20040935.pdfFDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ERJNAME/NAME OF BUSNESS I -
MAILING ADDRfSS_ ,j
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NAME
ADDRESS
CITY ZIP
TELEPHONE
K19119A
JOB
ADDRESS _0
PLAT NAME/SUBDIVISION NO.
PERMIT EXPIRES �-
PERMIT
NUMBER
ILOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE LINE SIZE NO. OF FIXTURES
SUITEIAPT#
LID NO.
LID FEE $
TF—SCP Approved
RW pernul Required
Street Use Permit Req'd
Inspection Required
Sidewalk Required
Underground
Winng required
PRV REQUIRED
YES E3 NO 13
REMARKS
OWN ER/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINdk MEVII1
ADDRESS
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CITY Z' ITELEPHONE
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TAX ACCOUJilT PARCEL NO.
NEW
;5�_RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
El
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
n
SIGN
REPAIR
GRADING
CYDS
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FENCE X
FT�
DEMOLISH
1:1 TANK
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OTHERMj�,
EGARAGE
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RETAINING WALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINESS QB-Ai;TIVITY) EXPJ-AIN:
NUMBER NUM13ER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORkTO 13E DONE
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
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: 180DAYS
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 CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
FIRE REVIEWED BY
DATE
DATE
VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
REO'D POSTED
OYES ONO I s
SEPA REVIEW
COMPLETE EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D I PROVIDED
REMARKS
CHECKED BY
L)
SIGN AREA HEIGHT
ALLOWED . PROPOSED I ALLOWED , PROPOSED
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR FRONT LJR SIDE REAR
LOT AREA I PLANNING REVIEWED BY
SPECIAL INSPECTION JAREA
REOUIREDE] YE
DATE
OCCUPANTI,L
GROUP
OCCUPANT
LOAD
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REMARKS 0
PROGRESS INSPEC71ONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REQ'D
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
FEE Description
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt 9
Total Amt. Due
Receipt #
I
FEE
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 I his 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 VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided..
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. FF I ISJIGNATURE A D—VE _T
SIGNATURE (OWNER OR ENT) DATE SIGNED (425)
zg� -1 . -0220
771
A17ENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
BY
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD � ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DATV��
FROM
t I PLEASI! SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PI.EASr SIGN
PROJECT 4,16 _21' 4
�_ ? �- sik/
SITE ADDRESS 2, ? ).-t-to
PERMIT #"�-()Q (_(—_Q q'; —ADB# DATE INSPECTED
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 the release of
PERFORMANCE BONDS and the granting of:
6, -30 C'
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
El Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED 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 ................. z
0
Retaining Wall ...........
0
M
Slab Insulation ..........
PLUMBING:
Underground ............. 0 M
C
Rough -In ................... M
0
-40
Commercial Final ...... 0 C
M
HEATING: M Z
Gas Test .................... C
Gas Piping .................
Equipment ................. 0 -n
n
Commercial Final .......
M M
EXTERIOR SHEATHING 0 _Cn
NAILING .......................... 0 r-
0 M
C Cn
FRAMING ........................
w
ITI 0
Z
FIRST FLOOR FRAMING ... I
INSULATION ...................
Floor Insulation ......... >
z
Wall Insulation ........... --I
Ceiling Insulation ....... C/)
z
SHEETROCK NAILING ... 0
SPECIAL INSPECTION ... ITI
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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