20050026.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PLAT NAME/SUBDIVISION NO� LOT NO
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LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
1 E SCIR Approved
RW Permit Required
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Street Use Permit Roq'd
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EXISTING PROPOSED
inspection Required
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PHUURESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ
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Description FEE Description FEE
Plan Check State Surcharge
FICE GLAZING % LOT SLOPE % it city S rcharge zk!�
HEAT SOU Building Permit
ECK NO: VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
cc PERMIT APPLICATION: 180DAYS
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PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS Engr. Inspection
rT SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
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!I IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Receipt #
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection
cc ALL CLAIMS FOR DAMAGES OF WHATEVER NAI URE, ARISING DIRECTLY OR INDIREC rLY
4 RMIT. ISSUANCE OF I HIS PERMIT SHALT. NOT 13E Total Amt. Due
x FROM THE ISSUANCE OF THIS PE QUIREMENT OF ANY CITY ORDINANCE Landscapeinsp.
01 DEEMED TO MODIFY. WAIVE OR REDUCE ANY RE
I ILITY 10 ENFORCE ANY ORDINANCE PROVISION.'
0 NOR LIMIT IN ANY WAY THE CITYS AB Receipt #
Recording Fee
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
GULATING CONSTRUC. this application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITI I CITY AND STATE LAWS RE CALL Building 011icial 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
WOR= COMPENSATI�N(41W-%�ANCE AND RCW 113 27 OFFICIA1 S SIGNAT URE DATE
D 1E SIGNED (425)
S T E/(?#N 0 - . / J M,_-,�
771-0220 T� A- BY D*E
EXT 1333
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IT IS U rLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILE - YELLOW
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD-ASSESSOn
041N PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTINU
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLWE SIGN
ENGINEERING DIVISION DATE
—rLr.Asi: SIGN
PLANNING DIVISION DATE
PIXASE SIGN
PROJECT &'C'Ad
SITE ADDREss_ AZ_ I Rta.&
PERMIT#Z00,5_� ADB# DATEINSPECTED-6 /z0//0L6-
DESCRIPTION OF WORK TO BE INSPECTED eo qp- �qal
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A field inspection was cond�cted to determine compliance with -approved plans. Final ap&oval
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
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of CORRECTION NOTICE given to owner/contractor by inpector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANTFINAL PROJECTAPPROVAL
Date Signature
I:tciiij):bitlg:i'oriiis:ocapi-vI 3/25/04
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASESIGN
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ENGINEERING DIVISION DATE-4&//
PLFASHSIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT
SITE ADDRESS
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PERMIT # 2 Q CC— 00�7
ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine compliance with -approved plans. Final appr oval
denotes that there are no objections from the above signed Department to the release of
PERF, ORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/con tractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
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3.
RE -INSPECTED OUTSTANDING ISSUES - GRANTFINAL PROJECT APPROVAL
Date Signature
1:(emp:b1dg:forms:ocaprv1 3/25/04
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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:
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
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OCCUPANCY ..................
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The Initials MT are Miltoll
temporary contract
ThOl"Ps011,,
Inspector 101, tile City.
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