20040816A.pdfDATE RECEIV
PERMIT EXPIRES
USE PERMIT
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CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB RE SUITEIAPT#
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PLAT NAME/SUBDIVISION NO LOT NO. LID NO.
MAILING ADDRESS LID FEE S
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Br: PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW Permit Floquirod [3
0 _0 _0 Street Use Permit Roq'd 0
CITY EXISTING — PROPOSED inspection Required 13
ZIP TELEPHONE Sidewalk Required [3
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C) REQUIRED DEDICATION— FT 0
Wiring required
NO. OF FIXTURES PRV REQUIRED
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YES NO 13
NAME METER SIZE
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1= ADDRESS REMARKS z
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE Z5
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STATE LICENSE NUMBER E'l(PIRATION DATE ECK RE 0 POSTED
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PROPER TAXii�,COUNT PARCEI I UUMPI-hit: , EX T ALLOWED PROPOSED ALLOWED PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
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ADDITION COMMERCIAL z
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PARKING LOT AREA REVIE D BY DATE
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REMODEL MULTIFAMILY SIGN REO'D I PROVIDED
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'W WUMBER No BER dF CRITICAL :zNAL_ 1 0? 3 &,
0 OF DWMELLING AREAS SPECIAL INSPECTION AREA OCCUPANT
M UNITS NUMBER REQUIRED [] YES LOAD
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11—Atf OA-clYr, hor-(A Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHE�K 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.
Engr. Review
PERMIT APPLICATION: 180 DAYS
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IL PERMIT LIMIT. I YEAR"PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'N 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
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Ul 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
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
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0 NOR LIMIT IN ANY WAY THE CITYS ABILI1Y TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt N
1 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 APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED 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.
WORKME
,�MPENSAT!99:1qS�R,ANCE AND RCW 18.27.
OFF1 S RE DATE
N OW DATE GNIED (425)
771-022U REL D BY /1DA
A17ENTION E)ff 1333
ITIS UNLAWFULTO USEOROCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL -FILE YELLOW - INSPE TOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. 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: ;5��2 C__�* FIRE DEPARTMENT DAT
PLEASE SIGN
ENGINEERING DIVISION DATE
PLEASESIGN
PLANNING DIVISION DATE
I'LrASC SIGN
PROJECT /V
SITE ADDRESS- 91- 3 b'L/
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PERMIT #21�20�j- ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED lFCItL61
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
PERF ORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
E3 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
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:teni1):b1dg:fbrms:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Foob......................
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Wall...........................
Pier/Porch .................
Ret4ining 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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