20050581.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAME�NAME OF BUSINESS
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PERMIT
NUMBER
JOB
ADDRES9/,-_ -N,,
PLAT NAMEISUBDI VISION NO
PERMIT EXPIRES / I
SUITE/APTP
LOT NO Lib NO
MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
CITY ZIP
TELEPHON
EXISI ING PROPOSED
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REQUIRED DEDICATION __ FT
NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
ADDRESS
TELEPHONE
NAME CBLP
ADDRESS
L) L3
CITY ZIP TELEPHONE
4-Z--413-qZ,Z'5
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STATE LICENSE NUMBER EXPIRATION DATE CI.j4CKED BY
e-_�L4 4e (e 6
PROPERTY TAX ACCOUNT PARCEL NO
[:]
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
MIXED USE
REMODEL
MILY
El
REPAIR
GRADING CYDS
1:1
DEMOLISH
TANK
[D
GARAGE
CARPORT
Ei
RETAINING WALL
ROCKERY
(TYPE OF USE, BQSINESS OR ACTIVITY) EXPLAIN
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NUMBER NUMBER OF
OF DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
I q �;T_A L(- t Y CW VJ/L�:T
HEAT SOURCE
LOTSLOPE%
r_1
PLUMBING / MECH
E]
COMPLIANCE OR
OF USE
CHANGE
SIGN
EFENCE
]
( — X_
OTHER
dFIRE
SPRINKLER
'FIRE
ALARM
VESTED DATE
LID FEE S
T ESCP Appfoved
RW Perind Required
Stitiell Use Poinut Requited
inspection Requited
Side*alk Required
Undotground
Witina required
PRV REQUIRED
YES 13 NO
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY
DATE
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FIRE REVIEWED BY DATE Lid
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-------------
VARIANCE OR U SHORELINE OR ADB# INSPECTION SEPA
REQ'D COMPLETED EXEMPT
13YES El NO I I
CA# ZONE SIGN AREA HEIGHT
WAIVER 13 1 ALLOWED . PROPOSED I ALLOWED . PROPOSED
STUDY 13
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR I FRONT L/R SIDE REAR
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PARKING
REO'D , PROVIDED LOTAREA I PLANNING REVIEWED BY DATE
FT.) I REMARKS
PLAN CHECK NO: Z
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.
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
*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 '
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
G I B Y C,
IVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
V IS
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
T I I W I
ION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
T
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WORKMEN' S COMPENSATIP� INSURANCE AND RCW 18:27,
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S I
T U E
SIGNATU,R IOWN R 0 A T): DATE SIGNED
C)
ATTENTIO
IT IS UNLAWFUI� 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.
1,11-3
SPECIAL INSPECTION
REQUIRED 13YES
REMARKS
GEOTECH REPORT
BY,
STRUCTURAL DESIGN
BY:
VALUATION
$ _ A
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscape Insp.
Recording Fee
CONSULTANT
CALL
FOR INSPECTION
(425)
771-0220
OCCUPANT
GROUP Z,
LOAD
FEE Description FEE
State Surcharge 2/6)v
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt
Total Anit. Due
7) 10
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Receipt # _4
APPLICATION APPROVAL
This appiwation is not a peraid until signed by the
BUilding Official or hlSlher DOPLAy and Fees are paid and
roupt is acKnowledged in space pfovided
OFFICIALS SIGNAT�4RF I DATj__
REI.�AS
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
BY ATE
LI)
ORIGINAL - Fit F - YELLOW INSPIECTOR
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
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT !C
SITE ADDRESS—
ol
PERMIT e2l M' _ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED 612 Air -
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:
D� GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by inspector
I .
FAMED FINAL INSPECTION - OUTSTANDING ISSUES
El Copy of CORRECTION NOTICE given to owner/contractor by hipector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signattirc
1:ten1p:b1dg:rbrms: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 ..................
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