20041088.pdfDATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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MAILING ADDRESS
CITY
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NAME
NAME
ADDRESS
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CITY
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STATE LACENSE NUMBER
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PROPERTY TAX ACCOUNT PAR(
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NEW
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ADDITION
REMODEL
REPAIR
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DEMOLISH
GARAGE
CARPORT
t1YPE OF USE, E
NUMBER
OF
STORIES
ZIP
TELE
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ZIP TELEPHONE
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EXPI AT41 'W—DATE CHECKED BY
NU.
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E] COMMERCIAL
MIXED USE
MULTIFAMILY
GRADING CYOS
TANK
RETAINING WALL
ROCKERY
SINESS OR ACTIVITY) XP At
tit" &/,:: 1� -
NUMBER OF
DWELLING
UNITS
TO BE DONE
PLUMBING if MECH
COMPLIANCE OR
OF USE
CHANGE
SIGN
FENCE
( X
OTHER
FIRE SPRINKLER
FIRE ALARM
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PERMIT EXPIRES _L(4
PERMIT
NUMBER
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PLAT NAMEISUBDIVISION NO� LOT No
LID NO
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LID FEE S
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Appfo,ed
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Rvi Poinia Required
Requal�d..,
strec.1 lj,.o Pofnia Requiled
Pof"'t
EXISTING PROPOSED
.qu'r"I
insimcuon Requircia
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REQUIRED DEDICATION FT
Uncergiound
Wiring (I-quifed
METER SIZE
LINE SIZE
NO OF FIXTURES
PRV REQUIRED
YES 13 NO
REMARKS
RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
OWNERICONTRACTOR
ENGINEERING REVIEWED �Y DATE
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DATE W
FIRE REVIEWED BY
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VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
REO'D COMPLETED I EXEMPT
OYES ONO I
CAft ZONE SIGN AREA HEIGHT
ALLOWED . PROPOSED I ALLOWED I PROPOSED
WAIVEIN
STUDY 13
LOT COVERAGE
ALLOWED PROPOSED
PARKING
RFO'D PROVIDED
FT.) REMARKS
TYPE
SPECIA INSPECTION
REQUIRED 13 YES
REMARKS
GEOTECH REPORT
BY:
TRUCTURAL DESIGN
BY:
ALUATION
Description
Plan Check
.. ..... .... ....... LOT SLOPEO/( VESTED DAT
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Building Permit
PLAN CHECK Ngi
Plumbing
ioo�
echanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC i9.00.005(A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESSORS
Fire Review
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
EDMONDS. WASHINGTON,
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
ISSUANCE OF THIS PERMIT SHALL NOT BE
FROM THE ISSUANCE OF THIS PERMIT.
WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp
DEEMED TO MODIFY,
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
� I A U THE OWNER OR THE DULY AUTHORIZED AGENT OF
REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT UR SIDE REAR
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LOT ARE N I PLA 4NING REVIEWED 13Y DATE (L
OCCUPAN
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CONSULTANT
OCCUPANT
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Description FEE
;FE
State Surcharge
City Surcharge
B 0 e
ase Fee
GIVEN IS CORRECT; AND I HA
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
invrhER T�! I DATE SIGNED (425)
Plan Ch1k. Depositll_�/5
Receipt
Total Arnt. Due
Receipt
APPLICATION APPROVAL
This j1ppi,cation is noll 1)(MI111 L01fil signed by me
BL,i(jintj ottioal or tiisitiw L-)vputy and Feeni ate paid, and
wcelpt is ackTi"lod(jed III SIMCO 1)(OvIdUd
-,)G 4� A F [)A] E
12- 771.0220
EXT. 1333 J
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 / IBC110 / IRC110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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ORIGINAI F11 F YELI nW
PINK -OVVNFR Got D ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
I'LLIA.SrSIGN
ENGINEERING DIVISION DATE
PIXASESIGN
PLANNING DIVISION DATE
MASI!' SIGN
PROJECT Q 4LLl 7- 6�06/L/67'1 Q
SITE ADDRESS—:2( A 1,,-4"
064y_ a 0 _ADB# DATE INSPECTED
PERMIT # 51-
DESCRIPTION OF WORK TO BE INSPECTED
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:
A, 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
Copy of CORRE CTION NOTICE given to owner/contractor by inpector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1: temp:bldg: forms: ocaprvl 3/25/04
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RECORD OF INSPECTIOI
INSPECTOR
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
GasTest ....................
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 ..................
is
DATE APPROVED
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