20050815.pdf13
F�ATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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$W PERMIT EXPIRES
PERMIT
NUMBER
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ADDRESS
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PLAT NAMEiSUBDIVISIO040.
LOT NO.
LID NO.
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LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
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Street Use Permit Required
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EXISTING PROPOSED
Inspection Required
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Sidewalk Required
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REQUIRED DEDICATION FT
Underground
Wirinq roquited
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METER SIZE
LINE SIZE
NO.
T RES
PRV REQUIRED
YESM N013
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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PROPERTY TAX ACCOUNT PARCEL NO
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PLUMBING / MECH
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FIRE SPRINKLER
FIRE ALARM
LOT COVERAGE
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NUMBER NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
STORIES UNITS Ly LOAD
Oikil REQUIRED 13YES ..� --I . . dLLV-
DESCRIBE WORK TO BE DONE 17, fpM UT 9E;V(!5__FVy4- I -'-xT10`_"`
REMARKS-
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GEOTECH REPOR
BY:
STRUCT112A D.
BY: V_-� jr) 1>4 140 PC- Pek 2 1
VALUATION
$ 771 6a
Description FEE Description FEE
Plan Check State Surcharge
ESTED DATE
City Surcharge
HEAT SOURCE LOTSLOPE
T__L- T Building Permit 0/7//;1
PLAN CHECK NO: Plumbing Base Fee
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 Grading CM
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Engr. Review
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASS . IGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection EReceipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE t.
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
NOR LIMIT IN ANYWAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' i pt # /2
Receipt #
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APP VAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE bULY AUTHORIZED AGENT OF This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. FF1 LS SIGNATjJRE D E
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S�I�GN!�JANER 0 GE lr�. DATE SIGNED (425) ir`0 NO I?
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Af3tNTION 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 / IBC11110 / IRC110.
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Soulld/Iloise origina - ting fi-oll; lenil vrary Collstruclioll sites ils a I es[III of,
C011SIRICtioll i1clivity are C.\Cllll)t froill file noise limits (if I-cC CIjjII)IeI-
5.30 0111Y during. the hour.,; ill' 7:00am to 6:00I)m oI, %%,eckda\,s and
10:00aill and 6:00pill oil Silt til-days. C.xCltjdillg Stindav 11 PERMIT#:
Holidilys. At all oiliel- fillies Ile '110 S and Federi
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isc " - 1 EXPIRES:
site.,; acti with the lloi.,�C limits ofThapter 5,30, unless
Z. Ilils I)CCII 911'1111C(l I)L11'.1441111 to ECC 5.30.120.
ISSUED:
City of Edmonds
THIS CARD MUST BE POSTED ON SITE AND AVAILABLE To THE INSPECTOR
Owner:
Site Address: 2- /�;A
Prniect: P(M, 1�
Setbacks for Zone
Front
Rear:
Side:
Height:
Variance #:
Inspections
Approve
Dale
Notes
#1 ENGINEERING
MOBILIZATION AND EROSION CONTROL INSTALLATION MUST BE APPROVED PRIOR TO COMMENCENIE NT OF ADDITIONAL WORK.
(425) 771-0220 x1326 Mobilization / Erosion Control
Tightline
Detention
Forms (sidewalk, driveway)
Water Service
- - - - - - - - - - - - - - - - - - - - - - -
- - - - - - - - - --- - - - - - - - - - --- - -
— - - - - — - - - - - - -
- - - - - - I
- - - - - - - - -- - - - - - - - -- - - - - -
---
Permit # Side Sewer
Permit # Right -of -Way
(s/w. c/g, paving)
#2 SITE/DEMOLITION Pre -Demolition
AsbestosPSCAA Permit
twer Cap i
f Cleaned Site/Final
#3 FOUNDATION Setbacks
Footings
Foundation Wall
Piers
Retaininp, Wall
Slab Insulation
—
- - - - --- - - - - - - - - - - - - -
- - - - - - - - - - - - - - - - - -- - - - - -
- - - - - - - - - - - --- - - - - - - --- - - -
--- - — - - - - - - - - - - - - - - -
- - - - - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - - - - - -- - -- - -
—
#4 PLUMBING Ground Work
.0 Permit # 14WO)IS) RoughIn
Grease Fixture
-- - -- - - - - - - - - - -
- - - - - - - - - - - - - - - - - -- - - -
#5 PUBLIC WORKS Cross Connection Control
(425) 771-0235 Trash Enclosure
#6 MECH/HVAC Gas Test/Pipe
Permit # Equi2ment
- - - - - - - - - - - - - - - - - - - --- - -
#7 FRAMING Exterior Sheathing
Shear Nailing
—First Floor Framing
Framinp,
Height Check
- --- - - - -- - - - - - - - - - - - - - - - - -
- - - - - - - 7 - - - - - - - - - - - - - - - -
- -- - - - - - - - - - - -- - - - - - - --- --- -
—
fe #8 INSULATE CAULK Wall
—Floor
Ceiling
- - - - - - - - - - - - - - - --- - - -- - -
#9 SHEETROCK NAIL
#10 FIRE —Hydrant
(425).771-0215 _FQC
Fire Protectigii System
Extinguishers
Addressing, Visibility
- - - - - - - - - - - - - - - - - - - - - - -
- - - - - --- - - - - - - - - - - - -
- - - - - - - --- - - - - - - - - - - - -- - -
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444 FINAL PRO ECT APPROVAL *, ,
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000 1-0 QE�e-1 (PI LVC lks PW PA- D&�t
Fire
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FINAL OCCUPANUY APFKU VAL
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'SPECTOR
THIS BUILDING OR ANY PORTION-THERE!2F 15 NOT TO BE OCCUPIED PER QBQ 109, UNTIL ALL
APPLICABLE CITY DEPARTMENTS HAVE GRANTED A FINAL APPROVAL
Call (425) 771-0220 x1333 for BVILDING INSPECTIONS,
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
M EMO TO: PERM11 C� H�ATOR, BUILDING DIVISION
17ROM: FIRE DEPARTMENT DATE
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ENGINEERING DIVISION DATE
AS r. S I G N
'PLANNING DIVISION DATE
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PROJECT
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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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PE RIFORMANCE BONDS and the granting of.
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GRANT FINAL PROJECT APPROVAL.
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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El Copy of CORRFCTION NOTICE given to owner/contractor by inpector
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FINAL PROJECT APPR
RE -INSPECTED OUTSTANDING ISSUES - GRANT I� OVAL,
Date Signature
1:(cnip:b1dg:fonns:ocaprv1 3/25/04
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS
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FOUNDATION:
Footing ......................
Wall............................
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Pier/Porch .................
Retaining Wall ...........
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Slab Insulation ..........
PLUMBING:
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Underground .............
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Rough -In ...................
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Commercial Final ......
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HEATING:
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Gas Test .....................
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Pas Piping .................
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Equipment .................
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Commercial Final ....
EXTERIOR SHEATHING
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NAILING ........................
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FRAMING .. ........................
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 ...
-MISCELLANiEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................
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