20050161.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
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CITY
NAME
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ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE I CUart�
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PROPERTY TAX ACCOUNT PARCEL NO.
NEW RESIDENTIAL
COMMERCIAL
ADDITION
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DESCRIBE WORK TO BE DONE
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved
RW Permit Reqwirm
EXISTING _ PROPOSED Street Use Permit Required
Inspection Required
Shirtwalk Requitea
REQUIRED DEDICATION FT Unaergiound
I wiring required
METER SIZE LINE SIZE FIXTURES I PRV REQUIRED
I YES 13 NOO
REMARKS
OWN ERIC ONTRACTOR RESPONSIBLE FOR EROSION CONTROUDIRAINAGE
ENGINEERING REVIEWED BY
DATE
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SPECIAL INSPECTION CONSULTANT OCCUI�ANT
REQUIRED DYES LOAD
REMARKS
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BY:
STRUCTURAL DESIGN
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9w4-VALUATION
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VESTED DATE
PLAN CHECK NO:
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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.*
kI 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
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THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
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TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABPR--CODE OF THE STATE OF WASHINGTON RELATING TO
W W to
ORKMEN'S COMPENSAT;?"I SIANCE AND RCW 18:27.
S I T
SIGNATURE (OWNER 0 DATE SIGNED
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
A ENTION EXT. 1333
IT I �NLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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A Fl A, L INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FIC�A OF OCCUPANCY HAS BEEN GRANTED, UBC109/ IBC110/IRC110.
FEE Description
State Surcharge
City Surcharge
Base Fee
I Plan Chk. Depositi X
FEE
Receipt #
Total Amt. Due
Receipt # --------
APPLICATION APPROVAL
This application is not a pernin until signed by the
Building Off scial or his,'hor Deputy and Fees are paid, and
receipt is acknowledged in space provided
OFFICIALS SIGN�,TURE DATE
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
DBY VIIE
ORIGINAL -FILE YELLOW/- INSPE&OR
PINK - OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FuRM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: DEPARTMENT DATE
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PLEASrSIGN
ENGINEERING DIVISION DATE
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DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine compliance with -approved plans. Final approval
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denotes that there are no objections from the above signed Department to tile release of
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PERFORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUE, S
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Copy of CORRECTION NOTICE given to owner/contractor by inpector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tem1):b1dg:fomis:oca1)rv1 3/25/04
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
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Retaining Wall ...........
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Slab Insulation ..........
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PLUMBING:
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Rough -In ...................
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Commercial Final ......
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HEATING:
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GasTest ....................
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Gas Piping .................
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Equipment .................
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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 ...
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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 ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
OX5- 40141