20050993.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONST RUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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CITY ZIP TELEPHONE
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NAME
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ADDRESS
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CITY ZIP TEILEPHI
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PROPERTY TAX ACCOUNT PARCEL NO.
NEW
ADDITION
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REPAIR
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GARAGE
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(TYPE OF USE,
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NUMBER
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MIXED USE
MULTIFAMILY
GRADING
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RETAINING WALL
ROCKERY
NUMBER OF
DWELLING
UNITS
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PLUMBING / MECH
COMPLIANCE OR
13 CHANGE OF USE
1:1 SIGN
IFENCE
( — X FT.)
OTHER
FIRE SPRINKLER
FIREALARM
[PERMIT EXPIRES
�PERMIT
NUMBER
JOB
ADDRESS SwRemp-T* C e
U"t,"J. 7 go
3 14V
PLAT NAMEiSUBDIVISION NO. LOT NO LID NO.
I LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved [3
RW Pormit Requjfw E3
Stleot 1.150 Pemil Required E3
EXISTING PROPOSED InSpection Requirod C1
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REQUIRED DEDICATION FT Undefground E3
Wiling f,qu,fed
METER SIZE LINE SIZE NO, OF FIXTURES PRV REOUIRED
1 1 YES13 NO13 k I
REMARKS
OWNER/CONTRACTOR
"I'ANK FILL
ENGINEERING REVIEWED BY
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ALLOWED PROPOSED
ALLOWED PROPOSED
STUDY
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LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
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FRONT LIRSIDE REAR
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PARKING
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PLANNING REVIEWED BY DATE
REQ*D PROVIDED
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REMARKS
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SPECIAL INSPECTION
REQUIRED OYES
REMARKS f
CONSULTANT
IP/ _,Z0007-1- t-
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
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
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 111.00.005(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
E EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
j 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
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
Cj;g!:j%E LABOR CODE OF THE STATE OF WASHINGTON RELATING
WORKMEN'S P N ATION INSURANCE AND IRCW 18:27.
CALL
FOR EICTION
SI TURE NER RAGENTI: 1-0-1, DATE SIGNED
(425)
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771-0220
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ATTE ION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE TIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A C RTI-
t I
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 1IR 10.
10104 PRESS HARD - YOU E MAKIW-Ar
FEE
OCCUPANT
GROUP
OCCUPANT
LOAD
Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a per"ut until signed by the
Building Official or hisihor Deputy, and Foes afe paid, and
receipt is acknowledged it) space provided
"IIALS SIGNAIfiRE DATE
COPIES
WA
ORIGINAL - FILE YELLOW ANSPECTf
PINK -OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE.
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DATE
FROM:
PLEASE SIGN
ENGINEERING DIVISION DATE
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PLEASE SIGN
PLANNING DIVISION DATE
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PLEASE SIGN
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PROJECTt,;?F/-v.9fl__
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SITE ADDRESS- �qo
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PERMIT #?_MT _ADB# DATE INSPECTED -7
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DESCRIPTION OF WORK TO BE INSPECTEDL /'6 7A7/---( /At-SIOW
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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
PERFORMANCE BONDS and the granting of
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to own.er/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/c.ontractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date Signature
Ltemp:bldg: forms: ocaprvi 3/25/04
. ..........
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall ..........................
Pier/Porch .................
Retaining Wall . ...........
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Slab Insulation ..........
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PLUMBING:
Underground .............
Rough -In ....................
M
M 0
Commercial Final ......
0
0
C
HEATING:
3: M
Gas 'Test .....................
ITI Z
-Gas Piping .................
Equipment .................
Commercial Final .......
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EXTERIOR SHEATHING
M M
NAILING ...........................
0
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FRAMING ........................
0 ITI
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FIRST FLOOR FRAMIN&..
0)
M 0
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INSULATION ...................
F1 oor Insulation ...... *
3:
Wall Insulation ...........
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Ceiling Insulation ...
SHEETROCK NAILING ...
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SPECIAL INSPECTION....
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................