20050021.pdfI
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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STAYE LICENSE NUM13ER EXPIRATION DATE I CHECKED 187Y
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PROPERTY TAX ACCOUNT PARCEL NO.
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ADDITION
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REPAIR
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GARAGE
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PERMIT
NUMBER
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PLAr NAME /SUBDIVISION NO
PERMIT EXPIRES
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LOT NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
REQUIRED DEDICATION FT
METER SIZE I LINE SIZE NO OF FIXTURES
SUITE/APTt$
LID NO
LID FEE S
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11
RVW Prima Required
13
Street Ust Perrivi Requited
11
inspection Required
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PRV REQUIRED
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING REVIEWED BY
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WAIVER 13
STUDY 13
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REQ'D , PROVIDED
FT.) N REMARKS
DATE
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51-Irt NE OR AD1111 INSPECTION SEPA
REQ'D COMPLETED EXEMPT
13YES 13NO I I
ZONE SIGN AREA I HEIGHT
ALLOWED , PROPOSED ALLOWED . PROPOSED
REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT UR SIDE REAR
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LOT AREA I PLANNING REVIEWED 13Y DATE
9: TYPE OF CONSTRUCTION CQDE OCCUPANI,,,
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M OF SPECIAL INSPECTION CONSUIL�Awlr OCCUPANT
0 STORIES UNITS 4 LOAD
DWELLING QUIRED 13YES
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DESCRIBE WORK TO BE DONE
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
1"712
Description FEE Description FEE
State Surcharge
Plan Check
HEAT SOURCE LOTSLOPE% VESTED DATE :ZU
Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee
nowsow� Mechanical
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 Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
W
IL PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
(n *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
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_j 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 #
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 Landscapelnsp. Total Amt. Due
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NOR LIMIT IN ANY WAY THE CITY's ABILITY TO - ENFORCE ANY ORDINANCE PROVISION.- Recording Fee Receipt # 4
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAI
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 OVNE IAGR c Y WITH CITY AND STATE LAWS REGULATING CONSTRUC. CALL Building Official or tuslim Deputy and Feesare paid, and
TION;,'AND IN ING TH HORIZED THEREBY, NO PERS014 WILL BE EMPLOYED
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IN H
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0 receipt is acknowicidged in space provided
IN VIOLATION F T1 A R 0 E OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S �P S 10 N NCE AND RCW 18:27.
OF71ALS SIPN�ATURE DATE
SIGNI�T�RET R AGE DAT SIGNE" (425
V, I hAYWAM 11illez,
771-0220 7ELEAS1115 BY f 6ATE
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE - YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 It IBC110 if IRC110. PINK -OWNER - GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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MEMO TO:
FROM:
PROJECT
SITE ADE
FINAL PROJECT APPROVAL FORM
TO:
D A T E: 9 Ileir
)IVISION
DEPARTMENT DATE 16 31
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PLEASE SIGN
PLANNING DIVISION DATE
PERMIT Agv--ADB# DATEINSPECTED W-4 / 15—
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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
El Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
D Copy of CORRECTION NOTICE given to owner/contractor by inpector
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2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date SiSplature
1:ten1p:b1dg:fbrms:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ......................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Stab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
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 ..................
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