20040954.pdfFINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
U)LL��ENGINEERING DIVISION DATE
_rLWE SIGN
PLANNING DIVISION DATE
P1 EA E SIGN
PROJECT
SITE ADDRESS
PERMIT ADB# 'DATEINSPECTED
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:
/Y GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
o Copy of CONDITIONS given to owner/contractor by inspector
I .
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
ocaprv1.doc.1:temp:b1dg:fbmis 10/0 1
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ............... e ..........
Pier/Porch ......
Retaining Wall ............
Slab Insulation ..........
PLUMBING:
Underground .............
Roulgh-1n; ...................
Comm�tci�ai 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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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
CITY ZIP TELEPHONE
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NAME
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CITY ZIP I TELEPHONE
NAME
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ADDRESS
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBEh EXPIRATION DATE
U N IT-C S -1 1 -7 (ft ((,6 --� /I, It) �,
PROPERTY TAX ACCOUNT PARCEL NO.
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
1:1 REMODEL
E3 MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
11 2 5 1 P A- R.4 <
NUMBER
NUMBER OF
OF
DWELLING
1+
STORIES
UNITS
DESCRIBE WORK TO BE DONE
HEAT SOURCE I GLAZING %
PLAN CHECK NO:
PLUMBING / MECH
COMPLIANCE OR
OF
CHANGE USE
SIGN
FENCE
( X FT)
OTHER
SPRINKLER
EiFIRE
FIRE ALARM
PERMIT EXPIRES
USE PERMT
ZONE NUMBER
JOB
sUITE/APT#
ADDRESS
0-7
PLAT NAME/SUBDIVISION NO.
LOT NO,
LID NO.
IJJ I LJA r,.* 17 P L P r �, I -�., f
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LID FEE $
TESCP APPfOvOu
0
PUBLIC RIGliT OF WAY PER OFFICIAL STREET MAP
HW ppro,11 Required
street use Permit Roq'd 0
EXISTING — PROPOSED
inspection Required 13
Sidewalk Required [3
REQUIRED DEDICATION— FT
Underground
winng required 13
SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIFIED
IMETER
I
YES 0 NO Ej
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU
SEPA REVIEW
COMPLETE , EXEMPT
EXP x
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REQ-D I PROVIDED
REMARKS
SHORELINEORADBI I INSPECTION tj No
RE9
P 00 9, T E D
OYES No S
_J�
N AREA HEIGHT
ALLOWED PROPOSED
PROPOSED I
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REQUIRED SETBACKS (FT) PROPOSED SETBACKS [FT)
FRONT SIDE REAR FRONT UR SIDE REAR
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DATE
CHECKED BY. ]TYPE OF �� I '" FAV
GROU P
CRITICAL 7AREA
AREAS SPECIAL INSPECTION PANT
T' OCCU
NUMBER S ELOAD
REQUIRED [:] YES
REMARKS
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PROGRESSINSP CTIONS PER USC 108/IBC109/IRC109 FINAL INSPECTION REO'D
Is
A %j 1� I a]
LOT SLOPE %
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: 160 DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHAI F 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 FROfA ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREc ny OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
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.,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
CK'
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
T T
HE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
0
T TI AND IN I
ION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
VI
T�ON
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
0
Wo 'ENS C
WORKMEN'S COMPENSAT19XJNSL�RANCE AND RCW 18.27.
SI T FIE (0
SIGNATURE (OWNER OR GENT) DATE SIGNED
0 ',1
VALUATION
I Lj--�450 "
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
ATTENTION EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRCI10.
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt 9
APPLICATION ROVAL
This application is not a Permit until signed by the
Building Olficial or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space Provided.
OFFICIALS S17GNATUIRIE qAT,
Vn
RELEA.SED B
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
DATE
RIGINAL - FILE YELLOi INS ECTOR
PINK - OWNER GOLD - ASSESSOR�
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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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