20050099.pdfDATE RECEIV
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BL�1111NESS
MAILING ADDRESS
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NAME
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CITY
PROPERTY TAX ACCOUNT
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ADDITION
REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
OF USE, BUSINESS
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ZIP I TELEPHONE
PERMIT EXPIRES
PERMIT
NUMBER
JOB
ADDRESS SUITE/APT#
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved E3
RW Permit Requirod E3
EXISTING PROPOSED
Street Use Permit Requited 13
E3
Inspection Requited
Sidewalk Requited
REQUIRED DEDICATION FT
underground
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Worinq required
METER SIZE
LINE SIZE
0. OF FIXTURES
PRV REQUIRED
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YES No
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REMARKS
OWNER/�O�(
, J RACTOR RESPONSIBLE FOR EROSION CONTROLJDRAINAGE
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FIRE REVIEWED BY
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COMPLIANCE OR
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1:1 MULTIFAMILY SIGN
LOT COVERAGE
ALLOWED PROPOSED
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REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
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PROPOSED SETBACKS (FT.)
FRONT LJRSIDE REAR
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PARKING
REQ'o PROVIDED
LOTARE
PLANNING REVIEWED BY DATE
GRADING FENCE
CYDS X FT.)
REMARKS
TANK
OTHER
RETAINING WALL
ROCKERY FIRE SPRINKLER
FIRE ALARM
OR
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DWELLING SPECIAL INSPECTION CONSULTANT
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REQUIRED LOAD
DESCRIBE WORK TO BE DONE
REMARKS
GEOTECH REPORT
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STRUCTURAL DESIGN
BY:
VAL LIATION
Description FEE Description FEE
Plan Check State Surcharge
TED DATE
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HEAT SOURCE LOTSLOPE% Building Permit City Surcharge
PLAN CHECK NO:
Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading.
SEPARATE PERMISSION.
a: Engr. Review
uj PERMIT APPLICATION: SEE ECDC 19-00-005(A)(5)
PERMIT LIMIT'. SEE ECDC 1i9-00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESSORS Fire Review
(n Plan Chk. Deposit
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_1 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
a: 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
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt #
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 APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or hi-Jher Deputy: and Foes are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COM
,,��SATION INSURANCE AND RCW 18:27. F AILS SIGNAT
PRE DATE
SIGNATURE WNE'R 0' NT)" DATE SIGNED
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771-022U R LEAS[fDi3Y
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 / IBC110 / IRC110. PINK -OWNER GOLD - ASSESSOR
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
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FiNAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT. COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
aENGINEERING DIVISION DATE
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FLEXE SIGN
PLANNING DIVISION DATE
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PERMIT # -21109 ��000' ADB# DATEINSPECTED. 9 Z9 //Z;,, _71
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DESCRIPTION OF WORK TO BE INSPECTED
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A field inspection was conducted to determine compliance with -a proved plans. Final approval
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denotes that there are no objections from the above signed Department to the release of
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PERFORMANCE BONDS and the granting of:
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy. ofCORRECTION NOTICE given to owner/contractor by inpector
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RE-fNSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbnns:ocaprv1 3/25/04
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
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Slab Insulation ..........
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PLUMBING:
Underground ...........
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Rough -In ...................
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Commercial Final ......
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HEATING:
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Gas Test .....................
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Equipment .................
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NAILING .......................
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FRAMING ........................
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FIRST FLOOR FRAMING...
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INSULATION .............
Floor Insulation .........
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Wall Insulation ...........
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Ceiling Insulation .......
SHEETROCK NAILING
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SPECIAL INSPECTION ...
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