20051155.pdfi DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINES
MAILING ADDRESS
CITY ZIP I TELEPHONF
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ADDRESS
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STATE LICENSE NUMBER
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EXPIRATION DATE
PROPERTY TAX ACCOUNT PARCEL NO.
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PLUMBING I MECH
ADDITION
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SIGN
REPAIR
GRADING CYDS
FENCE
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PERMIT
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PLAT NAME/StUBDIVISION NO.
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RECYCLE REVIEWED BY
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VARIANCE OR CU SHOPELINEORADB# INSPECTION SEPA
REQ'D 01 COMPLETED I EXIMPT
13YES 13N
CA# ZONE SIGN AREA HEIGHT
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SET BACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE
PIEQ*D i PROVIDED
REMARKS
SPECIAL INSPECTION'
REQUIRED 1113
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REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY,
VALUATION
Description
Plan Check
HEAT SOURCE
LOT SLOPE%
VESTED DATE
Building Permit
PLAN CHECK NO:
Plumbing
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Mechanical
Grading
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
Engr. Review
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 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.,
Fire Review
Fire Inspec lion
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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
CALL
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
FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENS
,��NSURANCE AND RCW 18;27.
(425)
771-0220
EXT. 1333
IIE 9 DA
R AGI DATE SWIGND,,,,
ATTINTION
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.
UUUU'�J�D �
GROUP
CONSULTANT
OCCUPANT
LOAD
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Recording Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt # Z?�
APPLICATION APPROVAL
This application is not a pwtnit uniii signed by the
Building Official or his1her Deputy and Fees ire paid. and
reApI is acknowlKqed in space provig 3d
OF =1A L )ATE
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6/05 PRESS HARD -,YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO.
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING. DIV IS ION
FROM: FIRE DEPARTMENT DATE C—C)s
PUAK SIGN
ENGINEERING DIVISION DATE
I'LEASH SIGN
PLANNING DIVISION DATE—
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PLEASESIGN
PROJECT
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SITE ADDRESS
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PERMIT #4q-0 5 �ADB# DATE INSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED 4FZ%2 L.7=
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A field inspection was conducted to determine complianc e 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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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 owner/contractor by inspector.
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FAILED FINAL INSPECTION OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
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2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fornis:ocaprv1 3./25/04
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ............ ........
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch ... ..............
Retaining Wall ...........
Slab Insulation ..........
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PLUMBING:
Underground .............
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Rough -In ...................
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Commercial Final .......
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HEATING:
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Gas Test ....................
107-1
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Gas Piping .................
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Equipment .................
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Commercial Final .......
EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ........................
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FIRST FLOOR FRAMING...
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INSULATION ...................
Floor Insulation .........
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
..................
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