20050383.pdfWar
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
CITY ZIP TELEPHONE
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NAME
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NUMBER
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NEW
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PLUMBING I MECH
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ADDITION
COMMERCIAL
COMPLIANCE OR
MIXED USE
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
X FT.)
DEMOLISH
TANK
017HER
GARAGE
Ei
RETAINING WALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIREALARM
(TYPE OF USE, BUSINES$ OR ACTIVITY) EXPLAIN
PERMIT
NUMBER
PERMIT EXPIRES
27,
JOB
ADDRESS
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PLAT NAME/SUBDiVISrON NO
LOT NO
LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
Pernm
RV4 Required
Street Use Pernid Required
E3
EXISTING PROPOSED
inspection Roquireci
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S.dowalk Required
E3
REQUIRED DEDICATION
FT
Underground
Witin required
[3
METER SIZE
LINE SIZE
NO OF FIXTURES
PRV REQUIRED
YES 13 NO
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION
CONTROUDRAINAGE
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ENGINEERING REVIEWED BY DATE
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NUMBER
NUMBER OF
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DWELLING
SPECIAL INSPECTION
CONSULTANT
OCCUPANT
STORIES
UNITS
REQUIRED C1 YES
LOAD
DESCRIBE IONE
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
$
Description
FEE
Description
FEE
P . Ian Check
State Surcharge
HEAT SOURCE
LOTSLOPE%
F
VESTED DATE
Building Permit
City Sur . charge
PLAN CHECK NO:
Plumbing
Base Fee
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
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapeinsp.
Total Amt. Due
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. -
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
Building Official or hisihor Deputy: and Foes are paid.and
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
receipt is acknowledged in space provided.
Wo
,��OMPENSATION INSURANCE AND RCW 18:27.
1; Cl S SIGNATiURE DATE
S4�NA�TURIE (O�NER OR A T I):
DATE SIGNED
(4:25)
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771--0220
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ATtE`RTION EXT. 1333
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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.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL -FILE YELLOW -INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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FINAL PROJECT.APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
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A-� NGINEERING DIVISION D
PLEASE SIGN
PLANNING DIVISION DATE
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PROJECT
SITE ADDRESS 763
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PERMIT # 2-0025' g�S ic33 ADB# DATEINSPECTED 0-3
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DESCRIPTION OF WORKTO BE INSPECTED
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�A field -inspection was conducted to determine compliance with -approved plans. Final appioval
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denotes that. there are no. objections from the above signed Department to the release of
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PERFORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0- Copy of CONDITIONS given to owne'r/contractor by inspector
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FAMED 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:temp:b1dg:fbrms:ocaprv1 3/25/04
FINAL PROJECiTAPPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
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ENGINE ERING DIVISION DATE 0/
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PLANNING DIVISION DATE
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PERMIT H2&105- Q-T83 AD134 DATEINSPECTED
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DESCRIPTION -OF WORK TO BE INSPECTED
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denotes. that there are no objections from the above signed Department to the release of
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RE -INSPECTED OUTSTANDING ISSUES - GRANTFINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:.fornis:ocaprv1 3/25/04
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall .... ......................
Pier/Porch .................
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Retaining Wall ...........
Slab Insulation ..........
PLUM BING:
3:
Underground .............
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Rough -In ...................
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Commercial Final ......
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HEATING:
Gas Test ....................
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Gas
Piping ..................
Equipment ... .............
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Commercial Final .......
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EXTERIOR SHEATHING
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NAILING ........... ..............
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FRAMING ........................
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FIRST FLOOR FRAMING...
INSULATION ...................
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3:
Floor Insulation .........
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Wall Insulation ...........
Ceiling Insulation .......
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SHEETROCK NAILING ...
1711
SPECIAL INSPECTION ...
MISCELLANEOUS ......
FINAL APPROVAL FOR
OCCUPANCY ..................