20050170.pdfA
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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWN NAM it - OF USINESS
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MAILING ADDRESS
CITY ZIP TEL�F`IiONE
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NAME
NAME
ADDRESS
CITY
STATE LIC
TELEPHONE
CBL#
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ZIP I TELEPHONE
EXPIRATION DATE I CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
M�03-a
-/30 -000
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
MIXED USE
REMODEL
MULTIFAMILY
REPAIR
El GRADING CYDS
DEMOLISH
TANK
GARAGE
1:1
RETAINING WALL
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CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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C- I — .—
PLUMBING I MECH
COMPLIANCE OR
CHANGE OF USE
XSIGN
FENCE
( X FT.)
OTHER
FIRE SPRINKLER
FIREALARM
NUMBER NUMBER OF
OF DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
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.��27 0
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PLAN CHECK NO:
VES:��
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.'
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND NG THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOL2� qOOOIF T HE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WnRKM N'S OMPENSATION INSUFIANCE AND RCW 18:27.
SIGNED
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ERMIT EXPIRES
I FP
PERMIT
NUMBER
JOB SUITEIAPTts
ADDRESS
PLAT NAME/S UBD IVI SION NO, LOT NO LID NO
I LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPAppfoved
RW Permit Required
Street LIS11 PeMil Required
EXISTING f' PROPOSED inspection Required
Side*alk Required
REQUIRED DEDICATION FT Unoetqfound
W111nq required
METER SIZE LINE SIZE NO OF FIXTURES PRV REQUIRED
1___� I 1_� I YES 13 NOO
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING
FIRE REVIEWED BY
VARIANCE OR CU
CAH
E
k-
DATE
SHORELINE OR ADB# I INSPEC�ION SEPA
REQ D COMPLETED PT
o It- YES 13NO
I 4(l 1 1 �
ZONE SIGN AREA HEIGHT
ALLOWED LLOWED PROPOSED
c� 12,&-I,ql4 v
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
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PARKING LOT AREA NING REVIEWED BY DATE
REQ'D . PROVIDED
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REMARKS
SPECIAL INSPECTION
REQUIRED 13 YES
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp
Recording Fee
CONSULTANT
CALL
FOR INSPECTION
(425)
771-0220
ATTENTION tX L I J,5-5
IT IS UNLAWFUL TO * olR�OCCLIPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 / IRC110.
OCCUPANT
GROUP M
OCCUPANT
LOAD
FEE Description FEE
state surcharge
City Surcharge
Base Fee
Plan Clik. Deposit
Receipt #
Total Amt. Due
LReceipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or histher Deputy and Foes are paid, and
receipt is acknowledged in space provided
FICIALS SICINATLJAE DAJE
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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FINAL PROJECT APPLROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
�Twmi7 E
nqa ENGINEERING DIVISION DAT
fLEASEW,N
PLANNING DIVISION DATE
PLEASESIGN
PROJECT U
SITE ADDRESS- IU
PERMIT ADB# DATE INSPECTED �31'2,q /01—
DESCRIPTION OF WORK TO BE INSPECTED
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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
0 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
El Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fonns:ocaprv1 3/25/04
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT_C-'1-,_�'T_ L-A 0 97
SITE ADDRESS —
IT ff C96- — 0 ADB# DATE INSPECTED 4-10 5-
PERM a -A 8
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine final 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
c3 Copy of CONDITIONS given to owner/contractor by inspector
I .
FAMED FINAL INSPECTION - OUTSTANDING ISSUES
o Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
ocaprvl.doc.l:temp:bldg:fom-isIO/OI
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
z
Pier/Porch ................. 0
Retaining Wall ........... 0
M
Slab Insulation ..........
PLUMBING:
M
Underground .............
C
171
0
Rough -In ...................
0 C
Commercial Final ......
M
M Z
HEATING:
_Z
Gas Test ....................
Gas Piping ................. C/)
0 -n
Equipment ................. -n
Commercial Final .......
M M
EXTERIOR SHEATHING 0
NAILING .......................... 0 M
C Cl)
9 C#)
FRAMING ........................ M 0
Z
FIRST FLOOR FRAMING ...
INSULATION ...................
3:
Floor Insulation ......... >
z
Wall insulation ........... :r
Ceiling Insulation ....... z
0
SHEETROCK NAILING ... —i
0
SPECIAL INSPECTION ... M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
70