20041066.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
N�iME OF BU
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MAILING ADDRESS
CITY
NAME
U
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I CITY
NAME
ADDRESS
CITY
STATE LICENSE NUMBER
TELEPHONE
ZIP I TELEPHONE
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ZIP I I TELEPHONE
EXPIRATION DATE I CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
El NEW
RESIDENTIAL
M ADDITION
COMMERCIAL
.[Kr REMODEL
MULTIFAMILY
E] REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
Ei RETAINING WALL
CARPORT
ROCKERY
(TYPE OF YSE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS jit,11�4
DESCRIBE WORK TO BE DONE
S'/V'jV/c;l
a 7
HEAT SOURCE
GLAZING %
PLUMBING/MECH
COMPLIANCE OR
CHANGE OF USE
PERMIT EXPIRES
USE PERMIT M(,.
ZONE
NUMBER
JOB 7�tCsc SUITEIAPT#
ADDRESS
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
TESCP Approved 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 13
street use Permit Roq'd C3
EXISTING — PROPOSED inspection Floquiled 13
Sidewalk Requited E3
REQUIRED DEDICATION- FT Underground
Wiring required 13
METER SIZE LINi NO. OF FIXTURES PRV REQUIRED
YES 13 NOE]
REMARKS
OWN Ej/CON TRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
ENGINEERING REVIEWED BY
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DATE
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VARICE OR CU
RELINE OR ADB#
INSPE.C�ION
BOND
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POSTED
OYES
ONO
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP 1
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,
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
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PARKING OT AREA P NNING REVIEWED BY DATE. 5
SIGN REQ'D PROVIDED CIL
EFENCE
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OTHER
EFIRE SPRINKLER
] FIRE ALARM
CRITICAL
AREAS
NUMBER
LOT SLOPE %
PLAN CHECK NO: 0 2, -1& VESTED PATE
iiiii`iii"iir -- 1 fee,�.
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERR11T dOVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
M
SEPARATE PERMISSION.
w PERMIT APPLICATION: 180 DAYS
n. PERMIT LIMIT., 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIREC1LY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL Nor BE
C5 DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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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 THE WORK AUTHORIZED THEREBY, NO PERSON WILL 13E EMPLOYED
IN VIOLATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 10.27.
SIGNATURE 1OWNER OR AGENT) ,, I I nAT17 qjr.mri-i
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CHECK& BY TYPE OF CONSTRUCTION CODE OCCUPANT
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED E] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RE01D
to
VALUATION
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
2
'5/
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
(425)
7PPLICATION APPROVAL
I his application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are Paid, and
receipt is acknowledged in space provided,
OFFICIA)-�41GNI TURE DATE
1-21
771-0220 SED
RELEA -B DAT
ATTENTION Off 1333 1) 4,
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 7
C ORIGINAL�- YELLr)W - 16ECTC
ATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DATE -d
FROM:
PIXASr SIGN
ENGINEERING DIVISION DATE
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PLEASESIGN
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PLANNING DIVISION DATE
PLFASE SIGN
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PERMIT (e ADB# DATEWSPECTED
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DESCRrPTION OF WORK TO BE INSPEC TED
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A field inspection was conducted to determine compliance with -approved plans. Final approval
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denotes that there are no objections from the above signed Department to the release of
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PERFORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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0 Copy of CONDITIONS given to owner/contractor by inspectoi,
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
El Copy of CORRECTION NOTICE given to owner/contractor by inpector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:ten1p:b1dg:f6n11s:ocaprv1 3/25/04
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pier/Porch .................
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Retaining Wall ........... 0
Slab Insulation ..........
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PLUMBING:
Underground .............
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Rough -In ................... C
M
0
Commercial Final ...... --I C-)
0
HEATING: M
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Gas Test .................... JO --I
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Gas Piping ................. --i
Equipment .................
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Commercial Final ....... -4
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EXTERIOR SHEATHING
NAILING .......................... 0_0
0
FRAMING ........................ 0 M
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FIRST FLOOR FRAMING ... Q
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INSULATION ...................
Floor Insulation .........
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Wall Insulation ........... z
Ceiling Insulation .......
SHEETROCK NAILING ... V\A% z
0
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SPECIAL INSPECTION ... 0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR 6 �_606
NM3
OCCUPANCY ..................
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