20050556.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NUMBER
JOB SUITE/APT#
ADDRESS 4/
61X
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OWNER NAMEINAME OF BUSINESS
PLAT NAME/SUB DIVISION NO.
LOINO
LID NO,
LID FEE S
MAILING ADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
REQUIRED DEDICATION ___ FT
TESCPApprovea [3
RW Permit Required [3
Street use Permit Required [3
Inspodion Required E3
SidaAalk Required 13
underground 13
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REMARKS
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GEOTECH REPORT
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Description.
Plan Check
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VESTED DATE
Building Permit
CHECK NO:
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Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE
SEPARATE PERMISSION,
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
W 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 0 R 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
01 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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Fire Review
Fire Inspection
Landscapeinsp.
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
OCCUPANT
GROUP
CONSULTANT
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 RELATING TO FOR INSPECTION
WORKMEN'S C INSURANCE AND RCW 18:27.
,��SATION
SIGNAT �%NeERR AGENT): DATE SIGNED (425)
A_ 771-0220
FEE Description FEE
state Surcharge 041t
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt # 21� A/)t)
Total Amt. Due (201v
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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
s SIGNAT4UE DATE
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Mt ED b�Y 4A-fE
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTIOWHAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 i IBC110 if IRC110-
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IT IS DUE TO THE QUALITY OF THE DOCUMENT.
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HNAL PROJECT APPROVAL FORM
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DATE:
MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
DEPARTMENT DATE
FROM: FIRE
PIXASI: SIGN
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denotes that there are no. objections from the -above signed Department -to thei release of
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of CORRECTION NOTICE given to owner/contractor by inpector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
Hemp :bl dg:fonns:ocaprv1 3/25/04
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS
.....................
FOUNDATION:
Footing
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Wall ..........................
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Pier/Porch .................
Retaining Wall . ...........
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Slab Insulation ...
PLUMBING:
Underground ..............
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HEATING:
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Gas Test ..................
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EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ......................
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FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
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Ceiling Insulation .......
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SHEETROCK NAILING ...
SPECIAL INSPECTION
MISCELLANEOUS .......
FINAL APPROVAL FOR
OCCUPANCY ..................
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