20040791.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
CITY
NAME
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ADDRESS
CITY
LICENSE NUMBER
ZIP I TELEPHONE
ZIP I TELEPHONE
DATE
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PERMIT EXPIRES,,,.g
USF PERMIT
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NUMBER /,�
JOB SUITE/AV i ff
ADDRESS I(P I I 1�;L Q (oil) 2� _: "L
PLAT NAME/SUBDIVISION NO. LOT NO.
LID NO.
LID FEE $
TESC P
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW p,,:jPR"oVq'.'i10d
EXISTING ---� P�9�SED
Street Use porouit floci'd E3
inspection Required
Sidewalk Required ff
REQUIRED DEDICATION- FT
underground
± .. ngoquilad E3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES NO 13
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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PROPERTY TAX ACCOUNT PARCEL NO.
2,
NEW
RESIDENTIAL
PLUMBING / MECH
ADDITIO N
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYOS
FENCE X %50FT)
(
DEMOLISH
TANK
OTHER
cGARAGE
o
RETAINING WALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
0 (2� " Nr/\ IZ� 0 -Y
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS ir NUMBERG-I-) Lk.!5
DFSCRIBEIV� BE DONE
HEAT SOURCE I GLAZING %
PLAN CHECK NO:
LOT SLOPE %
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'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 WHA`4'EVER NATURE, ARISING DIRECTLY Oil INDIREC1 LY
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
NOR LIMIT IN ANY WAY THE CITYS 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 COMPE N SATIONIN SU RANCE AND RCW 18.27.
SIGNATILRE (OWNER OR(AGENJ6. DATE S19NED
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEYPT
EXP I x"
LOT COVERAGE
ALLOWED PROPOSED
DATE
DATE
IORELINE OR ADB11 I INSPECTION I BOND
REq'D,- POSTED
OYES )qNO S
SIGN AREA HEIGHT
ALLOWED PROPOSED PROPOSED
",OW7
6 6
REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT QRSIDE REAR
PARKING I LOT AREA R� NING ROWE5, BY DATY
REO'D I PROVIDED
REMARKS
CHECKED BY
SPECIAL INSPECTION
REQUIRED [] YES
CONSTRUCTION
EA
GROUP I
OCCUPANT
LOAD
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REMARKS a
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PROGRESS INSPECTIONS PER UBC 108/ IBC109/ IRC109 FINAL INSPECTION REQ-D
VALUATION
$
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscape Insp.
Recording Fee
FEE Description
State Surcharge
10 City Surcharge
Base Fee
C_� � )t
'k-
CALL
FOR INSPECTION
(425)
771-0220
ATTE TIOW EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110,
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAI
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.
:Fl6ALA--S)G NATURE / ) 15ATE
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
BY * / DAT
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
FLFASE SIGN
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PLANNING DIVISION DATE
MY -ASP SIGN
PROJECT 12 &u AL a
SITE ADDRESS 06//
PERMIT #Zaaz_t—_ 0 7 �2 / _ADB#_ *DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
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
u Copy of CONDITIONS given to owner/contractor by inspector
1
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch ................. z
0
Retaining Wall ...........
0
ITI
Slab Insulation ..........
PLUMBING:
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Underground ............. 0 M
C 0
Rough -In ................... ITI 0
--1 0
0 C:
Commercial Final ...... --I
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HEATING: rn z
Gas Test .................... C —Z
Gas Piping .................
0 _n
Equipment ................. _n
Commercial Final .......
rn M
EXTERIOR SHEATHING 055
NAILING .......................... 0
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FRAMING ........................ (D
rn o
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FIRST FLOOR FRAMING ... __4
INSULATION ................... ;U
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x
Floor Insulation ......... >
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Wall Insulation ...........
Ceiling Insulation ....... Cn
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0
SHEETROCK NAILING ... i
0
SPECIAL INSPECTION ... 171
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
Tile initials MT are Miltol,
Thompson, a tclllporary contract
inspector for tile City.