20050773.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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CITY ZIP TEL&H�NE
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PERMIT EXPIRES
PERMIT
NUMBER L-5 7 7
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ADDRESS ,-,I <:_
PLAT NAME/SUBDIVISION NO. LOT NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
REQUIRED DEDICATION . FT
METER SIZE LINE SIZE NO. OF FIXTURES
SUITEiAPT#
LID NO
LID FEE S
TESCPAppfovod
RVV permit Required
Street Use Permit Requited
Inspection Required
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Wiring required
PRV REQUIRED
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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STATE LICENSE NUMBER EXPIRATION DATE ^FCKEID BY VARIANCE OR CU R ADB# INSPECTION SEPA
REO'D COMPLETED EXEMPT
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PROPERTY fAX ACCOUNT PARCEL NO. CAn
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STUDY 0 ALLOWED I PROPOSEO I ALLOWED , PROPOSED
NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT. - PROPOSED SETBACKS (FT.)
ADDITION COMMERCIAL COMPLIANCE OR ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
CHANGE OF USE z
MIXED USE
REMODEL PARKING LOTAREA PLANNING REVIEWED BY z
El MULTIFAMILY SIGN DATE n
REO'D PROVIDED CIL
REPAIR GRADING FENCE I
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DEMOLISH TANK OTHER
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RETAINING WAU FIRE SPRINKLER
CARPORT El ROCKERY FIRE ALARM
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p (TYPE OF USE BU E S OR CTIVITT-_____ �__
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TYPE OWN
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a NUMBER OF
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DESCRIBE WORK TO BE DONE REQUIRED 13 Yi LOAD
REMARKS
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GEOTECH REPORT
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Z STRUCTURAL DESIGN
BY:
VALUATION
Description FEE Description FEE
HEAT SOURCE LOTSLOPE% VESTED DATE Plan Check State Surcharge
Building Permit City Surcharge
PLAN CHECK NO:
Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
L- BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
put PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Engr. Review
0- PERMIT LIMIT., SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
'61 APPLIC ANT,,ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review
V
"d S Plan Chk. Deposit
;NINTERE AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY Receipt #
FROM THE ISSUANCE OF THIS PERMIT.
ISSUANCE OF THIS PERMIT SHALL NOT BE
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due z
NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Recording Fee Receipt #
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 APPLICATION APi�RO—fAirL�
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. This application is not a lieffnit until signed by the
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his!hur DOPLAY and ruesare Paid.and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO receipt '5dCkn0wIed9f'd in sPace providLd
WORKMEN'S COMPENS��PJM�URANCE AND RCW 18:27. FOR INSPECTION I
671 S SIGN /VRE DA E
SI�XTURE (OWNER R AGENT)�- DATE S19NED
(425)
771-0220 RELLA.ZA U BY DAT
ATT'tNT13N EXT. 133'3____
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 / IBC110 / IRC110. ORIGINAL - FILE YELLOW INSPECTOR
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES PINK - OWNER GOLD - ASSESSOR
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FINAL.PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE 1`6 -S
PLFASE SIGN
ENGINEERING DIVISION DATE
PLEASr SIGN
PLANNING DIVISION DATE
PI.EASE SIGN
SITE ADDRESS -
PERMIT 3 ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED/A6Z4�� �O �6
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
0 Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
I.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:f6rms: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 .............
-InRough ...................
Commercial Final ......
HEATING:
Gas Test .... ...............
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING ........................
FIRST FLOOR.FR AMING ...
INSULATION . .....
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETRoCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
'57
OCCUPANCY ..................
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