220
Orrice 1lcnus M-F 9-12 and 1-4
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MEMO TO:
FROM:
PROJECT
SITE ADDRESS
ry
tOVAL FORM
T06
DATE.
BUILDING DIVISION
DEPARTMENT DATE
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
G A C,6�0C r*
S3 3 e)-vzD
PERMIT # 64 or 7�f 5 ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
{.6 A-1.,*4 6�2..
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
❑ Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
❑ Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES = GRANT FINAL PROJECT APPROVAL
Date
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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 ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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