20040826.pdfDATE RECEIVED
PERMIT EXPIRES
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USE PERMIT
CITY OF EDMONDS ZONE UMBER
JOB uiTE/APT#
CONSTRUCTION PERMIT APPLICATION
ADDRESS
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0 ER NAME/NAME OF BUSINUPS
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
LID FEE S
UM MAILING ADDRESS CP to
j tTESCP Appioved [23
E7 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Perain R(IqUlrod 13
0 Sliest use Potoll, Req*d 13
inspection floquired C3
CITY FlP.'? TELEPHONE EXISTING - PROPOSED sidewalk Required E3
undelground
C, REQUIRED DEDICATION- FT - wiling req ... ed 01
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NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
NO 13
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I= ADDRESS REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP TELEPHONE rT�17V A TYM �T. Ir e%- 41W
USED INWATER SE iWIr � 1.1" � NIME)
NAME CBL4 THAT WHERE METAL WATER S117RVIC 7.
lal ENGIN RIV-PNNEPY IS USED FOrt *.TCTRICA
cc ADDRESS
0 GROUNDING PUPMO'�r7�, Pr-7LACEME _P uj
FIRE vJWWU0"11_AA,LBE(N.77 �775AYOALS (UP;uj
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STATE LICENSE NUMBER EXPI"ON DATE CHECKE',BY REO PO
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61 GROU11DING IS AL-byEgj2% A�MUVED
'55eT-<'FNC1 S V_�UV_UKNAEOU '-. I '( !\ � ; 1.
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LO COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FF.)
NEW RESIDENTIAL PLUMBING MECH ALLOW PROP"We"a RHINO 91126 ic) R1171c; PPAR z
A COMPLIANCE OR z
ADDITION COMMERCIAL CHANGE OF USE
PARKING LOT AREA PLANNING REVIEWED By DATE
REMODEL MULTIFAMILY SIGN REQ'D I PROVIDED
GRADING FENCE
REPAIR CYDS ( X FT) REMARKS
DEMOLISH TANK El OTHER
GARAGE RETAINING WALL IRE SPRINKLER
z CARPORT ROCKERY El FIRE ALARM
(TYPE OF USE, BU.W� 08 ACTfililTY) EXPL�IN, OCCUPANT
E CHECKED BY TYPE O?jN 5PTC;
re I A Q .' a � �) it', "- \ GROUP
CRITICAL ucl
W NUMBER NUMBER OF OCCUPANT
0 OF DWELLING AREAS SPECIAL. INSPECTION JAREA
M I UNITS NUMBE LOAD
0 STORIES A R REQUIRED [] YES
DESCRIBE WORK TO BE DONE
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINALINSPECTION REQ'D
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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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CL PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V) -APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
I EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECT LY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
a Landscapeinsp. Total Amt. Due
j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0
I NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Recording Fee Receipt #
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 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.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. OFFI rAIGNATURE /DE
SIGNkT (OWNER 0 GEN DATE SIGN (425)
771-0220 R EASED BY DAT�
AfTEINTI'dN Off 1343 -
ITIS UNLAWFULTO USEOR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL - FILE - YELLOW - INSPECTOR
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: FIRE DEPARTMENT DATE
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A, L r ___�ENGINEERING DIVISION DATE
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DESCRIPTION OF WORK TO BE INSPECTED fakil
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
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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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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
o Copy of CORRECTION NOTICE given to owner/contractor by inspector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
ocaprv1.doc.1:tenip:b1dg:fomis 10/0 1
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FO U NDAT ION:
Footing., ....................
Wall............................
Pier/Porch
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a ..
R I etaining Wall ............
Slab Insulation ..........
b
PLUMBING:'�
Underdround . ..............
Rough -in ....................
Commercial Final
HEATING:
GasTest ....................
GasPiping .................
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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