20050687 (2).pdfillol"�Iv2lbvv � DATE RECEIVED �7
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS I
CITY
NAME
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CITY
NAME
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
C3
E3
Street Use Permit Roq'd
13
EXISTING - PROPOSED
inspection Required
E3
Sidewalk Required
C3
REQUIRED DEDICATION- FT
Undeigtimnd
Wiring required
C3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO 13
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REMARKS
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OWNERMONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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REVIEWED BY
DATE
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STATE LICENSE NUMBER EXPIRATION DATE
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SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSIED
HEIGHT
ALLOWED PROPOSED
PROPERTY TAX A
'4T PARCEL NO.
EXP ,
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NEW RESIDENTIAL PLUMBING / MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT LIRSIDE REAR
ADDITION COMMERCIAL COMPLIANCE OR
OF
7� CHANGE USE
'VMODEL
PARKING
LOT AREA
PLANNING REVIEWED BY DATE
MULTIFAMILY SIGN
ROVIDED
REPAIR C:] GRADING CYDS E] FENCE
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REMARKS
DEMOLISH E:] TANK OTHER
GARAGE E:i RETAINING WALL ;FI I ;1E ;SP R ZIK _L El I
CARPORT ROCKERY
(TYPE OF USE, BIJSINES
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CHECKED BY
TYPE OF CON gR CTION
CODE
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OCCUPAMT
GROUP"e5,
NUMBER MBER OF
0 m OF DWELLING
0 STORIES N
CRITICAL
AREAS
NUMBER
SPECIAL INSPE CTION
REQUIRED YYE
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AREA
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REO'D
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VALUATION
Descrolption FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING% LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO, VESTED DATE Plumbing
I;D
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grad.ing
SEPARATE PERMISSION.
Engr. eview
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
(Al 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
9 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE 54
9 DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due
01 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
x Recording Fee Receipt #
1 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 APPLICATION APPROVAL
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 CALL, Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LAQQR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECT ON
I receipt is acknowledged in space provided.
WORKMEN'S COMPENS?t0FNQSVRANCE AND RCW 18.27.
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SI TU,�E (OWNER 0 GEN DAT]INED (425)
771-0220 11'ELE BW bAtE
A17ENTI Off 1333
IT IS UNLAWFUL TOISE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 0, <)-
RIGINAL LE YELLOW - �"Sp OR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - JNJ C30LD - A SESAR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
04/02 PRESS HARD -YOU ARE MAKING 5 COPIE GREEN - ACCOUNTING
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: COORDINATOR, -BUILDING DIVISION
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PROM: Y I -RE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING. DIVISION DATE
PLEASESIGN
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PLANNING Dr.vism DATE
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DESCRIPTION OF WORK TO BE INSPECTED Lt9Z9==
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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,
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PERFORMANCE BONDS and the granting of:
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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0 Copy of, CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Pate Signature
1: te mp:b1dg:fbnns:ocaprv1 3/25/04
RECORD OF INSPECTIONS
INSPECTOR,
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall........... ..........
Pier/Porch .................
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Retaining Wall .... ......
Slab Insulation ..........
PLUMBING:
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Undergroun d .............
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Rough -in ...................
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Commercial Final ......
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HEATING:
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Gas Tes t ...... ..............
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Gas Piping .................
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Equipment .................
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Commercial Final .......
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EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING .....................
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FIRST FLOOR FRAMING...
INSULAT16N ...................
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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....
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MISCELLANEOUS .......... -
FINAL APPROVAL FOR,
OCCUPANCY ..................