20040914.pdf0
FDATE REC
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PROPERTY TAX ACCOUNT
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ADDITION
REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
(TYPE OF USE, I
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ZIP
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TELEPHONE
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ErR`ESIDENTIAL
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MULTIFAMILY
GRADING
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OR ACTIVITY) EXPLAIN:
USE
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JOB
ADDRESS
PLAT NAME/SUBDIVISION NO.
PERMIT EXPIRES
PERMIT
NUMBER
41=�
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
4Z) REQUIRED DEDICATION- Fr
METER SIZE LINE SIZE _F NO. OF FIXTURES
SUITE/APT
LID NO�
LID FEE $
TIESCP Approved
RW Permit Raquurid
Street Use Pormit Aeq'd
Inspection Required
Sidewalk Required
Underground
Meng required
PRV REQUIRED
YES13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIORAINAGE
CBL #
N K
ENGINEERING REVIEWED BY
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PLUMBING if MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
EiFENCE
( X Fr)
OTHER
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FIRE SPRINKLER
FIRE ALARM
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NUMBER
NUMBER OF
CRITICAL
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OF
DWELLING
AREAS
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STORIES
UNITS
NUME
DESCRIBE WORK TO BE DONE
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HEAT SOURCE
GLAZING %
LOT SLOPE %
PLAN CHECK NO, VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU13LIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 160 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 DIRECI LY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF T141S PERMIT SHALL NOT BE
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO 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
11:11F OWNER. I AGRiE 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 LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
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S��IGNATUR,e( WNERORtGjE DATE
FIRE REVIEWED BY
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DATE
DATE
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VARIANCE OR CU
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INSPECTION
BOND
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POSTED
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SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP I
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LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/RSIDE REAR
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PARKING
LOT AREA
PLANNING REVIEWED BY DATE
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REQ'D I PROVIDED I
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REMARKS
CHECKED BY I TYPE OF
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 10B / ISCII 09 / IRC109 FINAL INSPECTION REQ'D
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
Z6
City Surcharge
I
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
501-
Recording Fee
Receipt #
_L�f
CALL
FOR INSPECTION
(425)
771-0220
APPLICATION APPROVAL
I his application is not a permit until signed by the
Building 0iticial or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
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j5A ZT1. I R E DATE
-flEeCiSeD By'_ D�&E
ATTENTION E)ff 1333
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/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- E
FIRE DEPARTMENT DAT
PLEASESIGN
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ENGINEERING DIVISION DATE
PLEASUSIGN
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PLANNING DIVISION DATE
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PERMIT ADB# DATE INSPECTED- JO --i
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DESCRIPTION OF WORK TO BE INSPECTED fls-rl eoA-,�' ez sic
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A field inspection was conducted to determine compliance with -approved plans. Final approval nx
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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: 0 &5
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
F� 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 inpcctor
2.
3.
RE-fNSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1: temp:bldg: forms: ocaprvl 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch ................. ---------
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Retaining Wall ........... ---------------
0
Slab Insulation ..........
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P LUMBING:
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Underground ............. --------------
0 M
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Rough -In ................... ---------------
0
0
0
Commercial Final ...... -------------
C:
-1 K
3: M
HEATING:
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Gas Test ....................
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Gas Piping ................. --------------
Equipment .................
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Commercial Final .......
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EXTERIOR SHEATHING
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NAILING.......................... -------------
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FRAMING........................ . — ------
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FIRST FLOOR FRAMING...
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INSULATION ................... --------------
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Floor Insulation .........
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Wall Insulation ...........
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Ceiling Insulation .......
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SHEETROCK NAILING ... ------------
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---------------
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................