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DATE RECE17
FPERMIT EXPIRES
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CITY OF EDMONDS
PERMIT
NUMBER ,
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CONSTRUCTION PERMIT APPLICATION
ADDRESS
NARiN�ME OF BUSINESS�
PLAT NAMEISUBDIVISION NO
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LID NO
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LID FEE S
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PU13LIC RIGHT OF WAY PER OFFICIAL STREET MAP
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EXISTING PROPOSED
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inspection Requited
S,qe�salk Requited
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ELEPHONE
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REQUIRED DEDICATION
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NAME
METER SIZE
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NO, OF FIXTURES
PRV REQUIRED
YESO NO 13
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ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE
FOR EROSION CONTROUDRAINAGE
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NUMBER OF
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WAIV!ERV ALLOWED PROPOSED ALLOWED SED
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
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PARKING LOTAREA PLANNING REVIEWED BY DATE 5
REC*D PROVIDED
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TYPE OF CONSTRUCTION
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REQUIRED 13 YES
REMARKS
(J (A J C__ tGEOTECH REPORT
BY:
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STRUCTURAL DESIGN
BY:
VALUATION
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.
Cr PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
L CL PERMIT LIMIT. SEE ECDC 19.00.005(A)(6)
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V V) "APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESSORS
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
2
Ir ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Ir
4 ISSUANCE OF THIS PERMIT SHALL NOT BE
4
x FROM THE ISSUANCE OF THIS PERMIT.
at DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
12S02ij NOR LIMIT IN ANY WAY THE CITY'S A131LITY 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
TH E AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TIO
)N? IND INN OING�WORRK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
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IN OLATIO OF:1 R CODE OF THE STATE OF WASHINGTON RELATING TO
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1-102?w�'LrTA nm FN :10 SURANCE AND RCW 18:27.
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DATE SIGNED
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
LandscapeInsp.
Recording Fee
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C(��E OCCUPAN
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CONSULTANT OCCUPANT
I LOAD
CALL
FOR INSPECTION
(425)
771-0220C
Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Anit. Due
Receipt #
APPLICATION APPR-bVA-L
This application is not a permit until signed by the
Building Official or his1her Deputy and Fees are paid,and
receipt is acknowledged in Space provided
FifWLS SIGNATWRE DATE
AfTENTION DING OR STRUCTURE UNTIL t:A 1. 1%)-3a
IT IS UNLAWFUL TO USE OR OCCUPY A BUIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1 09 1 IBC1 10 f IRCI 10.
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
71-1
ORIGINAL - FILE YELLOW - 11\1�111PECIC
PINK -OWNER GOLD - ASSESSOR
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RNAL PROJECT APPROVAL FORM
TO:
DATE:
MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLFA S"*"
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ENGINEERING DIVISION DATE9/_ 71
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PLANNING DIVISION DATE
PLEASFSIGH
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SITE ADDRESS ZZ 70 70- 14
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INSPECTED
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PERMIT DATE
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine com pliance 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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PERF ORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITR CONDITIONS NOTED
Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
E] Copy of CO'RRECTION NOTICE given to owner/contractor by inpector
1.
2.
3.
REMNSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:forn1s:oca1)rv1 3/25/04
FINAL PROJECT APPROVAL FORM
TO: U/464
DATE: W/-xv;��—
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASESIGN
ENGINEERING DIVISION DATE
PLEASESIGN
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PLANNING DIVISION DATE 1010.(e/
PLEASE SIGN
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PROJECT
SITE ADDRESS C:X,-7K 7/v 1,1,�
PERMIT#,,�' ADB#__ DATEINSPECTED 10ID(P.1-2,006—
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DESCRIPTION OF WORK TO BE INSPECTED �&V11_1111921_,-VZ11
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 the release of
PERFORMANCE BONDS and the granting of
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
El Copy or CORRECTION NOTICE given to owner/contractor by inpector
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2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date SignatUre
I:tciiii):bl(lg:f'ot-iiis:ocapi-vI 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
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Pier/Porch .................
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Retaining Wall ...........
0
M
Slab Insulation ..........
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PLUMBING:
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Underground .............
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0
Rough -in ...................
0 0
C
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Commercial Final ......
3: rn
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HEATING:
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Gas Test ....................
3:
Gas Piping .................
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Equipment .................
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Commercial Final .......
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EXTERIOR SHEATHING
0
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NAILING ..........................
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FRAMING ........................
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FIRST FLOOR FRAMING ...
INSULATION ...................
3:
Floor Insulation .........
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Wall Insulation ...........
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Ceiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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