20040892.pdfDATE RECEIVED ERMIT EXPIRES
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USE PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB In � - / SUITE/APT#
ADDRESS lot
OW ME OF BUSINESS
,,PER NAME/NA
C, PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
cc MALIN6 ADDRESS LID FEE $
z TESCIP Approved 0
:11 6 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP HIN Petnitt Required 13
0 .— :2 S Ll C1 '21 stinat use Permit oq'd [3
CITY gip TELEPHONE EXISTING — PROPOSED inspection Reciuve 0
Sidewalk Required 13
REQUIRED DEDICATION- FT unfierground
-775-/0 . Wiiing required [3
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YESIJ NO 13
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OWNER/CONTRACIOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE Z5
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COMPLIANCE OR 'V%0WAM
ADDITION COMMERCIAL El CHANGE OF USE Ann rkmir I , sum
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REMODEL 1:1 MULTIFAMILY E] SIGN RE -290rJ399
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GRADING FENCE
REPAIR 1:1 CYDS X FT) REMARKS
DEMOLISH 11 TANK OTHER
o GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT 13 ROCKERY FIRE ALARM
" (TYPE OF USE. BUSINESS 01�AcTIVITY)) EXPLAIN:
rL CHECKED BY ITYPE 01 S t CTION OCCUPA
0 KPVYI& VLI"& GROUP
13 NUMBER NUMBER OF CRITICAL
0 OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
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0 STORIES UNITS NUMBER REQUIRED [] YES LOAD
DESCRIBE WORK TO BE DONE
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PROGRESS INSPECTIONS PER UBC 108/IBC109/[RC109 FINALINSPECTION REQ'D
VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge _L2
PL-AN CHECK NO: VESTED DATE Plumbing Base Fee
I 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
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
Lu PERMIT APPLICATION: 180DAYS
CL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION c!20
'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, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
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4 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECI LY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERM11 SHALL NOT 13E
9 DEEMED TO MODIFY� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE LandscapeInsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
Il - --- - Recording Fee Receipt # 5
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/tier Deputy: and Fees are paid, and
IN V61LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknol�keclged in space provided,
OM N IN RANCE AND RCW 18.27.
OFF A S IGNATUR DATE
SIGNATURINNER 0 �GE DATE SIGNED
(425)
771-02 _rAS . ED BY
ATTENTION EXT 1 33
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING 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
PLEASESIGN
T n ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT
SITE ADDRESS— 92�3 S
AO
PERMIT# ADB# DATEINSPECTED
DESCRIPTION OF WORK TO BE INSPECTED WSL—
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
PERFORMANCE BONDS and the granting of:
X GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 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:tcmp:b1dg:fbrn1s: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:
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 EaR W
OQCJ4AaAr4CY ..................
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