20050206.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEiNAME OF BUSINESS
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CITY ZIP TELE PHON
STATE LICENSE NOM ER C�PII]IATIO
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PRQI?ERTY-TAX ACCOUNT PARCEL NO
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PERMIT
NUMBER
JOB
ADDRESS
PLAT NAMEISUBDIVISION NO
PERMIT EXPIRES
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LOT NO to NO
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved
RVV Permil Required
Street Use Permit Required
EXISTING PROPOSED.— Inspection Required
S,de*j1k Required
REQUIRED DEDICATIO14 FT underground
Wirino required
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I YES13 NO
REMARKS
OWNERiCONTRACTOR RESPONSIBLE FOR EROSION CONTROLYDRAINAGE
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
DATE CHECKED BYT VARIANCE OR C7
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NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
USE
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CHANGE OF
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MULTIFAMILY
SIGN
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REPAIR
GRADING
CYDS
FENCE
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GARAGE
RETAINING WALL
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CARPORT
ROCKERY
FIRE ALARM
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NUMBER
NOMBER OF
OF
STORIES
DWELLING
[UNITS
DESCRIBE WORK TO BE DONE
HEAT SOURCE I LOTSLOPE% I VESTED DATE
DATE
DATE
LSHORELINEORADBP I INSPECTION SEPA
REO'D COMPLETED EXEMPT
13 YES 13 NO
CAP SIGN AREA HEIGHT
WAIVER ALLOWED , PROPOSED I ALLOWED , PROPOSED
STUDY 13 1
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REQ*D . PROVIDED
FT.) I REMARKS
PLAN CHECK NO: Z--
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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.'
I HERE13Y 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 IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATIOTN_�U�ANCE AND RCW 18:27.
NER 01�+El)�
SIGNj�TURV low I DATE S1 I GNED
11024U919
SPECIAL 104SPECTIO
REQUIRED 13YES
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
REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT LJR SIDE REAR
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LOTAREA PLANNING REVIEWED 13Y DATE 9L
CONSULTANT
CALL
FOR INSPECTION
(425)
RELEASED BY, /DATE
ATTENTION t:A L I -jjj
IT IS UNLAWFUL TO USE OR OCCUPY AqUILDING OR STRUCTURE UNTIL L �
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- 0 IGINAL -FILE - YELLOW -INSPECTOR
n� OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 if IRC110. X.,
PINK -OWNER - GOLD - ASSESSOR
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10104 PRESS HARD - YOU ARE MAKING 4 COPIES
OCCUPANT
OCCUPANT
LOAD
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt 0
Total Amt. Due
Receipt #
APPLICATION AP �ROVAL
This application is not a permit until signed by the
Building Official or hisftr Deputy and Fees are paid. and
receipt is acknowledged it) space provided
OFFICI��LSIGFNT RE 11 ATY
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FINAL PROJECT APPROVAL FORM
TO:
D A T E:
MEMO TO: P T0R,-BbqLDING DIVISION
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FROM: Itm FIRE DEPARTMENT DATE
I'LEASP SIGN \T
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ENGINEERING DIVISION DATE 0
I'LEASESIGN
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PLANNING DIVISION DATE
PLEASLSIGN
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PROJECT
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PERMIT M Z
ADB# DATE INSPECTED -
DESCRIPTION OF WORK TO BE INSPECTED CE
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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 the release of >
PERFORMANCE BONDS and the granting of 9
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GRANT FINAL PROJECT APPROVAL 9 Cn
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GRANT PROJECTAPPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/con tractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:teni1):b1dg:forn1s:ocaprv1 3/25/04
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch ................. z
0
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground ............. M
M 0
Rough -In ................... 0
0
Commercial Final ...... C
7r M
HEATING: M z
Gas Test .................... C:
Gas Piping .................
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Equipment .................
don-,n:_!.;idI Final .......
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EXTERIOR SHEATHING 0 Cn
0
NAILING .......................... 0 r
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FRAMING ........................ Cn
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FIRST FLOOR FRAMING ...
INSULATION ................... ;U
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Floor Insulation ......... >
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Wall Insulation ...........
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Ceiling Insulation ....... z
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SHEETROCK NAILING ... --I
SPECIAL INSPECTION ... M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................