20040787.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAMM /NAME OF IIU I �ESS
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MAILING ADqR
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CITY
ZIP TELEPHONE
NAME
ADDRESS
CITY ZIP
NAME
TELEPHONE
1CBL #
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1�IW) 7
zip TELEPHONE 7A4
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STATE LICENSE NUMBER EXPIRATI A E _R#
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r-7 0.-
PROPERTY3��X_ ACCOUNT PARCEL NO
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NEW
RESIDENTIAL
ADDITION
:�r OMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
oGARAGE
CARPORT
RETAINING WALL
ROCKERY
MPE OF USE, BUSINESS,Gfi ACTIVITY) EXPLAIN:
1 1) fv("Vil l,,
M NUMBER NUMBER OF
OF DWELLING
0 STORIES UNITS fu
DESCRIBE WORK TO BE DONE I
HEAT SOURCE I GLAZING %
LUMBING / MECH
F�
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( x FT
OTHER
FIRE SPRINKLER
FIRE ALARM
PERMIT EXPIRES
USE
ZONE PERMIT
NUMBER
JOB SUITE/APT#
ADDRESS
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO�
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 0
RW Prunut Required C3
EXISTING
Silent Use Permit Roq'd 13
— PROPOSED
Inspection Required 0
Sidewalk Required 13
REQUIRED DEDICATION. FT
underground
Wiring required E3
MET SIZE LINE SIZE NO. OF FIXTURES
PRV REQUIRED
0
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YESIJ No
REMARKS
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OWN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONTROI]DRAINAGE
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ENGINEERING R
FIRE REVIEWED BY
IAl`fE CMIW
7ED �BY
EXP I RIPINO I IS WED
REQ'D
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14; REOUIRE
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DATE W
ELEVRI
ELECTRI
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NL AT 425-2(1�0- 13 09
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CHECKED BY ITYPE, 0 R ION
GROUP,5�77
CRITICAL MF_
AREAS SPECIAL INSPECTION AREA OCCUPANT
S
NUMBER REQUIRED [] YES LOAD
REMARKS
PROGRESS INSPEC11ONS PER UBC 108/IBC109/IRC109 FINAL INSPECTI
ON REO'D
LOT SLOPE %
PLAN CHECK N�Lq' , LILI Ll I VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK T
BE DONE ON PRIVATE PRIDPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
a. PERMIT LIMIT* I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
"I SEE BACK OF PINK PERMIT FOR MORE INFORMATION
W
APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMI ESS THE CITY OF
5 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENT S FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREC I LY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
TO NOR LIMIT IN ANY WAY THE CHYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
I HER E By ACKNO
kGIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMP CITY AND STATE LAWS REGULATING CONSTRUC.
Ly Wll�f
TION; AND IN DOING THE WORK AUT RIZIEL THEREBY. NO PERSON WILL 13E EMPLOYED
IN VIOLATION OF THE LABOR C09f OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INS f ANCE AND RCW 18.27.
SIG OWNER ORA DATE SIG#D
74, v
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
EXT 1333
FEE Description
State Surcharge
T77 City Surcharge
I I / Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
this application is not a perinil until signed by the
Building Official or his/her Deputy. and Fees are paid. and
receipt is acknowledged in space provided
OFF7LS IGNA I /TU F DAI
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RELEASED BY j5ATE if
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
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ENGINEERING DIVISION DATE i
PLEASE%IGN 0
PLANNING DIVISION DATE
PLEASE SIGN 9
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PROJECT C
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SITE ADDRESS- 0 C:
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# ADB# DATE INSPECTED M Z
PERMIT 194-6� K 0 -1
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DESCRIPTION OF WORK TO BE INSPECTED IMCV60 S WSL
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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: M M
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-GRANT FINAL PROJECT APPROVAL Z
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector CD
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FAELED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
1.
2.
3.
RE-fNSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:ten1p:b1dg:rorms:ocaprv1 3/25/04
I
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall....................
Pier/Porch .............
Retaining Wall ............
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0
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:Slab Insulat* n ...........
0
PLUMbING:
Underground ............
--I
Rough -in ............... !;..i -
---------
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C
M
Commerc0 Final . ......
0
0
0
C:
HEATING:
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Gas Test ....................
Ga� Piping .................
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Equipment .................
0 -n
Commercial Final .......
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EXTERIOR SHEATHING
--I
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NAILING ..........................
0
0
FRAMING ........................
0 M
C Cn.
FIRST FLOOR FRAMING ...
9 Cn
Q 0
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INSULATION ...................
A
X
Floor Insulation .........
--I
Wall Insulation ...........
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Ceiling Insulation .......
M
Cn
SHEETROCK NAILING ...
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0
SPECIAL INSPECTION ...
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0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
IV;
OCCUPANCY ..................
7 97