20050178.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
71
CITY ZIP T LEP.HONE
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NAME
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ZITY, ZIP LEPHONE
NAME
ADDRESS U
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CITY ZIP
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STATE LICENSE NUMBER
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
ADDITION
REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
(TYPE OF USE, BUSINEE
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NUMBER
OF
STORIES
DESCRIBE WORK TO BE
CBL.9.
TELEPHONE
EXPIRATION DATE PHECKI
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RESIDENTIAL
OMMERCIAL
MIXED USE
El MULTIFAMILY
13 GRADING CYDS
NK
RETAINING WALL
ROCKERY
S OR ACTIVITY) EXPLAIN
NUMBER OF
DWELLING
UNITS
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( — X —FT.)
OTHER
FIRE SPRINKLER
FIREALARM
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PERMIT
NUMBER
JOB
ADDRESS
PLAT
NO
PERMIT EXPIRES
LOT
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
REQUIRED DEDICATION FT
METER SIZE I LINE SIZE T_ NO. 01
REMARKS
OWNERiQ
ENGINEERING REVIEWED BY
/11
Ef
BLE FOR
SUITEIAPT#
LID NO
LID FEE S
TESCPApproved
0
RW Permit Required
0
Street Use Permit Required
0
inspection Requited
CI
Sidewalk Required
13
Underground
13
Wdllnq required
13
XTURES
PRV REQUIRED
YES 13 NOO
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CONTROL/DRAINAGE
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DATE
DA Lu
E OR ADB# INSPECTION SEPA
REQ'D COMPLETED I IXEIIPT
10YES [3NO I
CA# ZONE SIGN AREA HEIGH
WAIVER 13 ALLOWED PROPOSED ALLOWED PROPOSED
STUDY 13
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3
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
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PARKING LOTAREA ING REVIEWED BY DATE
REQ"D I PROVIDED
LREMARKS
Wark
OCCUPANT
GROUP
SPECIAL INSPECTION CONSULTANT OCCUPANT
REQUIRED E3 YES I I LOAD I
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY
VALUATION
Pin— i, o I
Description
C:"'�+(
Plan Check
HEATSOURCE
LOTSLOPE%
VESTED DAT E
Building Permit
PLAN CHE70:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
Engr, Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESSORS
Fire Review
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
DEEMED
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
OEM IQ CORRECT; AND TH 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- CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSATION I RANCE AND RCW 18:27.
SIGNATUREAWNE9,49:A00t): DATE S)GNED (425)
771-0220
E!Vlr 411,111
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
/
Receipt ft
APPLICATION APPROVAL
This application is not a porrnit until signed by the
Building Official or his/her Deputy and Fees are paid and
receipt is acknowledged in spacp provided
F. fil A - S SIGNATUFIE DATE
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110.
J0104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL -FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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FINAi, PROJECT APPROVAL t oRM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PIXASESIGN
ENGINEERING DIVISION DATE
PLF,XSV SIGN
PLANNING DIVISION DATE
PIXASC SIGN
PROJECT
SITE ADDRESS
PERMIT ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED-3
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
El Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
F1 Copy of CORRE CTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1: tenip: b Idg: forms: ocapnl 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 ....................
GasPiping .................
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 .................. .1 k296L
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