20050401.pdfI
DATE RECEIVED
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PERMIT EXPIRES
CITY OF EDMONDS NUMBER C)'_U.5 -_ Ul-/() /
CONSTRUCTION PERMIT APPLICATION JOB Ad Jb SUITE/APT#
ADDRESS 7e
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NAME
ADDRESS
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P PLAT 14AME ISU BDIVI SION NO.
LAT N AME'SU
LOT NO,
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
RW Permit Required
EXISTING PROPOSED
Street Use Permit Requited
InspeCtior, Required
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REQUIRED DEDICATION FT
S'dowalk Required
Underground
Wiring requ,fPd
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METER SIZE, LINE SIZE OF FIXTURES
PRV REQUIRED
NAME
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STATE LICENSE NUMBER
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PROPERTY TAX ACCOUNT PARCEL NO.
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EXPIRATION DATE C MCK 11
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GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
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PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
YES 13 NO 13
REMARKS
OWNERICONTRACIOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED
FIRE REVIEWED BY
DATE
6215,
DATE
VAIRIANCE OR CU SHORELINE ORADBN I INSPECTION SEPA
REO'D COMPLETED I EXEMPT
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TYPE OF
NUMBER
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NUMBER OF
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DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT
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Description
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Plan Check
HEAT SOURCE
LOT SLOPE%
VESTED DATE
Building Permit
PLAN CHECK NO:
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
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
Engr. Review
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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
Engr. Inspection
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'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.,
Fire Review
Fire Inspection
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Recording Fee
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- 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 RELAT114G TO FOR INSPECTION
WORKMEN'S
,�PENSATION INSURANCE AND IRCW 18:27.
SIG 40WNE ORAGE: D S119NED 1 (425)
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FEE Description
State Surcharge
City Surcharge
Base Fee
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FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
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APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided
FICIAJ� SIGN
DATE
LEASED 4Y I DATE'
ATTENTION. EXT. 1333
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 I 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
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DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE M
PLEASFSIGN
ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE
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DESCRIPTION OF WORK TO BE INSPECTED 7—
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A field inspection was conducted to determine complianc ' e with -approved plans. Final approval
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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
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.0 Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
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RE -INSPECTED OUTSTANDING ISSUES - Gl;�ANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fornis:ouprv1 3/25/04
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ....................
FOUNDATION:
Footing ............ I ..........
Wall..........................
Pier/Porch .................
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Retaining Wall ...........
0
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Slab Insulation ..........
PLUMBING:
Underground .............
M
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Rough -In ...................
—40
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:Commercial Final ......
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HEATING:
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Gas Test .....................
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Gas Piping ..... .......
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Equipment .............
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Commercial Final .......
M M
EXTERIOR SHEATHING
a 50
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NAILING ..........................
0 M
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FRAMING ........................
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FIRST FLOOR FRAMING...
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INSULATION ...................
Floor Insulation
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Wall Insulation ...........
Ceiling Insulation .......
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SHEETROCK NAILING
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ........... .......
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