20040986.pdfDATE RECEIVE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NA ' INAME OF BUSINESS
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NAME
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STATE LICENSE NUMBER EXPI /12; ATE CHECKED BY
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ADDITION
REMODEL
REPAIR
El
DEMOLISH
GARAGE
CARPORT
(TYPE OF USE, BUSINE
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COMMERCIAL
MIXED USE
MULTIFAMILY
GRADING CYDS
TANK
WALL
EiRETAINING
ROCKERY
JR ACTIVITY) EXPLAIN
PLUMBING / MECH
COMPLIANCE OR
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CHANGE OF USE
SIGN
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SPRINKLER
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FIRE ALARM
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PERMIT
NUMBER
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ADDRESS,
PLAT NAME/SUBDIVISION NO.
PERMIT EXPIRES
LOT NO,
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
REQUIRED DEDIC ATION FT
METER SIZE I LINE SIZE NO, OF FIXTURES
4__7�
SUITEIAPT#
LID NO�
LID FEE S
TESCPApproved
RW Permit Required
Stireet Use Permit Required
Inspection Required
Sidewalk Required
Underground
Woma reauired
PRV REQUIRED
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FIR, FlEf)"15011YA STAlf E" E1,1:,:L if i-61 CAL PEknr14 AND
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ALLOWED PROPOSED , FRONT SIDE I REAR I FRONT LIR SID
PARKING I—DED I LOTAREA PLANNING REVIEWED BY DATE
REQ'D . PROV I
FT.) 0 REMARKS
NUMBER NUMBER OF
OF DWELLING
STORIES UNITS Iz
DESCRIBE WORK TO BE DONE I
.ell
Sle
HEAT SOURCE
PLAN CHECK NO:
LOTSLOPE% I VESTED DATE
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
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING-TH"ORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATIC,ti-OF THfi LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEJVS COMUENSATION INSURA_NCE AND RCW 18:27.
ER
DATE SIGVED
I ill-4 /
CONSTRUCTION
OCCUPANT
GROUP
SPECIALINSPIECT'ON
CONSULTANT
OCCUPANT
LOAD
REQUIRED 13 YES
REMARK
GEOTECH REPORT
BY:
STRUCTURAL DESIGN/
BY
VALUATION
4.1691i ...
12
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
)WA5
Recording Fee
Receipt P
APPLICATION APPROVALI
Tnis application is not a pernif until signed by file
CALL
Building official or his/her Deputy and Fees are paid, and
FOR INSPECTION
receipt is acknowledged in space provided
FF IALS SIG "TURE DATE
(425)
LAAZ
PEELEA"SKD
771-0220
BY
---------------------------
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 if IRC110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEME SIGN
jk_ 1"Y �6,cAD L' i`V— ENGINEERING DIVISION DATE_/2,��
rLEASE SIGN
—PLANNING DIVISION DATE
nXASF SIGN
PROJECT
SITE ADDRESS A ve-F
PERMIT #2 UO 4— (2796 —ADB# DATE INSPECTED
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
a Copy of CONDITIONS given to owner/contractor by inspector
I .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
I .
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3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign,
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PECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
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..,id"ETBACKS .....................
FOUNDATION:
Fo6 ting ...............
-Wa 11 ..........................
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
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OCCUPANCY .................. _41-z
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