20050809.pdf9
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
,-7-'( 'Pty\j'C_
CITY ZIP TELEPHONE
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NAME
ADDRESS
NAME CBL4
CblikjT�2CL
ADDRESS
'P. C? -
CITY ZIP TELEPHONE
1�), ��35 S.5cy y cftl C)
STATE LICENSE NUMBER EXPIRATION DATE f CiJFC�ED BY j
I K, T't- R (!- (-) x C. k l —�4
PROPERTY TAX ACCOUNT PARCEL NO
92-012
6 G()
k c,2
6 (!" 0
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
MIXED USE
REMODEL
L7'
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
EGARAGE
]
CARPORT
El
RETAINING WALL
ROCKERY
(TYPE OF USE. BUISIVESS,OR ACTIVITY) EXPLAIN
PLUMBING / MECH
COMPLIANCE OR
USE
CHANGE OF
D
SIGN
FENCE
( X
OTHER
,4 FIPF R921hl.!�LER
NUMBER NUMBER
OF DWELLIV
STORIES 2, 6+w, I UNITS
DESCRIBE WORK TO BE DONE
IN
IRE
e :.�'
e
PERMIT EXPIRES
PERMIT
NUMBER
JOB
ADDRESS �_p
15
SUITE �P`rts
7
PLAT NAMEiSUBDIVISION NO.
L01 NO
CID N 0'
I
LID FEE S
PUBLIC RtGHT OF WAY PER OFFICIAL STREET MAP
TESCPAppiroved
RW Point Required
Sifeet use Permit Requited
EXISTING PROPOSED
inspecti3n Requited
Sidewalk Requited
REQUIRED DEDICATION ___
FT
I undergiound
Witing roquired
METER SIZE
LINE SIZE
NO. OF FIXTURES
I PRV REQUIRED
YES 13 NOM
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY
DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU SHORELINE OR AOB# I INSPECTION SFPA
REQ'D COMPLETH) FAFKIPT
OYES 13 NO I I
CAP ZONE I AREA HEIGHT
WAIVER13 , PROPOSED I ALLOWED , PROPOSED
STUDY 13
LOTCOVERAGE
ALLOWED PROPOSED
PARKING
REO'D , PROVIDED
FT.) I REMARKS
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REQUIRED SETBACKS (FT.) I PROPOSED SETBACKS (FT.) I
FRONT SIDE REAR FRONT URSIDE REAR C)
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LOTAREA I PLANNING REVIEWED 13Y DATE n
10.
OF CONSTRUCTION
SPECIAL INSPECTION
REQUIRED C1 YES
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
CODE
CONSULTANT
OCCUPANT
GROUP
10011
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
l'- BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
2 Engr. Review
m PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
W
CL PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V) "APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
Uj OLD HARMLESS THE CITY OF
_1 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND H
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt #
m / pa� -
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Vie—
E Landscape Insp. Total Arrit. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANC
�O NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
imi - Recording Fee I Receipt ill P1 711,eT ;L
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF This application is not it permit unlit signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Otficlal of hisMur Deptity and Fees are paid and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED ter.eipt isacknowledqed it) space provided
IN VIOLATION OF THE LA60R COMF;_OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION I
WORKMEN'S COMPENSAT��URANCKirD RCW 18:27. 0 __Ici�A _s1 t L I F DATE
(425)
SIGNATURE (0 R 0 AGENT DATE SIGNED
ILI
771-0220 R Ve- A DBY I I / DATE
EXT. 1333 Vill jell
ATT E N T 10 N
IT IS , UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI.. ORIGINAL - FILE - YELLOW - INSPECT
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 if IRC110. PINK -OWNER - GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASESIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
-PLANNING DIVISION DATE
PLEASE SIGN
PROJECT
SITE ADDRESS__7
PERMIT t'�Qej�Xl ADB# DATE INSPECTED
7-
DESCRIPTION OF WORK TO BE INSPECTED If
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
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
El Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:ten1p:b1dg:forms: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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