20040937.pdf11
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DATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME NAME OF BUSINESS
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MAILING ADDRESS /t /) 7
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CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY I V /zip ITELEPHONE
PERMIT EXPIRES ZI &j1Z=72—
SE PERMIT f-T-
ZONE NUMBER 7
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PLAT NAMEISUBDIVISION NO. LOT NO, LID NO,
LID FEE $
-TESCP Approved
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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Fiw Permit Required
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E EXISTING - PROPOSED
Inspectwn Required
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S,d,,aj. Required
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REQUIRED DEDICATION- FT
Underground
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wiring required
M M ETER SIZE
LINE SIZE
NO. OF FIXTURES
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PRV REQUIRED
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YES 0 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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NAME FqC0 CBL #
ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY
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C'206 - _'� 7 VARIANCE OR CU HORELINE OR ADBI I INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE K Y REQ'D POSTED
/ Lf 6(110 &7-rp �1 SEPA REVIEW SIGN AREA OYES ONO S HEIGHT
< PROPERTY TAX AC 0 ��L N COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED I PROPOSED
EXP
NEW U--- �ESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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ADDITION F� COMMERCIAL E
CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE 5
REMODEL E] MULTIFAMILY SIGN REO'D PROVIDED
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REPAIR GRADING CYDS n ( X FT) REMARKS
OTHER
DEMOLISH 03-*'TANK 1:1
GARAGE o RETAININGWALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE -OF USE. BU INES EXPLAIN:
L 5 F4 OR AC;WrrY) CHECKED BY :�=T jrON JU9. OCCUPANTe
7AIVI'( i)(vco /-<Z I aA f. wrl GROUP
W NUMBER NUMBER OF CRITICAL
In OF DWELLING AREAS SPECIAL INSPECTION JARtA OCCUPANT
In NUMBER REQUIRED [] YES LOAD
0 STORIES UNITS
DESCRIBE WORK TO BE DONE
REMARKS z
ClIzi PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REQ'D
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Description FEE Description FEE
HEAT SOURCE GLAZING % LOT SLOPE % Plan Check State Surcharge
1 Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
L_ BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
Lu PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION p
U) 8APPLICANT, 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
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt #
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT HE Landscapeinsp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE A I
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I NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION AP LICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a pOrMit Until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and roes are paid, and
IN VIOLAT124,4,OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION rece)pt is acknowledged in space provided.
WORKMEr 2� PENSATION INS��CE ANDXW 18 27. :;IALS I DATE/
OFFICI I
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E jOW ER OR AGE DATE Nt7 (425)
JG�NED
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�) 1/ 771-0220 RELEASED BY U DfE-"
ATTENTION EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A 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:
M[EMO TO: PERMr�3� _)63W&OR,,,.UILDING DIVISION
FROM:
� t U, FIRE DEPARTMENT DATE
""Z"SE SIGN /
I ENGINEERING DIVISION DATE.
PLEASESIGN z
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PLZASH SIGN M
PROJECT q =5
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DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine final 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
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
c3 Copy of CONDITIONS given to owner/contractor by inspector
1 .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
1 .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign�
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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 FOR
OCCUPANCY .................. ire
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