20040912.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER IN E/NAME OF BUSINESS
MAILING ADDRESS
CITY IT VLEPHONE
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NAME
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STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
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CARPORT
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PLUMBING / MECH
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NUMBER
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PLAT NAME/SUBDIVISION NO
PERMIT EXPIRES —,
PERMIT
NUMBER
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LOT NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
SUITE/APT#
LID NO.
LID FEE S
TESCP Approved
RW Permit Required
Street Use Permit Ro(I'd
Inspection Required
Sidewalk Hequired
Underground
Wiring required
PRV REQUIRED
YES 11 NO 1:1
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
VARIANCE OR CU I SHORELINEORADEIN
SEPA REVIEW L: S)
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DATE
DATE
INSPECTION I BOND
REO'D POSTED
OYES ONO $
HEIGHT
ALLOWED . PROPOSED
PARKING LOT AREA I PLANNING REVIEWED BY
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REMARKS
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Description
Plan Check
Building Permit
Plumbing
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 Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
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PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
CODE
FEE Description
State Surcharge
city Surcharge
Base Fee
FEE
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
M IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
ANY AND
Receipt
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM
Fire Inspection
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4 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
71HIS SHALL NOT 13E
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF PERMIT
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Total Amt. Due
9 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Receipt H
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION..
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
This application is no I a permit until signed by the
/THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
Building Olficial or his/tier Deputy: and Fees are paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
TLIC I AnnO �nnf: OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged in space provided. —
IN VIOLATION OF
WORKMEN'S COMPENSATq*C7S1cI(1ANCE AND RCW 18,27. DA7
OFXICIAL I N URE
SIGN (OWNER OR GENT DATE SIGNED (425)
rjATE
771-0220 RELEASED BY
ATTENTION EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBCi10/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD -ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: C-1. FIRE DEPARTMENT DATE
PLEALSE SIGN
ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE
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PERMIT #_2t, �I'L( ADB# DATE INSPECTED
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DESCRIPTION OF WORK TO BE -INSPECTED C-)/L_\qq &
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 the release of
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PERFORMANCE BONDS and the granting of:
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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El Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sigiiature
1:tenip:b1dg:forius:ocaprv1 3/25/04
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NSPECTIONS
RECORD OF I
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch ................. z
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Retaining Wall ........... --I
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Slab Insulation ..........
PLUMBING:
Underground .............
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Rough -In ................... M 0
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Commercial Final ......
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HEATING: M Z
Gas Test .................... C _Z
Gas Piping .................
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Equipment ................. _n
Commercial Fina I ....... x
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EXTERIOR SHEATHING
NAILING .......................... 0
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FRAMING ........................ (n
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FIRST FLOOR FRAMING... Z r-
INSULATION ...................
Floor Insulation .........
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Wall Insulation ........... --I
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Ceiling Insulation ....... Cn
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ... M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................