20040882.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNE 4AME/NAME OF BU , SINE�
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MAILIN,�ADDRESS
CITY 71 TELEPHONE
NAME
ADDRESS
01 ��
USE
ZONE
JOB
ADDRESS
PLAT NAME/SUBDIVISION NO,
PERMIT EXPIRES
PERMIT
NUMBER
SUITE/APT#
LOT NO. LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
TE—SCIP Appiroved
RW polmll Requoind
Street U50 pormit Rori'd
Inspoction Roquirad
SIdewillik Roquired
underground
wiring laquirad
PRV REQUIRED
YES 0 NO 0
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP TELEPHONE t"_M?
U - i - !CF.= R e 7, 77- =11
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STATE LICENSE NUMBER EX7PRATI 3 DATE HECK BY DING I� EjgjNO FZy rR T)
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PROPERTY TAX ACCOUNT PARCEL NO. COM LE PAILL
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OPOSED SETBACK
E] NEW KRESIDENTIAL PLUMBING MECH ALL --fRoal - JIM REAR_ FRONT UR SIDE REAR'
COMPLIANCE OR
ADDITION f__j COMMERCIAL CHANGE OF USE
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED
GRADING FENCE
REPAIR CYDS ( X FT) REMARKS
OTHER
E] DEMOLISH TANK
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY El FIRE ALARM
ITYPE OF USE, BUST OR ACTIV[M EXPLAIN: CHECKEDBY ITYPEIIS ICTION OCCUPANT
NT GROUP
u3 NUMBER NUMBER OF
CRITICAL
OF DWELLING AREAS SPECIAL INSPECTION —I AREA OCCUPANT
M NUMBER REQUIRED LOAD
o STORIES UNITS
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/iSC109/iRC109 FINALINSPEC11ON REQ'D 5
at
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 7THIS PERMIT COVERS WORK TO
It BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
cc
Ld PERMIT APPLICATION: 180 DAYS
EL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'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
2 EDMONDS, WASHINGTON, IFS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALI. CLAIMS FOR DAMAGES OFWHATEVER NATURE, ARISING OIRECTLYORINDIRECTLY
FROM THE ISSUANCE OF rHIS PERMIE ISSUANCE OF THIS PERMIT SHALL. NOT BE
Landscapeinsp. Total Amt. Due
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE Cl LYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION Recording Fee Receipt #
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY wi'm CITY AND STATE LAWS REGULATING CONSTRLIC- 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 LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO FORINSPE receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. OF CI SIGNATUZRE D E
SIGNA%UF 6WNER AGEN DA SIGNED (425)
c7
7 -0220 )ASFD BY
7 0 71 DATE
ATTENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL -FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/1RC110. 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
IGN
h- ENGINEERING DIVISION DATE,/
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DESCRIPTION OF WORK TO BE INSPECTED VALA f�Z- L.1 PZ-,q-c A,,f
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A field inspection was conducted to determine compliance with -approved plans. Final approval
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denotes that there are no objections from the above signed Department to tile release of
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PERFORMANCE BONDS and the granting of:
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by inspector
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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:ten1p:b1dg:forms:ocaprv1 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:
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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