20040774.pdfDATE RECEIVED
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6SE PERMIT (gl
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CITY OF EDMONDS 7i I
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CON STRUCTION PERMIT APPLICATION ADDRESS
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�: _TG ADDRESE PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 0
0 (00 Street Use Permit floq'd
CITY TELEPHONE EXISTING PROPOSED inspection Required
e, Sidewalk Required [3
REQUIRED DEDICATION Fr Underground
ZIP I , wiring requitud 0
NI&E METER SIZE LINE SIZE NO, OF FIXTURES PRV REQUIRED
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STATt LICENSE NUMBER i)��j I ATE C ECKE J�_ REO'D POSTED
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1/11,4PPENCIM 1141.� 1 94 7
-j PROPERTY TAX ACCOUNT PAR�El_ No SEPA REVIEW SIGN AREA HEIGH
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
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NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRuNT SIDE REAR FRONT L/R SIDE REAR 0
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE IL
1:1 REMODEL El MULTIFAMILY SIGN REQ'D PROVIDED
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E] DEMOLISH 1:1 TANK F-1
GARAGE RETAINING WALL FIRE SPRINKLER
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: CHECKED BY JTYPF.�O TRUCTION CODE OCCUPANT
GROUP
NUMBER NUMBER OF CRITICAL —
OF DWELLING AREAS SPECIAL. INSPECTION AREA OCCUPANT
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0 STORIES UNITS NUMB REQUIRED [] YES
DESCRIBE WORK TO BE DONE
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PROGRESS INSPECTIONS PER ILIBC108/113C1109,11RC1109 RNAL INSPECTION REQ'D F3
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Alit? L-7194,57-3 1 0-4 1 Description FEE Description FEE
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iIIEAT SOURCE GLAZING % LOT SLOPE % BuildingPermit_ City MSurcharge 157
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
2 Engr. Review
W PERMIT APPLICATION: 180DAYS
W
IL PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
- U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
q IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp. Total Amt. Due
DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
X1 Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
RECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
OWNER. I REE TO 0 WITH CITY AND STATE LAWS REGULATING CONSTRUC- 1 his application is not a permit until signed by the
TI N; AND IN DO G T HORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or hisihor Deputy: and Fees are paid, and
IN VIOLATIO 0 TI B C OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMf,,N'S P S ID I S ICE AN" -1111 1B.27. OFFICIAlt IGNATU DA E
GNA URE AG�NgT) DATE SINE (425) C,
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q771-0220 -1fi1jEi1.EA11SE BY DATE
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ATTENTION 33��
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADEAND APPROVALOR A CERTIFICATE OF OCCU- RIGINAL-FILE YELLOW! INSPEdTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. �"OPINK-OWNER COLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM
I TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE,2!�,�
PI.A E�SIGN
PLANNING DIVISION DATE
PLEASH SIGN
PROJECT
SITE ADDRESS— VIP A
PERMIT �ADB# DATEINSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
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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:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
1 .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORBE CTION NOTICE given to owner/contractor by inpector
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3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tenip:b1dg:forrns:oca1)r%,1 3/25/04
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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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