20050225 (2).pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
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PERMIT EXPIRES
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PLAT NAMF/SUBDlViSION NO.
LOT NO
LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Apprmeo
RW Permit Required
Street use Permit Required
EXISTING PROPOSED
Inspection Required
S,do*jlk Required
REQUIRED DEDICATION
FT
underground
Wiving required
METER SIZE
LINE SIZE
NO OF FIXTURES
PRV REQUIRED
YES E3 NO
REMARKS
OWNERiCONTRACTOR RESPONSIBLE
FOR EROSION CONTROL/DRAINAGE
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ENGINEERING REVIEWED BY
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ALLOWED PROPOSED
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REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
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FRONT LJRSIDE REAR
PARKING
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PLANNING REVIEWED BY DATE
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REO'D . PROVIDED
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HEAT SOURCE LOTSLOPE% VESTED DATE
PLAN CHECK NO:
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 IN DOING T14E WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
DATE SIGNED
SIGNATUI�FHOVVVI!'�.&,,y� 1��
TYPE OF CONSTRUCTION
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SPECIAL INSPECTION
REQUIRED 13YES
REMARKS
CONSULTANT
OCCUPANT
GROUP R1 1113
OCCUPANT
LOAD 421'-V-
FEE Description FEE
State Surcharge
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City Surcharge
Base Fee
Plan Chk. Deposit (V A-)
Receipt #
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Total Amt Due
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APPLICATION APPROVAL
This application is nota pormit until signed by the
Building Official or his/hor Deputy and Foesare paid, and
receipt is acknoAledged in space provided
OFFICIALS SIGNA1URE DATE
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RELEASet,B>/� DATE
EXT. 1333
ATTENTION/ .,XV
IT IS UNIL�,WFUL T 1 0 USfEPR CCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTIO'N AAS BEEN MADE AND APPROVAL OR A CERTI- ORIG
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110, P11,
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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
CALL
FOR INSPECTION
(425)
771-0220
YEAW - 14PECTC
R GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MENIO TO: PE 1IT INATOR, BUILDING DIVISION
FROM: cl), FIRE DEPARTM ENT DATE
I'LL A SE S lit,'
h rASL SIGN ENGINEERING DIVISION DATE
-PLANNING DIVISION DATE
PROJECT
SITE ADDRESS— 2_�51(,
P E R-M IT ft 2-- 2,
S ADBM DATE INSPECTED S_(/
DESCREPTION OF WORK TO BE INSPECTED_
A field inspection is -as conducted to determine compliance ividi -approved plans. Final approval
denotes (flat there are no objections from the above signed Depar(ment (o the release of
PER - FORINIANCE BONDS and the -ranting of: 171
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FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 COPY Of CORRECTION NOTICE given to Owner/contractor by inpector
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:1emp:b1dL,:f0M,s:ocaprvI 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 .................
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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