20050009.pdfI
DATE RECEIVED
CITY OF EIJMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NA E/NAME OF BUSINESS
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PERMIT EXPIRES :2
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PLAT NAME/SUBDIVISION NO. LOT NO LID NO
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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METER SIZE
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OF FIXTURES
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/ORAINAGE
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STATE LICENSE NUM13ER EXPIRATION DATE CHECKED BY
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PROPERTYJA�X ACCOUNT PARCEL NO
NEW
RESIDENTIAL
PLUMBING / MECH
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COMPLIANCE OR
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REPAIR
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(TYPE OF USE, BUSINE
OR ACTIVITY) EXPLAIN:
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DESCRIBE WORK TO BE DONE
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PLAN CHIECK NO?.,1. VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK To
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
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SEPARATE PERMISSION.
uj PERMIT APPLICATION: ISO DAYS
IL PERMIT LIMIT! I 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
rE EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
q ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
r FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
J DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
REVJJFWED BY
FIRE REVIEWED BY
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ALLOWED PROPOSED
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REMARKS
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OCCUPANT
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SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [_1 YES LOAD
REMARKS
PROGRESS INSPECTIONS PER USC 1081IBC109/IRC109 FINAL INSPECTION REO'D
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
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Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due 14'c;s�
Recordino Fee
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
- AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
GIVEN IS CORRECT,
A
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYE This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC APPLICATION APPROV I
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON D CALL Building 011icial or his/her Deputy: and Fees are paid, and
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
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FIML, SjNA RE DATE
SIGNATUR�E OR GEN DATE SIGNED
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SED BY D
ATTENTION R
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILA FINAL EXT 1333
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. ORIGINAL - FILE YELLOW - INSPEC70
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES PINK - OWNER GOLD - ASSESSOR
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FINAL PROJECT A'P'PROVAL FORM
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DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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PLEASr SIGN
ENGINEERING DIVISION DATE z
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PLANNING DIVISION DATE �Z /q
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DESCRIPTION OF WORK TO BE INSPECTED
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denotes that there are no objections from the above signed Department to the release of -n x
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PERFORMANCE BONDS and the granting of:
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
[:1 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:teinp:b1dg:fbrnis:ocaprv1 3/25/04
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
li__w ENGINEERING DIVISION DATE
PLFASESIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT.
SITEADDRESS—
PERMIT �-ADB# DATE INSPECTED 5-
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:
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
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date SiDiature
1:temp:b1dg:roniis:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
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Pier/Porch .................
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Retaining Wall ...........
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Slab Insulation ..........
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PLUMBING:
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Underground .............
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Rough -in ...................
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Commercial Final ......
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HEATING:
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GasTest ....................
Gas Piping .................
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Equipment .................
Commercial Final .......
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EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ........................
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FIRST FLOOR FRAMING ...
INSULATION ...................
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Floor Insulation .........
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Wall Insulation ...........
Ceiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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