20060082.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PERMIT
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PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
LID FEE E
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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Description
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ADDITION ❑
0 STUDY
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUICE
LOT cbvifF'AGE
REQUIRED SETBAOKS(FTI
PROP.pSED SETBACKS(FTI
CHANGE OF USE
MIXED USE
REMODEL MULTIFAMILY ❑ SIGN
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT VR SIDE REAR
0 REPAIR E3 GRADING CYDS E3 FENCE % FT)
PARKINGOT
AREA
PLANNING REVIEWED BY DATE
OTHER —_
E3DEMOLISH rl TANK
REO'D I PROVIDED
Receipt a
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
❑GARAGE RETAINING WALL FIRE SPRINKLER
c3ROCKERY ❑
REMARKS
z CARPORT FIREALARM
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
(TYPE OF USE, BUSINESS ORIVI�%PLAIN:
Receipt k
Vw' NUMBER,..�/� NUMBER OF
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TYPBOF CONSTRyCTION
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REQUIRED ❑ YES
REMARKS
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Description
FEE Description FEE
HEAT SOURCE LOT SLOPE.
Plan Check
State Surcharge
Building Permit
City Surcharge J
PLAN CHECK NO:
qTHEPUBLIC
Plumbing
Base Fee
THIS PERMIT AUTHORIZES ONLY THEWORK NOTED. THIS PEO
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUICE
Mechanical
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES,RE
Grading
SEPARATE PERMISSION.
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PERMIT PERMIT APPLICATION: SEE ECOCt8.00.005(Aj(5)
PERMIT LIMIT: SEE ECOC 18.00.005(AII61
Engr. Review
Recording Fee
Engr. Inspection
—' Plan Chk. Deposit
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
•APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
Receipt a
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
f 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
Fife Inspection
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TotalAmt. DUE '
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscape insp.
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r NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
APPLICATION APPROVAL
[HERE V ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT: AND THAT 1 AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
CALL
Thls applleallon Is not a Pc .I until s18netl h1 ft
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC”
FOR INSPECTION
Buliam0011,111111 hH-1 Deputy Intl F11S are PAA Intl
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOY ED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
oc2lPl lsacknowletlgetl In apace p, 1-d
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
(425)
off NA R OA
SIGNATURE IOWNER AGE T): DATE SIGNED
771-0220
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EXT. 1333
RELEASED DY D E
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI.
ORIGINAL FILE • YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 t IRC110•
PINK .OWNER - GOLD - ASSESSOR
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ENGINEERING INI'SECTION
FEE RECONCILIATION
Project Name: !V i 3b,lr ItrmzeS
Contact notified of fees due: ❑ by phone —.0-Eo"erection notice given
Date Paid:
Receipt #:
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Address: Z4''
❑ Engineering Notified of Payment Received
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Building Permit #: �l�)US URS
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Permit Fees Collected at Permit Issuance
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# of Inspections: X $50.00
= $
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Receipt #: �D Receipt
Copy Attached: Yes 104--1)
Only required if refund is due
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Total Inspections Performed
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# of Inspections: �j X $50.00
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Inspection Fees TO BE PAID $
Contact notified of fees due: ❑ by phone —.0-Eo"erection notice given
Date Paid:
Receipt #:
Collected By:
❑ Engineering Notified of Payment Received
REFiIAD Due $ f
Reconciled By: Date �Z
Original to: Permit File Copy to: ❑ Engineering Admin (refunds only)
Revised 312166
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FINAL PROJECT -APPROVAL FORM
TO:
DATE: -
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
L ENGINEERING DIVISION DATE 5-12(p Lo
PLFl3E SIGN
PLANNING DIVISION DATE
PI.EASESIGN
PROJECT -r i s��f22A��rffie "
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SITE ADDRESS q0 " #V,� i4) / /
PERMIT # 240 G�g� ADB# DATE INSPECTED S Zak l D �F
DESCRIPTION OF WORK TO BE INSPECTED M (.
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
❑ Copy of CONDITIONS given to owner/contractor by inspector
L
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
❑ Copy of CORRECTION NOTICE given to owner/contractor by inpector
I.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
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Permit Inspection Details
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FINAL APPROVAL FOR
OCCUPANCY ..................
RECORD OF INSPECTIONS
1,
INSPECTOR DATE APPROVED
SETBACKS ......... "
+
FOUNDATION:
Footing ......................
Wall ...................... ..
ttttiiii
Pier/Porch ................
Retaining Wall ......
l'
..... .... .
"M SIa6 lns�lation .A ._. �.
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.PLUMBING:
....Undergrounds...........
'' .,... ..
Rough-in
Commercial Final ......
...
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HEATING:
a
Gas Test ...................."
Gas Piping .................
.Equipment ................. ,
Commercial Final ...._.
"
EXTERIOR SHEATHING
•' -
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING...
.,,.
"
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
"
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................