20050539.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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OWNER/CONTRACTOR RESPONS113LE FOR EROSION CONTROUDRAINAGE
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IGN AREA H E
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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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REMARKS
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SPECIAL INSPECTION CONSULTANT OCCUPANT
REQUIRED 13 YES LOAD
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
I i I / U Description FEE Description FEE
1?,'A) 7' Plan Check State Surcharge
H AT URCF
T SLOPE% VESTED DATE
C1 411--1 Building Permit City Surcharge
PLAN CF ECK NO: / 1_,� t
Plumbing Base Fee -�? f%
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC - on
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19-00.005(A)(5)
W
il PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr Inspection
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESSORS Fire Review
LL1 Plan Chk. Deposit
_1 IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF 0
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
cr 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
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp
0 Total Amt. Due
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 Recording Fee Receipt #
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This applicalion is [lot a POro"I WIN Slyned by the
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Offictal or hiq/hor Deputy and Feesilre paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION rocelpt isockf)(m1fadoeti III space Provided
WORrE�'S COMPENSATI��JRANCE AND RCW 18:27.
INER O(Aq NTj: DATESIGNED OF _I(7rALS SIGNAluk DA' E
to "
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SIG ATU�E (O%M (ZI,25)
771-0220 REL D B
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ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE 0. CCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSF E EN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 IF IBC110 If IRC110. OR[ �1 AL - FILE ELLOW - INSPECTOR
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES � I - OWNE GOLD -ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:*
MEMO TO: PER -MIT COORDINATOR, BUILDING DIVISION
MENT DA
F
ROM. FME DEPART TE
PIA:XSE SIGN
ENGINEERING DIVISION DATE
NXASC SIGN
PLANNING DIVISION DATE
PIXASESIGN
PROJECT MILLS
SITE ADDRESS- 32- q M 6AD Oct� i�)Z- LX
PERMIT# a�:Ql) -ADB# 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 the 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
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbrnis:ocaprv1 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 .................. oa sr-
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