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CITY OF EDMONDS ZONE
CONSTRUCTION PERMIT APPLICATION JOB
OWNER NAME NAME OF BUlESS ADDRESS
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NUMBER
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Legal Description of Property _ include all easements
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Propeny
T:r Account 137--o3/- p22-o 3
Parcel No.
NEW ESIDENTIAL PLUMBINGrMECH
ElADDITION COMMERCIAL CHANGE OF USE
ElREMODEL APT BLDG. SIGN
REPAIR ❑ GRADING ❑ ((ENCE K-PT)
coos
DEMOLISH INSERT TOVE El HWIM POOL
OT TUBSPA
GARAGE D RETAINING WALL/ ❑
CARPORT ROCKERY RENEWAL
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER NUMBER OF ♦ CRITICA ''/).^/
OF / CWELLING /II A AREAS
0
PERMIT
NUMBER O '71
ESCRIPTION CHECK
SUODIVISION NO
LID NO
FIGHT OF WAY PER OFFICIAL STREET
MAP
TESCP Approves
_ _ REQUIRED DEDICATION
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NO OF
IXTUBES
PnV REQUIRED
YES❑NO✓t�X"OS
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DATED
REVIEWED BY
SEPA REVIEW
SIGNAREA
HEIGHT
COMPLETE I
EXP
EXEMPT
ALLOWED
PR
ALLOWED PROPOSEDD,,
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LOT COVERAGE
REQUIRED SETBACKS
(FT.) PROPOSED SETBACKS (FT.)
ALLOWED
PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAM
ISPECIAL INSPECTOR IAREA I OCCUPANT
❑ YES REQUIRED E5 LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108
FINAL INSPECTION REOUIRED
VALUATION FEE
PLAN CHECK FEE
HEAT SOURCE'.
GLAZING /I
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PLUMBING
Plan Check No. / L/
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGWILL
Any construction on the public domain (curls, sidewalks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
4.
i
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
''ADPlicant. on behalf of his or her spouse, heirs, assigns and
END. INSGc TIONFEE
,n successors In interest, agrees to indemnity, defend and hold
w harmless the City of Edmonds, Washington, its officials,
:I
aemployees, 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
PLAN CHECK DEPOSIT
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omodify, waive or reduce any requirement of any city ordinance
;
m nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision."
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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
ATTENTION
APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
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state laws regulating construction; and in c1cing the work authoriz•
AUTHDRQES
This application is not a permit until
I
ad thereby, no person will be employed in violation of the Labor
THE
oaLx THE
signed by the Building Official or his/her
it
Code of the State of Washington relating to Workmen's Compensa.
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Deputy; and fees are paid, and receipt is
;
tion Insurance and RCW 18.27,
INSPECTION
acknowledged in space provided.
SIG NALURE NER OR AGENTI DATE SIGNED
DEPARTMENT
G i I
CITY OF
OFFICI SI URE
CJ
EDMONDS
10
CALL FOR
RELE°
°TE
Eq ° (�
ATT NTION
INSPECTION
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771 022o
ORIGINAL — F,e YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTION 109
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RECEIVED
OCT 2 6 1999 FINAL PROJECT
APPROVAL FORM
ENGINEERING
T04414
-
DATE:_ L �-`I f
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM:
PI—SESIGN
FIRE DEPARTMENT DATE
iLw
PLEASE SIGN
ENGINEERING DIVISION DATE NOS g` �ti
PLANNING DIVISION DATE
eIf seslcN �p
PROJECT OZL
SITE ADDRESS Q30 q lI .
PERMIT # O 7 % �- ADB# - DATE INSPECTED No kk
DESCRIPTION OF WORK TO BE INSPECTED )`-' tea nspcot �v� Jc o I r—i
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 granting of:
Dc Final approval of the described work
Performance Bonds associated with the project may be released
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Y' GRANT FINAL PROJECT APPROVAL
GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
ocaprvl.doc.l:temp:bldg: forms6/98
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ...................,
y
FOUNDATION:
��^^
Fooling ....................
Well .......................
Pier/Porch................
Retaining Well............
Slab Insulation............
PLUMBING:
Underground .............
Rough -In .................
Commercial Final........
HEATING:
Gas Test .................
Gas Piping ................
_ Equipment ................
Commercial Final.........
EXTERIOR SHEATHING
NAILING ....................
FRAMING
....................`�-
INSULATION:
Floorinsulation...........
Wall Insulation ...........
Ceiling Insulation.........
SHEETROCK NAILING ......
SPECIAL INSPECTION ......
MISCELLANEOUS
FINAL APPROVAL
FOR OCCUPANCY........
32 X I
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