20040957.pdfDATE RECEIVED �� 1� e
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
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CITY
NAME
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STATE LICENSE NUMBER
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REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACT V4T-Y)
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PERMIT
NUMBER
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PLAT NAMEiSU BD IVI SION NO,
LOT NO
LiD NO
LiD FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
[ESCPApprovixi
RVV Flermal Required
Street Use Perinit RequlfA
EXISTING PROPOSED
inspection Required
___
Skje*alk Requvect
REQUIRED DEDICATION FT
Undergioun(I
ftwig regulied
METER SIZE
LINE SIZE
F_NO. OF FIXTURES
PRV REQUIRED
YES 13 NOO
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
731
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BY
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
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FIRE SPRINKLER
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FIRE REVIEWED BY
DATE
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WAIVER 113 ALLCWED PROPOSED ALLOWED PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
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Description
Plan Check
HEAT SOURCE LOTSLOPE% VESTED DATE
L Building Permit
PLAN CHECK NO: Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION. Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection
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 MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp.
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording 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 771-0220
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. CALL
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 FOR INSPECTION
WORKMEN'S C;5��SATTW+Ikk�RANCE AND RCW 18:27,
SIGNATUR; R G E LNT): DATE SIGNED (425)
E: Wr .1 12 11 01
OCCUPANT
GROUP
OCCUPANT
LOAD
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Depositi
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his)her Deputy and Foes are paid,and
roccip) is acl%nowledge.0 in space providw!
OFFL7St1jNI. E DA/
RELEASED BY DATE
ATTENTI(M
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBcj0q if IBC110 I IRC110-
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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FINAL PROJECT A�PRQVAL FORM
TO:
DATE:
MEMO TO: PE Cqq'k�DrIRO UILDING DIVISION
FROM: FIRE DEPARTMENT DATE
7PI77 aIGN
ENGINEERING DIVISION DATE-
NXASF SIGN
PLANNING DIVISION DATE
MAN SIGN
PROJECT____EY/9-J
SITE ADDRESS 6S_LL, 12 L
- oc(, ADB# DATE INSPECTED
PERMIT
DESCRIPTION OF WORK TO BE INSPECTED U S T 1J 6c,) t �-Y 6
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
o Copy of CORRECTION NOTICE given to owner/contractor by inspector
1 .
OR
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pier/Porch .................
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Retaining Wall ...........
Slab Insulation .......... 0
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PLUMBING:
Underground .............
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Rough -In ................... C 0�
M 0
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Commercial Final ...... 0 f—
HEATING: M
M z
Gas Test .................... C
Gas Piping ................. r
Equipment .................
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Commercial Final ....... n
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EXTERIOR SHEATHING M M
NAILING .......................... 0
0
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FRAMING ........................ C Cn
F. Cn
FIRST FLOOR FRAMING ... M O�
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INSULATION ...................
Floor Insulation .........
Wall Insulation ........... z
Ceiling Insulation ....... :E
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SHEETROCK NAILING ... z
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................