20050855.pdfI
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAME/NAME OF 13UFAINESS
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CITY
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CITY ZIP
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STATE LICENSE NUMBER
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PROPERTY TAX ACCOUNT PARCEL NO.
NEW
ADDITION
REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
(TYPE OF USE, BUSINES
RESIDENTIAL
2—COMMERCIAL
1:1 MIXED USE
[:] MULTIFAMILY
TELEPHONE
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CBLN
61 15,6
2 [PERMIT EXPIRES
PERMIT
N U IM B E R
JOB SUITE/APTH
ADDRESS
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PLAT NAMEISUB DIVISION NO.
LOT NO
LID NO.
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LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
13
1:1
RW Permit Required
Street Use Priml Required
[3
EXISTING PROPOSED
inspection Required
[3
Sidewalk Required
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REQUIRED DEDICATION FT
underground
13
Waino required
METER SIZE LINE SIZE NO. OF FIXTURES
PRV REQUIRED
YES13 NOO
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE W
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GRADING
CYDS
TANK
EiRETAINING
WALL
ROCKERY
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TION DATE CHECKED BY VARIANCE OR CU SHORELINE REO'D COMPLETED EXEMPT
6L I I OYES 13NO I . 1
CA# ZONE SIGN AREA HEIGHT
WAIVER C1 ALLOWED PROPOSED ALLOWED PROPOSED
STUDY 13 1 1 1
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
E3 PLUMBING I MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
oCOMPLIANCE OR z
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PARKING LOT AREA PLANNING REVIEWED BY DATE
SIGN REQ'D I PROVIDED
FENCE
( x FT.) REMARKS
OTHER - I--
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EFIRE SPRINKLIRI
FIREALARM
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NUMBER NUMBER OF j� shA � —,I J \R1 411-�
OF DWELLING SPECIAL INSPECMdN CONSULTANT
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71
STORIES
UNITS
REQUIRED 13YES
DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT
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BY:
STRUCTURAL DESIGN
BY:
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VALUATION
Description
Plan Check
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building Permit
PLAN CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
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BE DONE ON*PRIVATIE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
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PERMIT APPLICATION: SEE ECDC i9.00.005(A)(5)
PERMIT LIMIT: SEE ECDC ig.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
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'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 HE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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Fire Review
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Fire Inspection
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LandscapeInsp.
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NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
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FRocording Fee
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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
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
C jo
CALL
FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
(425)
RE(OV ON OR AGEN
DATE SIGNED
OCCUPANT
GROUP
OCCUPANT
LOAD
FEE Description FEE
f`�O State Surcharge
City Surcharge_
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Roccipt #
APPLICATION APPROVAL
This application is not a parani until signed by the
Building Official or his/her Doputy and Fees are paid. and
tticti,pt isacknovylinigod in space provided
F� 1 G N,4� U � F DATIP
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ATTENTION 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 / IBC110 / IRC110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
DATE
ORIGINAL FILF YELLOW JrISPECTOR
PINK -OWNFR GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
N1 EMO TO: PERN Om>qq R, BUILDING DIVISION
DEPART11ENT DATE
FROM: FIRE
VILANC SUM
ENGINEERING DIVISION DATE
P1.F.ASLS16N
PLANNING DIVISION DATE
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SITE ADDRESS—
DATE INSPECTE i0l a /0C
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PERMIT ADB#
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DESCRE?TION OF WORK TO BE INSPECTED Ut.200 00" FWAVICIA"-J sly J?P&-t
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A field inspection was conducted to determine compliance ppro% appro*
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denotes that there are no objections from the above signed Department to flie releas.
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PERFORMANCE BONDS and the era n
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS. NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
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FAI D FINAL INSPECTION - OUTSTANDIN
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given to owner/contractor by inpector
Copy of CORRECTION NOTICE 1.
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R,E-INSPECTED OUj:STANDING ISSUES - GRANT FINAL PROJECT , APPROVAL
Date 0 5- Signature
Henip:bIdglommocapn-1 3!25/04
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ....................
FOUNDATION:
Footing ......................
Wall...........................
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Pier/Porch .................
Retaining Wall ...........
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Slab Insulation ...........
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PLUMBING:
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Underground ............
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Rough -in I ............
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Commercial Final ......
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HEATING:
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Gas Test ....................
.,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 ...
INSULATION ...................
Floo - r Insulation ....
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Wall Insulation ...........
Coiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
Cud-,
OCCUPANCY ..................
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