20040943.pdfDATE RECEIVED z [PERMIT EMPIRES
USE PERMIT
CITY OF EDMONDS ZONE 6 NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS L7
OWNER NAME/NAME OF BUSINESS 7r, 1)
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ELC -MAILING ADDRESS LID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required [3
street use Permit Roq'd 0.
34 PC) e; inspection Required
CITY ZIP NE EXISTING PROPOSED Sidewalk Required
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NAMF, METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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'Y�a&14�ACC -1 74-26, VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
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NUMBER OF CRITICAL ;,D / -
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PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINALINSPECTION REQ'D
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
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PLAN CHECK VESTED DATE
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Plumbing Base Fee
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS wonK TO
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t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 Grading
:3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. Engr. Review
uj PERMIT APPLICATION: 180 DAYS
91. PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) OAPPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
q 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 N
ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALT Not 13E
C] DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. ue
0 NOR LIMIT IN ANY WAY THE CIIYS ABILITY 10 ENFORCE ANY ORDINANCE PROVISION'
ml Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION IN,
—GIVEN IS CORRECT; AND T14AT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
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THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
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TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her 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.
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ORKMEN'S COMPENSATION INSURANCE AND RCW 10 27.
lt—� ALS S19TATURE DATE
4ATUREk.,NIER OR.CAGENT) DATE SIGNED (425)
771-0220
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ATTENTION EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- V
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PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK - WN - GOLD - ASSc,,SOR
09103 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
I M�'fl ENGINEERING DIVISION DATE
'OLEASt SIGN -
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT &10n 6MIUL
SITE ADDRESS- -I!doq WL Sf SW
PERMIT # 43 .—ADB#_DATE INSPECTED—Lq-14m—
DESCRIPTION OF WORK TO BE INSPECTED S1
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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_gONDS and the granting of:
X GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El 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:b1dg:fonns: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 FOR
OCCUPANCY ..................
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