20040997.pdfa
FDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY TELEPHONE
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NAME
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ZIP I TELEPHONE
PERMIT EXPIRES
PILRMIT 41
NUMBER
.JOB SUITE/APT#
ADDRESS
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PLAT NAFAEiSUBDIVISION NO. LOT NO. LID NO
I LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved
RW Permit Requml C3
Streel Use Permit Required 13
EXISTING PROPOSED irispeclion Required 13
Sidewilk Required 0
REQUIRED DEDICATION FT Underground 0
Wifitic? u.qutfed [3
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I I YESO NOE3
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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NAME CBL#
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ENGINEERING REVIEWED
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FIRE REVIEWED BY
DATE
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE CUECKED BY VARIANCE OR CU ,.SHORELINE OR ADB# INSPECTION SEPA
REO'D COMPLETED EXEMPT
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ZONE SIGN AREA HEIGHT
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PROPERTYTAX ACCOUNT PARCEL NO.
WAIVER 13
ALLOWED, PROPOSED ALLOWED PROPOSED
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STUDY 13
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NEW RESIDENTIAL PLUMBING / MECH
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LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
REAR
ALLOWED PROPOSED
FRONT SIDE REAR FRONT URSIDE
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COMMERCIAL COMPLIANCE OR
ADDITION P0 -1 1:1
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CHANGE OF USE
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REMODEL MSIGN
PARKING
LOT AREA PLANNING REVIEWED BY DATf
El MULTIFAMILY
REQ'D PROVIDED
GRADING FENCE
REPAIR 1:3 CYDS E] x FT.)
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TANK OTHER
DEMOLISH 1:1 11
GARAGE RETAINING WALL FIRE SPRINKLER
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CARPORT ROCKERY FIRE ALARM
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(TYPE OF USE, BUSINESS OR ACTIVIT PLAIN.
TYPE OF CONSTRUCTION
OCCUPANT
GROUP
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NUMBER NUMBER 0—F
OF DWELLING
SPECIAL INSPECTION
CONSULTANT OCCUPANT
LOAD
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STORIES UNITS
REQUIRED 13YES
DESCRIBE WORK TO BE DONE
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REMARKS
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GEOTECH REPOR
BY:
STRUCTURAL DESIGN
BY:
VALUATION
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Description
FEE Description FEE
I Plan Check
State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit
City Surcharge
ECK NO: Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
Grading
OONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
Plan Chk. Deposit
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Total Amt. Due
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 Landscapelnsp.
0
NOR LIMIT IN ANY WAY THE CITY's 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 This application is riot a perunit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or hisihor Deputy and Feesare paid.and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt sacknowledged in space provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
v�paKmews-etWRE.NSATloq4tkSURANCE AND RCW 18:27. " OF ICIftS SIGNATU9E DAT�
'-SIGNATURE-W AGENT DATE SIG�D (425)
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771-0220 R F 4�1 f
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE LINT I fic t1)12j1V111
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 i IBC110 f IRC110.,
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
D BY
190
ORIGINAL -FILE YELLOW - INSPECIC
PINK -OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
['LEASE SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
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C2.c,�__,V::�I�,,.�L_PLANNING DIVISION DA E
PLEASESIGN
PROJECT__2�)��
SITE ADDRESS I Ohl -7
PERMIT #aOD4 - NqJ _ADB#
INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED f)j hN)
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
0 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
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date SignatUrc
1:temp:b1dgA'ornis:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pier/Porch .................
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Retaining Wall ...........
0
Slab Insulation ..........
PLUMBING:
Underground .............
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Rough -In ...................
M
0
Commercial Final ......
0
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3: M
HEATING:
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Gas Test ....................
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Gas Piping .................
Equipment .................
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Commercial Final .......
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EXTERIOR SHEATHING
0
NAILING ..........................
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FRAMING ........................
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ITI 0
FIRST FLOOR FRAMING ...
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INSULATION ...................
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Floor Insulation .........
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Wall Insulation ...........
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Ceiling Insulation .......
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SHEETROCK NAILING ...
0
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SPECIAL INSPECTION ...
0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................