20041006.pdfW
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
LL)�, I �Iul_ I) Is, 1 4-, 11 1A, �-, k- I 6-Vi) ('� �� . r ti�_'Ak )11, 1_1�'Llk
MAILING ADDRESS
CITY ZIP T�LEPHONE
NAME
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CITY ZIP TELEPHONE
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NAME CBLO
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ADDRESS
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CITY
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ZIP
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TELEPHONE
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STATE LICENSE NUMBER
EXPIRATION DATE
PROPERTY TAX ACCOUNT PARCEL NO.
NEW
RESIDENTIAL PLUMBING MECH
ADDITION
OMMERCIAL COMPLIANCE OR
EZKC CHANGE OF USE
REMODEL
MULTIFAMILY F� SIGN
REPAIR
GRADING FENCE
CYDS E] ( X FT)
DEMOLISH
TANK 171 OTHER
GARAGE
RETAINING WALL 4FI-R: SPRINKLER
CARPORT
ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
A
NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
USE
ZONE
JOB
ADDRESS ^7
PERMIT EXPIRES
PERMIT
N U M BE R
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PLAT NAME/SUBDIVISION NO LOT NO.
UITE/APT#
LID NO.
LID FEE S
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
FiW permit Required
Q3
stittet use Pennit Req'd
13
EXISTING - PROPOSED
inspection Required
13
Sidewalk Required
C3
REQUIRED DEDICATION- FT
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Undotground
Wiring fOqUired
METER SIZE
LINE SIZE
PRV REQUIRED
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YES 0 NO 11
REMARKS
OWNER/CONTRACTOR RESPQNSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING REVIEWED BY
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DATE
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,/ARIANCE OR CV RELINE OR ADB# INSPECTION BOND
ro REO'D POSTED
I OYES ONO IS
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP I
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE HEAR FRONT LJR SIDE REAR
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PARKING LOT AREA [PLANNING REVIEWED BY DATE
REO'D I PROVIDED
REMARKS
CHECKED B TYPE OF CONSTRUCTION CODE OCCUPANT
GROUP
103 ._Z
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED LOAD
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/ IBC109/ IRC109 FINAL INSPECTION REO'D 1 F3
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VALUATION
$
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C)i - - V— Description FEE Description FEE
A190Y, Plan Check State Surcharge
HEAT SFURCE GLAZING % LOT SLOPE % Building Permit 37 City Surcharge
PLAN CHECK NO* VESTED DATE 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 PUBLIC
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
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PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION . ....
Fire Review Plan Chk. Deposit
(n *APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREiT, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPI OYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NAT URE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF I HIS PERMIT SHALL NOT HE
C3 DEEMED 7*0 MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.. _7
Recording Fee Receipt #
)PA9 'r 5
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APP ION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
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 WASHINGION RELATING TO FOR INSPECTION feceipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW IB.27.
OFFICIALS SIGNATURE DATE
SIGNATURE (0
EL INNER OaGEN. DATE SIG ED'� (425)
771-0220
RELE BY )ATE
ATTENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL 00 1
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL -FILE - YELLOW -INS 4ECT R
PANCY HAS BEEN GRANTED. UBC109,11BC110/1RCII0, PINK - OWNER - COLD - ASSESSOR
09!03 PRESS HARD -YOU ARE MAKING 4 COPIES
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FINAL PR63ECT APPR O-V-AL.FORM
D AT E:
T IL DING'DIVI.SION
MEMO TO: PE C 0 �T R
(-.:" (-2, fc:,!5:
FIRE DEPARTMENT DATE
FROM: 7
EASE SIGN
ENGINEERING DIVISION DATE z
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PLAN�IING DIVISION DATE 0
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PLEASE SIGN
PROJECT-21�4a."-
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PERMIT # T- M
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DESCRIPTION OF WORK TO hil-43MU,
A field inspection was conducted to determine compliance with - approved plans. Final approval
objections from the above signed Department to the release of
denotes that there are no
PERFORMANCE BONDS -and the granting of:
GRANT FINAL PROJE CT APPROVAL
GRANT PROJECT APPROVAL WIT14 CONDITIONS NOTED
Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
RE —INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fornis:oc-,,prv1 3/25/04
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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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