20040880.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNERPE/NAME OF BUSIVESS
MAILING ADDRESS
CITY ZIP
NAME
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CITY zip
NAME
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ADDRESS
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ZIP
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STATE LICENSE NUMBER
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PROPERTY TAX ACCOUNT PARCEL NO.
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TELEPHONE
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TELEPHONE
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EXPIRATION DATE E
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE QF USE, BUSINESS 09 ACTI�.R EXPLAIN:
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uj NUMBER NUMBER OF
0 OF DWELLING
UNITS
0 STORIES
DESCRIBE WORK TO BE DONE
HEAT SOURCE
GLAZING %
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
EFENCE
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OTHER
FIRE SPRINKLER
FIRE ALARM
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CRITICAL
AREAS
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NUMBER
LOT SLOPE %
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PLAN CHECK NO: 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 1 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 CIT-Y OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECILY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
7
j PERMIT EXPIRES
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u PERMIT
ZONE
NUMBER
U-1- L'Le�3a�
JOB SUITE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
TESCP App(croad [3
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required D
Street Use Permit Roq'd E3
EXISTING — PROPOSED inspection Required [3
Sidewalk Required 13
Underground
REQUIRED DEDICATION— FT Wiring required 13
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 No
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REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE G
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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 LADQLLCODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEJWa-CGMPENSAV0Q INSURANCE AND RCW 18.27.
DATE S�I�NED�
I DATE
ENGINEERING REVIEWED BY rihil�- MAKSHAL
P IR c OF N T Fn PL_
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FIRE REVIEWED!ANK FILL, t9%r_-A%0VAL, OR CW0 cc
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VARIANCE OR CU SHORELINE OR ADB# INSPECTION I BOND
REO'D POSTED
111YES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED I PROPOSED ALLOWED , PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE
REO'D I PROVIDED
REMARKS
CHECKED BY jTypE_7MrN C�Df�2 OCCUPANT.
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REOUIREDE] YES LOAD
REMARKS z
PROGRESS INSPEC11ONS PER UBC 108/ IBC109/ IRC109 FINAL INSPECTION REO'D -
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
I I I -ur-r.111,111
ATTENTION EXT 1333
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.
FEE Description FEE
State Surcharge
City Surcharge P-5
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
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.
OFFICIALS SIGNATURE DAT
17
7
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
BY
ORIGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER GOLD-ASSEsson
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: C --------FIRE DEPARTMENT DATE,�L__L/
OLrASP SIGN
ENGINEERING DIVISION DATE
P1.13ASE SIGN
PLANNING DIVISION DATE
I'MASL SIGN
PROJECT
SITE ADDRESS- C, t,6/
PERMIT# 2_(J ffS_ 0 ADB# DATE INSPECTED 1A Y
DESCRIPTION OF WORK TO BE INSPECTED
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 tile release of
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by inspector
I .
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:temp:b1dg:fomis:oca1)rv1 3/25/04
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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:
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 APRwVA6-RW 0
j)zew%Rff'cy ..................
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