20050224.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINES
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MAILING ADDRESS
CITY ZIP TELEPHONE
1131
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NAME
Warr,m
ADDRESS
CITY ZIP
NAME 1�
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ADDRESS
3-S (3, G) * L.)_w
CITY ZIP
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STATE LICENSE NUMBER
PROPERTY TAX. Ar
QCOUN�T PARU� NO
TELEPHONE
TELEPHONE
Y ZJ - 290 ,0600
EXPIRATIO DATE CHEC
4,16
7, 04�,
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PERMIT EXPIRES ��Z ff rZ /I
USE PERMIT
ZONE 7
NUMBER -
JOB SUI f E,APT it
ADDRESS
PLAT NAME/SUBDIVISION NO. L01 NO. LID NO�
LID FEE S
TESCP Approved 0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit RequIred 0
street use Permit Req d 0
EXISTING — PROPOSED inspection Required 0
Sidewalk Required 0
REOUIREDDEDICATION— FT Underground
Wiring required 0
METER SIZE LINE SIZE NO. OF FIXTURES PTV REQUIRED
I I YES 0 NO 0
REMARKS
OWNERICONTRAC TOR RESPONSIBLE FOR EROSION CONTROLJDRAINAGE
ENGINEERING
FIRE REV - IEJED BY
BY VARIANCE OR CU SHORELINE OR ADB#
NEW
RESIDENTIAL
0 PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
m CHANGE OF USE
REMODEL
APARTMENT
F-1 SIGN
REPAIR
GRADING
CYDS
FENCE
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DEMOLISH
TANK
OTHER
Ei GARAGE
RETAINING WALL
C] RENEWAL
CARPORT
ROCKERY
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
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uj NUMBER
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NUMBER OF
FDVVELLING
UM LLI O�//
CRITICAL
AREAS
NUMBER
o STORIES It
UWTS
UNITS
-1 DESCRIBE WORK TO BE DONE
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HEAT SOURCE I GLAZING % I LOT SLOPE 'I-,
PLAN CH�p VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
t
cc PERMIT APPLICATION: 180 DAYS
LU
13. PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS 10iE CITY OF
_j AND AGENTS FROM ANY AND
�j EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES,
cc ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
4
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 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 IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIIDLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPE"N INSURANCE AND RCW 18.27
DATE SIGN7
SIGNATURE
SEPA REVIEW
COMPLETE EXEMPT
EXP I
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D I PROVIDED
CHECKEDBY ITYPE
SPECIAL INSPECTOR
REQUIRED F-1 YES
REVIEWED/DATE
SIGN AREA
ALLOWED , PROPOSED
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INSPECTION BO D
REO'D JPOSNTED
YES 0 NO
HEIGHT
ALLOWED . PROPOSED
REQUIRED SETBACKS (FT.) I PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT L/R SIDE REAR 13
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LOT AREA I PLANNING REVIEWED BY DATE
REMARKS
PROGRESS INSPECTIONS PER
OCCUPAN
OCCUPANT
LOAD
108/FINAL INSPECTION REQJ'D
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/-)�-7A Im
VALUATION
FEE
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADING"'r L
-STAIESURCII GE
16
-FR"ltl--REVIEW FEE
Mr. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
RECEIPT
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IF—
RECEIPT
peTTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
5�98
TOTAL AVIOUN1 DUE
CALL
FOR INSPECTION
(42
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E 333
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APPLICATION APPROVAL
This application is not a permit unitl signed by the
BUilding Olficial or his/her Deputy and Fees are paid and
rerotpl is acknowledged in spaco provided
�Flc L, SIC, TURE DATE
'C L
E�7VSED BY DATE
9A/5
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. ORIGINAL FILE YELLOW 14SPECT4
PINK OWNER GOLD - ASSESSOR
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FINAi, PROJECT APPROVAL I oRM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASESIGN
ENGINEERING DIVISION DATE
PLEASESIGN
PLANNING DIVISION DATE
PLrAS1: SIGN
PROJECT
SITE ADDRESS �JV S4 Z T X�,
AD
PERMIT # B# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
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
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
I .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
El Copy of CORRECTION NOTICE given to owner/contractor by inpector
I .
01
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:ten1p:b1dg:r6nus:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pier/Porch .................
Retainirig Wall ...........
Slab Insulation ..........
PLUMBING*
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
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 44/ �vs
OCCUPANCY ..................
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