20050176.pdfCEIVED PERMITEXPIRES _4�
USE PERMIT
ZONE 7
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS S7
OW%R�NAMEINAME OF BUSINESS A ro OLA
AA�M,\� PLAT NAME/SUBDIVISION NO LOT NO LIO NO.
tc MAILING ADDI`16�s
u LID FEE $
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TESCP Approved 13
Pull' RIGHT OF WAY PER OFFICIAL STREET MAP AW Permit Required [3
IN CC Pkjb11__ni
cl Street use Permit Port'd 0
ZIP TELEPHONE EXISTING — PROPOSED Inspection Requited [3
Sidewalk Required 0
REQUIRED DEDICATION. FT underground
Witing fortmrod 0
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES NO
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROODRAINAGE
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ENGINEERING REVIEWED BY DATE
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STATE LICENSE NUMBER EXPIR TION DATE Q11ECKEQ BY VARIANCE OR CU SHORELINE OR ADBI INSPECTION BOND
REO'D POSTED
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SEPA REVIEW SIGN AREA HEIGHT
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0 COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED I PROPOSED
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NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
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_-1Z;I`-"COMMERCIAI_ CHANGE OF USE E
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PARKING LOT AREA PLANNING REVIEWED BY DATE 5
REMODEL MULTIFAMILY SIGN REO'D PROVIDED (L
GRADING FENCE I I
REPAIR CYDS ( X FT) REMARKS
DEMOLISH TANK El OTHER
GARAGE RETAINING WALL
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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M OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
cr STORIES UNITS NUMBER REQUIRED [:] YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS 0
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D Zi
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VALUATION
$
Description FEE Description FEE
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Plan Check State Surcharge
HEAT SOURCE_ GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO: Z. .1 111 VESTED DATE Plumbing Base Fee
0 _2 5
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
2 Engr. Review
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UJI PERMITAPPLICATION: ISO DAYS
CL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESCHS Fire Review Plan Chk. Deposit
2
j IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CIrY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
cc ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECrLY OR INDIREcrLY 26
x FROM THE ISSUANCE OF I HIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
'31 DEEMED ro MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CIFY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.4
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 at his/her Deputy: and Fees 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 �(1hiPENSAT40U,I N S U RANCE AND RCW 16,27.
�E (1, 1 OFFICVIAI -BIG N NATURE DATE
E DW]R R GENT)N"j DATE SIGNED (425)
RELEASEnfI3 DR;E
771-0220 V, �
AT4tNTIOW'-/ EX7 1333 10 �
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGNIL- jrj YE LLUW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
09103 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
PLUASH SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PIXASI: SIGN
PROJECT S=
SITEADDRESS_
PERMIT o 11 ADB# DATEINSPECTED (5 _'o
DESCRRTION OF WORK TO BE INSPECTED SdVff
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 tile release of
PEPW ORMANCE 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
FAELED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
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2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date SignatUre
1:tei1ip:b1dg:forn1s: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:
Gas Test ....................
Gas Piping ..... I ...........
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
OCCUPANCY ..................
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