20040875.pdfDATE RECEIVED le9,
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
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PROPERTY, TAX ACCOUNT PARCEL NO
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ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
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TANK
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CARPORT
ROCKERY
(TYPE OF USE, BUSINESS 0 ACTIVITY) EXPLAIN:
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SUITE/APT#
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
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LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
13
13
Street Uric Permit Roq'd
13.
EXISTING PROPOSED
Inspection Required
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Sidewalk Required
13
REQUIRED DEDICATION FT
Underground
Wiring reqmrad
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YES 13 NO
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REMARKS
OWNER/CONIRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
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VARIANCE OR CU HORELINE OR ADBI I INSPECTION I BOND
REO'D POSTED
OYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIFT SIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE 5
REO'D I PROVIDED i a.
REMARKS
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SPECIAL INSPECTION JAREA
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REMARKS
iPROGRESS INSPECTIONS PER UBC
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HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: 0 �/, Z//— I VESTED DATE
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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: 180 DAYS
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 WHATEVER NATURE. ARISING DIRECTLYORINDIRECILY
FROM THE ISSUANCE OF rHIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT- OF ANY CIrY ORDINANCE
NOR LIMIT IN ANY WAY THE CI FYS A1311.11Y 10 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 LABPR CODE OF THE STATE OF WASHINGTON FIFLATING TO
WORKMENfS COMPENSATIO14 INSURANCE AND RCW 11127.
I STGE (0wJMECNTV/ DATE SIGNED
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Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
CODE
OCCUPANT
AlGROUP
OCCUPANT
LOAD
IBC109/IRC109 FINAL INSPEC11ON REQ'D I I
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FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
I his application is not a pennit until signed by the
Building 011icial or his/her Deputy: and Fees arc! paid, and
receipt is acknowledged in space provided
OFFICIAIS SIGNATURE DAT F
14 F I FX4 1) R� DATE
ATTENTION- ' EXT 1333 U4
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE ANDAPPROVAL OR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBCiO9/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
3
ORIGINAL FILE
PINK OWNER
ELLOW- INSP
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*Fence njust be located on private property.
eProperty owner responsible for determining
property lines.
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Fence -shall not enclose or prevent acces
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APPIHOVED AS NOTED
BY ENGINEERING
Date:
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASESIGN
ENGINEERING DIVISION DATE,3
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE StGN
PROJECT
SITE ADDRESS
PERMIT Zi- _ADB# 'DATE INSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED 4-1CJ
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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
o Copy of CONDITIONS given to owner/contractor by inspector
I .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
o Copy of CORRECTION NOTICE given to owner/contractor by inspector
I .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_—
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION,
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final ......
HEATING:
GasTest ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
F L
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
The Initials MT are Milton
Thompson, a temporary contract
inspector rol. tile City.
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