20050582.pdfF—DATE �CCEIVED
CITY'OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF RU NE
771 -
W�MNLI ADDRESS — -
CITY-,, ZIP
TELEPHONE"'
AME
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PERMIT
NUMBER
JOB
ADDRESS
PERMIT EXPIRES
NANOE/SUI37DIVISION NO.
LOT NO
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PUS7LID
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U13LIC RIGHT OF WAY PER OFFIC
FEE S
IAL
STREET MAP
rESCP Approved
C3
EXISTING PROPOSED
RW Permit Required
Street Use Permit Required
0
0
InsPection Required
E3
REQUIRED DEDICATION
Sidewalk Required
13
FT
Underground
E3
M :E TERSSIZE
:
NO OF FIXTURES
Willing required
PRV REQUIRED
:
YES13 NO13
RE A K
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OWNER/CONTRACTOR RESPONS113LE
FOR
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ADDRESS ENGINEERING REVIEWED BY DATE
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CITY TELEPHONE FIRE REVIEWED BY --Nm�
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4.,,A4 ei lex)316 4 413. 1-1 21-IZ 11 — C/
STATE LICENSE NUMBER > a:
EXPI ION DATE CHECKED VARIANCE 0 DRADB# INSPEC�ION SE A
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PROPER YES 13 NO
TYTAXACCO NTPARCELNO. CA# ZONE SIGN AREA
HEIGHT
WAIVER [3
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6L—L STUDY [3 ALLOWED PROPOSED ALLOWED PROPOSED
NEW RrRESIDENTIAL
11 PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ADDITION COMMERCIAL COMPLIANCE OR ALLOWED PROPOSED FRONT SIDE REAR FRONT LJRSIDE REAR
ElMIXED USE CHANGE OF USE "I "I "I "I "I "I "I "I "I "I z
REMODEL. .... .... . . ......... ........... .. ............... . z
IULTIFAMILY SIGN PAR I G LOTAREA PLANNING REVIEWED BY z
REQ'D IDED DATE
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REPAIR
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GRADING
CYDS
11
FENCE
DEMOLISH
( � X — FT.)
REMARKS
TANK
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OTHER
GARAGE
CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
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STRUCTURAL DESIGN
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CONSULTANT
Description FEE Description FEE
HEAT S LIKE LOT SLOPI:; 1:1 VESTED DATE Plan Check State Surcharge
Ou
F_ I Building Permit
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fPLAN CHECK NCI- City Surcharge
Z, Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTE6. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
75 DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
t SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19 00.005(A)(5) Engr. Review
PERMIT LIMIT: SEE ECDC 19.00-005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
En 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESSORS Fire Review
W IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE C TY OF Plan Chk. Deposit
EDMONDS. WASHINGTON, ITS OFFICIALS I
EMPLOYEES, AND AGENTS FROM ANY AND
< ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY 0 Fire Inspecti Receipt #
x R INDIRECTLY on
13 FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
_1 DEEM TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp,'
NOR LIMIT IN ANY WAY THE CITY'S A131LITY TO ENFORCE ANY ORDINANCE PROVISION.. Total Amt. Due
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT TH Recording Fee Receipt #
E INFORMATION
GIVEN IS CORRECT: AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION ROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. This application is not a Permit until signed by the
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 CALL Building Official or Ills/her Deputy and Fees are Paid. and
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. FOR INSPECTION TeceIPI Is acknowledged in space Provided
SIGNATURE OFFIC14
NEn A DATE SIGN I ED (425) LS SIGNA . TU , Rr AT
771-0220
RELEASED PY
AT ENTION ATE
IT IS EXT. 1333
UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
PPROVAL OR A CERTI- 5
A FINAL INSPECTION HAS BEEN MADE AND A
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 if IBC110 / IRC110.
ORIGINAL -FILE YELLOW - INSPECTOR
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES PINK -OWNER GOLD - ASSESSOR
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FINAju PROJECT APPROVAL k oRM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING E IVISION
FROM: YM-E DEPARTMENT DATE —L-
PLEASE SIGN
ENG NEERING DIVISION DATE
PLEASESIGN
PLA G DIVISION DATE
PLEASESIGN
PROJECT
SITE ADDRESS
PERMIT tfe2t�— ADB# DATE INSPECTED. -
DESCRIPTION OF WORK TO BE INSPECTED t'
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
FAILED FINAL INSPECTION - OUTSTANDING ISS JES
0 Copy of CORRECTION NOTICE given to oNvner/contractor by inpector
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tet11p:b1dg:fomis: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:
GasTest ....................
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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