20040763.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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USE PERMIT
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ADDRESS 16 1/ �, A&t tu
PLAT NAMEISUBDIVISION NO. LOT NO, LID NO
LID FEE $
FESCP Approved E3
PUBLIC RIG] iT OF WAY PER OFFICIAL STREET MAP
AW Permit Required Q
Street Use permit Hort'd E3
EXISTING - PROPOSED
inspection RoqUlfod 13
Sidewalk Haquirod 13
REQUIRED DEDICATION- Fr
underground
13
Wifingfoquifed
METER SIZE LINE SIZE NO. OF FIXTURES I PRV REQUIRED
I I YESM NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
BY DATE
L I TE LEPHONE FIRE REVIEWED BY DATE
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STATE LICENSE NUMBER EXPIRATION DATE T
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PROPERTY TAX ACCOUNT PARCEL NO.
NEW
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PLUMBING / MECH
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COMPLIANCE 08
CHANGE OF USE
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GRADING
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ROCKERY
FIRE SPRINKLER
FIRE ALARM
VARIANCE OR CU jjHUREl!IN1j 0RA1JV# " ' OTEN BOND
ST BI-- rjQ9 0611. POSTED
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SEPA REVIEW " " % I 1L&I,GNAj EIGHT
COMPLETE , EXEMPT ALLOWED pPROPOSED
EXP I.
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
[ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
PARKING
REO'D I PROVIDED
FT HE
) I MARKS
LOT AREA I PLANNING REVIEWED BY DATE
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UMBEI AREAS SPECIAL INSPECTION IAFfEA OCCUPA1,11
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DESCRIBE WORK TO BE DONE tj A�_
REMARKS
PROGRESS INSPECTIONS PER UEIC 108/FINAL INSPECTION REOID z
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VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
I Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
:1
SEPARATE PERMISSION. — --------
2 Engr. Review
Lu PERMIT APPLICATION: 180 DAYS
IL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
I SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk- Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF -------
2 EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND z
Fire Inspection Receipt
< ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF 1 HIS PERMiT SHALL NOT HE
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DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Total Amt. Due
o NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.4
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION Recording Fee Receipt #
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DU& AUTHORIZED AGENT OF APPLICATION APP)3R0VkAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a Pefortil until Signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her 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 PNSATJOR-M�NANCE AND RCW 18.27.
OF I NAT RE
DAT
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DIVE SIGNED
RFLF.AsED
771-022
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ATTENTION EXT 1333 ATE
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. INSPECTOR
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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R E C. E"I V 5� D FINAL PROJECT APPROVAL FORM
I SEP 14 2004 T 0:
DENELCIPMENT SERVICTS MR.
DATE: L
7-7—
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: ASE SIGN� FIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJEC
SITE ADDRESS
IT #_2f ADB#
PERM V�-07 ---------PATE 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
64
/7 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
0 Copy of CORRECTION. NOTICE given to owner/contractor by inpector
01
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbrms:ocaprv1 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 ........... 0
0
Slab Insulation .......... M
PLUMBING:
Underground ............. W
M
Rough -In ................... C
M
0
Commercial Fin�l ...... 0
0 C
HEATING: T_ M
M Z
Gas Test ....................
C
Gas Piping .................
Equipment .................
0 -n
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Commercial Final ....... --I
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M M
EXTERIOR SHEATHING
NAILING .......................... 0 —0)
0 r-
0 M
FRAMING ........................ C (n
0)
FIRST FLOOR FRAMING ... Q 0
Z
INSULATION ...................
Floor Insulation .........
Wall Insulation ........... z
Ceiling Insulation .......
SHEETROCK NAILING ... z
0
SPECIAL INSPECTION ... 0
M
MISCELLANEOUS ..........
FINAL APPROVAL FOft-
OGCUPANCY ..................
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