20041030.pdfPERMIT EX PIRES
DATE RECEIVED I 1 —1
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CONSTRUCTION PERMITAPPLICATION JOB SUITE/APT#
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M U2 PLAT NAME/SUBDIVISION NO NO LID NO.
W MAILING ADDRESS
LID FEE $
TESCP Approvea 0
0 f PUBLIC RIG117 OF W �ER OFFICIAL STREET MAP RW Permit Required Q
Street Use Poneill Roct'd 13
ZIP TELEPHONE EXISTING � PROPOSED inspection Required 13
Sidewalk Required 0
REQUIRED DEDICAI ION FT underground
NAME METER 7_7 Wiringroquired 0
SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES NO
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ADDRESS — W
REMARKS z
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY
ZIP TELEPHONE z
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NAME CBLP
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ENGINEERING REVIEWED BY
cc ADDRESS DATE
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CITY ZIP TELEPHONE E #/VW E DATE ui
IN- 11-7101
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STATE LICENSE NUMBER EXPIRAT17N DATE IANCE OR -14 SI 10RELINE OR ADBN NSPECTION BOND
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k G-� 6 6, (,)GTW SEPA REVIEW SIGN AREA OYES ONO is HEIGHT
PJRPER,�T AC NT PARC jinr') -7 COMPLETE I EXEMPT ALLOWED , PROPOSED' ALLOWED , PROPOSED
_j 187 EXP
NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
1:1 7 ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
ADDITION OMMERCIAL COMPLIANCE OR z
11 CHANGE OF USE I
PARKING LO
E] REMODEL MULTIFAMILY T 7LANNING REVIEWED BY DATE
E] 1:1 SIGN REO'D PROVIDED
REPAIR GRADING FENCE I I I
13 CYDS 1:1 X � FT) REMARKS
El DEMOLISH 1:1 TANK O;;�JFR
GARAGE RETAINING WALL FIRE SPRINKLEh
z CARPORT 1:1 ROCKERY FIRE ALARM
(TYPE OF USE, BUSIN ;,ORIIIACIIVI EXPkAI
cc CHECKED 13Y ITYPE OF CONSTRUCTION CODE OCCUPANT
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NUMBER NUMBER OF
I WELLING CRITICAL 121V1
M OF D AREAS SPECIAL INSPECTION JARE OCCUPANT
0 STORIES UNITS NUMBER Q
_: ........ 1_ — REQUIRED LOAD
DESCRIBE WORK TO BE DONE [:1 YE!
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINALINSPECTION REO'D F3
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VALUATION
—Description FEE Description FEE
HEAT SOURCE Plan Check IZI, State Surcharge
GLAZING % LOT SLOPE %
Building Permit City Surcharge
PLAN CHECK NO: � 1--17
VESTED DATE
") 1,
Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
:3 Grading
I'_ SEPARATE PERMISSION.
cc PERMITAPPLIc riON: 100DAYS Engr. Review
CL
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Fire Review
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Plan Chk. Deposit
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
cc Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NAruRE, ARISING DIRECTLY OR INDIRECTI-Y Receipt #
FROM THE ISSUANCE OF THIS PERMIT
ISSUANCE OF THIS PERMIT SHAIA NOT BE
_j DEEMED TO MODIFy, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
x 0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt #
,
1 HEREBY ACKNOWLEDGE THAT I I IAVE READ THIS APPLICATION; THAT THE INFORMAI ION ---
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC I his application is riot a PCH1111 until signed by ihe
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL
IN VIOLATION OF THE LABQB COD OF THE STATE OF WASHINGTON RELATING TO Building Olficial or his/tier Deputy: and Fees are paid, and
WORKMEN'S COMPENSAT)011_1��ANCE AND RCW 18.27. FOR INSPECTION receipt is acknowledged In space provided.
SIGNATURE (OWNER OR GENT) DATE SIGNED OFFICLAUS S 0, IGIjIA I (JAE DATE
(425) y- A ?) ,
A
771-0220
Rl:[ EASED 13Y DATE,
ATTENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBCI09/IBC110/IRC110. OHIGINAV FILE YELL71 N �5P/ECTOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES PINK�"'OWNLH GOLD-ASSESSOA
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171
FINAL PROJECT APPROVAL FORM
01 00 q TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DAT
PLEA.SE SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASESIGN
CT-41,3
PROJE ___7 �ra-
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SITE ADDRESS S CJAZ's'1;r
PERMIT # 24��) �J, _ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED kl_Z) 0) 4_)__
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 release of
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
[I Copy of CORRE CTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:forrns:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
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Retaining Wall ...........
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Slab Insulation ..........
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PLUMBING:
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Underground .............
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Rough -In ...................
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0
Commercial Final ......
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HEATING:
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Gas Test ....................
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Gas Piping .................
Equipment .................
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Commercial Final .......
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EXTERIOR SHEATHING
NAILING..........................
0
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FRAMING ........................
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FIRST FLOOR FRAMING ...
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INSULATION ...................
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Floor Insulation .........
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Wall Insulation ...........
Ceiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .................. . . . . . .
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