20041075.pdfI DATE REC
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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REQUIRED DEDICATION. FT winng coquirud [3
METER SIZE LINE SIZE__ NO. OF FIXTURES PRV REQUIRED
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONIROL/DRAINAGE 5
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FIRE REVIEWED BY DATE ul
VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
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SEPA REVIEW SIGN AREA HEIGHT
COMPLETE E�EMPT ALLOWED PROPOSED ALLOWE PROPOSED
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ALLOWED PROPOSED FRONT SIDE REAR FROWT W� IDE�KR AR
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REMARKS
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CHEOED BY I TYPE 1 -.2
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,LYRUCTION ICO E I OCCUPANT,_.,
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SPECIAL INSPECTION_ JAREA OCCUPANT
REQUIRED [:] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINALINSPECTION REO'D
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Description FEE Description FEE
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ml- �� 69 Plan Check State Surcharge 47L5-L
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HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAWCHIECK NO: VESTED DATE Plumbing Base Fee
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
L BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
ui
CL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF Fits OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt it
cc MS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
4 ALL CLAI
xi FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due 01"
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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 not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his/her Deputy: and Fees are paid, and
TION, AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED receipt is acknowledged In space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSATIO�q INSURANCE AND RCW 18.27. FF LS SIGN URE DATE
SIGNATURE,(qWNER-� A EN DAT�, SIGNtD (425)
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6ATE
0 771-0220 A LEASED BY
ATTENTIO , N PP EXT 1333 1-� �1 �f
ITISUNLAWFULTOUSEORUUL,Ur TABLI11-DING OR STRUCTURE UNTILAFINAL (-Ikolk ) �
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INSPECTION HAS BEEN MADE ANDAPPROVALOR A CERTIFICATE OF OCCU- ORIGIN� FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC1091IBC110/IRC1i0- PINK--�4-NER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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Date:
10/18/2004 imict plain
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RNAL PROJECT APPROVALi FORM
DATE:
MEMO TO: PERMIT COORDINATOIZ, 13UMDING DIVISION
FROM: FIRE DEPARTMENT DATE
LEASE SIGN
ArotY� ENGINEERING DIVISION DATE
—PLANNING DIVISION DATE
PLEASE SIGN
P ECT C_
ROJ 7— 1 06Df 7_—�
SITE ADDRESS Rz- yJ
PERMIT UWd:� A.DB# DATE INSPECTED.
DESCRIPTION OF WORK TO BE INSPECTED 6*10
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A field inspection was conducted to determine compliance with -approved plans. Final app ioval
-above signed Departme
nt to the release of
denotes that there are no objections from the
PERF, ORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to. ownei-/contractor by inspector.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of CORRECTION NOTICE given to owncr/contractor by inpector
2.
3.
RE-IN'SPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:rornis:oca1)rv1 3/25/04
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RECORD OF INSPECTIONS
.............. .... ..........
SETBACKS
FOUNDATION:
Footing too
Wall
Pier/Porch 10,61,411, too
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 1111611,9114 111.8 6
Floor Insulation 14,11111,
Wall Insulation 41,011,111,
Ceiling Insulation "I'll*
SHEETROCK NAILING
SPECIAL INSPECTION
INSPECTOR DATE APPROVED
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MISCELLANEOUS
toot,'
FINAL APPROVAL FOR
OCCUPANCY
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The 111itiecils MT larc Miltoll
t -11101" y colltract
ell #Ir
illspector for the city*
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