20050163.pdfFDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAZi,'AME OF BUSINESS
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CITY ZIP TELEPHONE
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NAME
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TELEPHONE
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO
-7 & 34 1 L3 0a.
NEW
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RESIDENTIAL
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PLUMBING / MECH
ADDITION
1;;:I40MMERCIAL
COMPLIANCE OR
CHANGE OF USE
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MIXED USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYCIS
FENCE
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DEMOLISH
TANK
OTHER
GARAGE
CARPORT
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RETAINING WALL
ROCKERY
FPERMIT EXPIRES
PERMIT
NUMBER 7- o0i'S -0) (C5
JOB SUITEiAPT#
ADDRESS
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO
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LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved 13
RVV Pennit Requiled
sifeel use P0111111 Requited
EXISTING PROPOSED
inspection Requiroa 13
Sidewalk Requiten
REQUIRED DEDICATION --- FT
Uncle.rqround
Mum . reQuiled
METER SIZE
LIN
NO. OF FIXTUREJ
PRV REQUIRED
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED BY
FIRE REVIEWED BY
---I -� VARIANCE OR CU
By
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WAIVER 13
STUDY 13
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REQ'D , PROVIDED
FT.) I REMARKS
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DATE
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SHORELINE ORADI111 I INSPECTION SEPA
REQ'D COMPLETED EXEMPT
13YES [3 NO I I
ZONE SIGN AREA HEIGHT
I ALLOWED . PROPOSED I ALLOWED . PROPOSED
REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT L/R SIDE REAR
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LOT AREA I PLANNING REVIEWED BY DATE 5
p: (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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TYPE OF CONSTRUCTION
CODE OCCUPAN
GROUP
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LLI NUMBER NUMBER OF
OF DWELLING
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SPECIAL INSPECTI
ONSULTANT OCC6PANT
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0 STORIES UNITS
REQUIRED 13YES
LOAD
DESCRIBE WORK TO BE DONE
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REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
$ �?Mqc -,
Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE LOTSLOPE% VESTED DATE
Building Permit
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City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
LMechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NC IS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE. PUBIC
Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
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SEPARATE PERMISSION.
2—
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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06 PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
Engr Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
En 'APPLICANT, ON BE14ALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
Plan Chk. Deposit
LLJ
_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 ft
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
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Total Amt. Due
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0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Recording Fee
Receipt # /-t') 27'5( o
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
This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
CALL
Building Official or hisiher Deputy and Fees are paid and
TION:
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
receipt is acknowledged in space provided
FOR INSPECTION
WORKMEN'S COMPENSATI�":k?RANCE AND RCW 18:27.
OFFI�qTIAIGNA�RE DATE
GENT);/ DATE SIGNED
SIGNATURE ((TWISIE2RO95
(425)
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771-02 20
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RFtEASED BY 4fE
ATTENTION
EXT. 1333
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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, JELLOW - INSItECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110.
PINK -OWNER - GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4
COPIES
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FINAL PROJECT APPROVAL FuRM
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DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE
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PLEASESIGN
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PLANNING DIVISION DATE
PIXASrSIGN
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PROJECT &�=e 10
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SITE ADDRESS 3�2� S
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PERMIT #9-Co'�� C12 4�0,�3 ADB# DATE INSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED R/Q/
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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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X GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
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FAMED FINAL INSPECTION - OUTSTANDING ISSUE, S
0 Copy of CORRECTION NOTICE given to owiier/contractor by inpector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sigiiature
1:tenip:b1dg:forn1s:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch ................. z
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Retaining Wall ...........
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Slab Insulation ..........
PLUMBING:
Underground ............. M,
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Rough -In ................... 0
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Commercial Final ......
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HEATING: z
Gas Test .................... C
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Gas Piping ................. 3:
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Oil
Equipment ................. n
Commercial Final .......
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EXTERIOR SHEATHING 0 5
NAILING .......................... 0 r-
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FRAMING ........................ CD
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FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
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Wall Insulation ...........
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Ceiling Insulation .......
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SHEETROCK NAILING ... __11
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SPECIAL INSPECTION ... M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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