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DATE RECEIVED �Vl
I FPERMIT EXPIRES
US9 PERMIT :;;I
1W . ....... 7
ciTy 6F EDMONDS ZONE NUMBER 21,
JOB SUI1E/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAME/NAME OF BUSINESS
PLAT NAME/S UB DIVISION NO. LOT NO. LID NO.
LID FEE $
LCC MAILING ADDRESS
U TESCP Aorifoved 0
z $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 0
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0 Street Use Permit Raq'd 0
EXISTING — PROPOSED Inspection Required Q
CITY ZIP EPHONE Sidewalk Required 13
S. Underground
C) REQUIRED DEDICATION— FT wiring fuquiru E3
[ I Z_ %_� r — —
NAME METER SIZE LINE SIZE ] NO. OF FIXTURES PRV REQUIRED
YES 13 NO
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/D RAIN AGE
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CITY ZIP NE
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NAME CBL
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ADDRESS
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TELEPHONE
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CITY ZIP -7
IANCE OR ORELINE OR ADBN IUSPECTION
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY 9" E3Y REO'D POSTED
7' ES ONO IS
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- SIGN AREA HEIGHT
f SEPA REVIEW )T ALLOWED PROPOSED ALLOWED
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMF PROPOSED
0ol) <� 7- 1 w C.) 0 0 EXP
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
NEW 13 RESIDENTIAL PLUMBING MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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COMPLIANCE OR
ADDITION OMMERCIAL El CHANGE OF USE
O'C
PARKING LOT AREA PLANNING REVIEWED BY DATE
Z�REMODEL 1:1 MULTIFAMILY SIGN REQ'D PROVIDED
GRADING FENCE I I I
REPAIR 1:1 CYDS ( X FT) REMARKS
El DEMOLISH 13 TANK OTHER
GARAGE RETAINING WALL I
,>-F RE SPRINKLER
z CARPORT ROCKERY Al� FIRE ALARM
" (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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AFR G OCCUPANT
GROUP
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NUMBER NUMBER OF CRITICAL
0 'liob( AREA OCCUPANT
OF DWELLING AREAS LOAD
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0 STORIES UNITS
DESCRIBE WORK TO BE DONE
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINALINSPECTION REO'D
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VALU�T O�
77
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
/M
PLAN CHE VESTED DATE Plumbing Base Fee
CK NO:
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
It: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 1BODAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. 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 #
< ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRFrTLY OR INDIRECTLY
X FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PE,,MIT SHALL NOT BE Landscapelnsp. Total Amt. Due
0 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0
M, 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 APPLICATION 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 permit 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 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. OFF CI DAT
/YG ATIJR� �NER_ AGE� DATEJIGNE (425)
N 7 771-0220 RELEASED qBY DATE
—)fffENTION EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR ACERTIFICATE OF OCCLI- ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/16CI10/IRC110. PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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V'11NAL FKUJEU'1'A1r1rKVVAU I'UKIVI
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PI&ASESIGN
ENGINEERING DIVISION DATE
PLEASESIGN
PLANNING DIVISION DATE
PLEA -SE SIGN
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PROJECT A y (I ---
SITE ADDRESS�f 3 7
PERMIT �ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED k-L- A
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:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
[:1 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISS . UES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:forms:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
z
0
Pier/Porch .................
0
171
Retaining Wall ...........
Slab Insulation ..........
Cl)
PLUMBING:
M
C
ITI
Underground .............
0
—40
0
Rough -In ...................
M
M Z
Commercial Final ......
C: z
HEATING:
Gas Test ....................
Gas Piping .................
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Equipment .................
M M
0 (n
Commercial Final .......
0 r-
0 M
EXTERIOR SHEATHING
C: CD
NAILING ..........................
Q 0
Z r—
FRAMING ........................
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FIRST FLOOR FRAMING ...
INSULATION ...................
z
Floor Insulation .........
Wall Insulation ...........
z
0
Ceiling Insulation .......
0
171
SHEETROCK NAILING ...
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
��IuOCCUPANCY ................