20050017A.pdf'FOATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
S, E:-- Q $�_
MAILING ADDRESS
CITY ZIP TELEPHONE
NAME
ADDRESS
NA��ME�r
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ADDRESS
CITY ZIP
TELEPHONE
P411
NUMBER
e
EXPIRATION DATE
C BY
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PERMIT
NUMBER
JOB
ADDRESS
PLAT NAMEISUBDMSION NO
PROPERTY TAX ACCOUNT PARCEL NO
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PLUMBING / MECH
F� ADDITION
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COMPLIANCE OR
OF USE
MIXED USE
CHANGE
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MULTIFAMILY
SIGN
F� REPAIR
GRADING
CYDS
r_1
FENCE
( X FT.)
TANK
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ElGARAGE
ED RETAINING WALL
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FIRE SPRINKLER
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CARPORT
ROCKERY
FIREALARM
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(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN.
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to NUMBER NUMBER OF
OF DWELLING
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DESCRIBE WORK TO BE DONE
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HEATSOURCE t LOTSLOPE% VESTED DATE
PLAN CHECK NO:
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS. DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00,005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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 BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
SIG� ATU (OWNER OR AGENT): DATE SIGNED
PERMIT EXPIRES
SUITEIAPTP
LOT NO LID NO
ILID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 7 E SCP Appfoyed
RW Permit Renuired
Street Use Permit Requited
EXISTING PROPOSED inspection Required
Side.wailk Requirej
REQUIRED DEDICATION FT Underground
METER SIZE LINE SIZE NO OF FIXTURES PRV REQUIRED
YES 13 NO13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING REVIEWEQ BY UA
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SHO'6ELINE RADB9
INSPECTION
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REQ'D
14401
COMPLETED EXE!.YT
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SIGN AREA
HEIGH
WAIVER
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ALLO%VEO PROPOSED
ALLOWED PROPOSED
STUDY 13
LOT COVERAGE
REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR FRONT LJRSIDE REAR
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LOTAREA PLANNING REVIEWED BY DATE
REQ'D PROVIDED
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REMARKS IF
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SPECIAL INSPECTION
CONSULTANT
REQUIRED 13YES
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recordina Fee
CALL
FOR INSPECTION
(42 5)
771-0220
OCCUPANT
GROUP
OCCUPANT
LOAD
FEE Description
State Surcharge
e-=
_5 City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt # y
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a pernia until signed by the
Building Official or his/her Deputy and Fees are pa.d, and
receipt is acknowledged in space provided
FICIALS SlfV4ATURE DATE
Lck
L,ItAtED BY . j DATE
OTENT110N t,& L 1.5.5,5 1 VZ,,
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.
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL -FILE YELLOW 4 INSP/CTOR
PINK -OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
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FROM: FIRE DEPARTMENT DATE
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ENGINEERING DIVISION DATE-.�:�
KEASE IGN
PLANNING DIVISION DATE
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PROJECT kj!�- Ar A
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PERMIT c. v�� - Cr) / 7 —ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED o= ea
A field inspection was conducted to determine final 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
GRAW PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
o Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_
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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 ....................
GasPiping .................
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 .................. 7--7-
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