20050733.pdfDATE ROCEIVE1
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
4E OF B Sl E
MAILING A9DRESS
716
CITY zip TELEPHONE.
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NAME
ADDRESS
NAME
ADDRESS
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CITY ZIP
STATE LICENSE NUMBER
S� U-1 Q C_ I �V I I �%y
PROPERTY TAX ACCOUNT PARCEL NO.
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
MIXED USE
REMODEL
MULTIFAMILY
REPAIR
GRADING CYD
DEMOLISH
TANK
EiGARAGE
CARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN
P RMIT
NUMBER
JOB
ADDRESS
PERMIT EXPIRES
SUITEIAPT#
PLAT NAMEISUBDIVI SION NO. LID NO�
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
13
RW Permit Required
Street Use Permit Required
13
EXISTING PROPOSED
inspection Required
13
Sidewalk Requiremcl
13
REQUIRED DEDICATION FT
Uncicirgiound
13
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wiring required
METER SIZE
LINE SIZE
NO OF FIXTURES
PRV REQUIRED
YESO NOO
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REMARKS
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15
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY
DATE
W
FI(REV WtBY DAT ui
TELEPHONE
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EXPIRATION DATE I IANCE OR CL( ELINEORADBO INSPECTION SEPA
REO'D COMPLETED I EXEMPT
13 YES [3 Nol
CA# ZONE SIGN AREA HEIGHT
WAIVER 13 1 ALLOWED PROPOSED I ALLOWED PROPOSED
STUDY 13 1 1
LOTCOVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
PLUMBING I IVIECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR LD
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COMPLIANCE OR 2
CHANGE OF USE I — z
PARKING LOTAREA PLANNING REVIEWED BY DATE
SIGN R E O'D PROVIDED
FENCE
S x FT.) REMARKS
OTHER
FIRE SPRINKLER
FIRE ALARM
,�-_ I aL-- h L./.r Ot., IN D LD
TYPg OF CONSTRUCTION
A.
NUMBER
OF
STORIES
BER'OF
DWELLING
NITS A
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SPECIAL INSPECTION
REQUIRED 13YES
DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT
BY:
'V* L L /-i (L
STRUCTURAL DESIGN
BY:
VALUATION
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Description
Plan Check
HEAT SOURCE
LOT SLOPE%
VESTED DATE
Building Permit
PLAN CHECK NO:
Plumbing
Mechanical
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.
Grading
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC i9.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
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.-
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Fire Review
Fire Inspection
Landscapelnsp.
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
1 CODE OCCUPANT
�_/CM3 IGROUP _E2
CONSULTANT OCCUPANT
LOAD
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL
TION; AND IN DOING TH W RK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF TH LA�BOR CODE OF VE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMP S�T RAN?F,^D RCW 18:27.
SIGNATURE (0 ER 0 ENT DATE SIGNED (425)
77-1 norm
ATItNTION EXT. 1333
IT IS UNLAWFUL 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 I IBC110 f IRC110-
`10104 PRESS HARD - YOU ARE MAKING 4 COPIES
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
It Receipt #
APPLICATION APPROVAL
This application is not a pound until signed by the
Building Official or hisilhor Deputy: and Fees are paid. and
receipt is acknowledged in space provided.
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kL --FILE IqLOW - INSPECTC
- OWNER VOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: —FIRE DEPARTMENT -DATE R-
PLrASESIGN
ENGINEERING DIVISION DATE
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PLEASE SIGN
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PLANNING DIVISION DATE
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PLEASE SIGN
PROJECT_,V�e'
SITE ADDRESS
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PERMIT # ADB# DATEINSPECTED (f —3/—(u
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DESCRIPTION OF WORK TO BE INSPECTED
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A field inspection was conducted to determine compliance with approved plans. Final approval
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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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FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES.
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[:1 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:fbrms:ocaprv1 3/25/04
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
DATE
FROM: FIRE,DEPARTMENT -9'
PLEASE SIGN
ENGINEERING DIVISION DATE
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PLEASESIGN
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PLANNING DIVISION DATE
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PLEASESIGN
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PROJECT S2X(a/y-�
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PERMIT #_2����ADB# DATE INSPECTED 7-0
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DESCRIPTION OF WORK TO BE INSPECTED
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PERFORMANCE BONDS and the granting of;
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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RE -INSPECTED OUTSTANDING. ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbrms:ocaprv1 3/25/04
RECORD -OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall............................
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Pier/Porch .................
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Retaining Wall
Slab Insulation ..........
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PLUMBING:
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.............
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Rough -in ...................
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Commercial Final ......
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HEATING:
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GasTest ....................
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.Gas Piping .................
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Equipment .................
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Commercial Final .......
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EXTERIOR SHEATHING
0
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NAILING ..........................
FRAMING .........................
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FIRST FLOOR FRAMING ...
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INSULATION ................. .
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Floor Insulation ...
Wall Insulation ...........
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Ceiling Insulation ..... .
SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..........
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