20040775.pdf9
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME Of BUSINESS
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MAILING ADDRESS Pl. PJ-R-5�_
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CITY zip
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NAME
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LICENSE NUMBER
PROPERTY TAX ACCOUNT
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REPAIR
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(TYPE OF USE, BUSIMM
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EXPIRATION DATE I CHEC
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RESIDENTIAL
COMMERCIAL
MULTIFAMILY
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RETAINING WALL
ROCKERY
OR ACTIVITY) EXPLAII
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NUMBER NUMBER OF
OF _� I A I DWELLING
STORIES I' NITS
DESCRIBE WORK TO BE DONE
HEAT SOURCE
PLAN CHECK NO:
GLAZING %
1:1 PLUMBING/MECH
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COMPLIANCE OR
USE
CHANGE OF
SIGN
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A I V— I I PERMIT EXPIRES
USE PERMIT
ZONE NILIMBERe�104 _011S
JOB SUITEIAPT#
ADDRESS f�QU:��
PLAT NAME/SUBDIVISION NO LOT NO. LID NO.
LID FEE $
I ESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP nw Permit Required
Street Use Pwrnil Req'd
EXISTING PROPOSED Ingpoction Required
sidewalk Required
REQUIRED DEDICATION FT Underground
I wiring require
METER SIZE LINE SIZE NO. OF FIXTURES I PRV REQUIRED
YES 13 No El
REMARKS
OWN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONIROL/DRAINAGE
ENGINEERING REVI
FIRE REVIEWED BY
VARIANCE OR CU
By
SEPA REVIEW
COMPLETE , EXEMPT
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LOT COVERAGE
ALLOWED PROPOSED
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DATE
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SIGN AREA HEIGHT
ALLOWED , PROPOSED ALLOWED , PROPOSED
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REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING I LOT AREA I PLANNING REVIEWED BY DATE -1
REQ'D I PROVIDED IL
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FT-) I REMARKS
FIRE SPRINKLER
FIRE ALARM
CHECKED BY TYPE IUC`Tg)(�� I CODE OCCUPANf
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CRITICA . 1 6M
AREAS It SPECIAL INSPECTION JAREA OCCUPANT
NUMBER010L REQUIRED YES LOAD
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PROGRESS INSPECTIONS PER UBC 108/IBC109/iRC109 FINAL INSPECTION REQ'D FS
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CK6 /ALUATION
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.
PERMIT APPLICATION: 160 DAYS
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PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) '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 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 13E
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY 1'0 ENFORCE ANY ORDINANCE PROVISION.'
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
FEE Description FEE
State Surcharge
ity Surcharge
2 P c
Base Fee
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- CALL
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 FOR INSPECTION
W OMPENS NCE AND RCW 18.27.
NE R T) DATE[IGNED (425)
20
7 2
ATWNTIO*5�_:e mba�-�_ ULLe.(2__S ItEeW1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. USC109/IBC110/iRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 CC
Plan Chk. Deposit
Receipt 0
Total Amt. Due
Receipt it Al
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.
-FICIAL$_SqGNATURE DAT
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ORIGINAL -FILE YELLOW,INSPE
PINK -OWNER GOLD -ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISiON
FROM: -FIRE DEPARTMENT DATE.
PLEASP SIGN
DIVISION DATE-4/i le-r
ENGINEERING
PLEASr SIGN
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PLANNING DIVISION DATE
PIXAS11 SIGN
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PROJECT
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PERMIT #--00'f—d T� ADB# DATEINSPECTED -7
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DESCRIPTION OF WORK TO BE INSPECTED
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A field inspection was conducted to determine compliance with -approved plaits. Final approval
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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El Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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0 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:ten1p:b1dg:fori11s:ocaprv1 3/25/04
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
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Retaining Wall ...........
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Slab Insulation ..........
PLUMBING:
Underground .............
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Rough -in ...................
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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
0
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NAILING ..........................
0 M
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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 ...........
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Ceiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
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