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200015
CITY OF EDMONDS
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REMARKS
PROGRESS INSPECTIONS PER USC 10131FINAL INSPE CTION REG-D 2.
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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STATE SURCHARGE
MIT APPLICATI N: 190 DAYS
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
;APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
FEE
LOAQS�
M EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANYAND
NSPECTIO�EE
ALLC�IMS FOR DAMAGES OF W�ATEVERNATURE.A $SING DIRE-L,
ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
I FROM THE ISSUANCE OF THIS PERMIT
D��.E[DT6.ODF WAIVE OR REDUCE ANY REQUI F ANY CITY ORDINANCE
I Y REMENTO
RECE TPT - I
0 NORLIMITINANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP PLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
LAWS REGULATING CONSTRUC
CALL
T hppt p.,mil -0.1,0d by th,
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THE OWMER. I AGREE TO C MPLY WITH CITY AND STATE
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TION; AND IN DOING THEW RKAUTHORIZEDT B - NO PERSON WILL BE EMPLOYED
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RELATING TO
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F O-R INSPECTION rocoppt is acknowlodg d �, p p-ld.d.
R CODE 0, T.EH'RM OF WASHINGTON
IN VIOLATION OF THE LA SO STAT
DATE
WORKMENS COMPENSATION INSURANCE AND RCW 18.27.
DAT
(425)
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771-0220
11LI DATE
ATTENTION
EXT 333
IS UNLAWFUL TO USE 08 OCCUPY A BUILDING 08 STRUCTURE UNTIL 771-0221
IT
MADE AND APPROVAL OR A CERTIFI-
06INAL MILE - YELLOW - INSPECTOR
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CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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CONTROL CATCH BASIN co
SYSTEM CROSS SECTION
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NOTES:
1. Call Engineering Division C771-0220) for a tightline and detention system inspection
before backfilling and for final inspections. APPROVED By
2, Responsibility for operation and maintenance of drainage systems on private property is the
responsibility of the property owner. Material accumulated in the storage pipe must b flush
out and removed from the Catch basins to allow proper operation. no outlet control orifice DATE
must be kept open at all times.
PROJECT REVIEW CHECKLIST
PROJECT NAME: PLAN CHECK #:
PROJECT ADDRESS: RECEIPT DATE:_ -----
PLAN. IWATER I I
FIRE I.BLDG. jA9W9R191B_Ed E NG.'�
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curb & Gutter Required
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Side Sewer Availability
Calculate Sewer connection Fee If No LID #
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Existin Water Main Size
Water Meter Size
Service Line Size
Water Meter Char A Required
H drant Re uired
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Fire Line Char a Required - Sprinkler
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Reviewed By:
GINEERI
FIRE PLANNING
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R E C 0 R D OF C 0 N T A C T S
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7
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RECEIPT #
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29
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12
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PAID $ RECEIPT DATE
33
SS PERMIT f DATE ISSUED7,),.Ig ZilwECEIPT #
_
14.
PAID $ RECEIPT # DATE
34
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36
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WTER SIZO q PAID $ DATE911q/Do RECEIPT
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FINAL PROJECT AI!PROVAL FORM
'�'ZCEIVED TO:
0 C T 2 '12000
'INGINEffillve DATE:—
NIEMO TO: PEMT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTNIENT DATE-
06
Ofitq_ENGINEERING DIVISION DATE-124L
PLANNING DIVISION DATE —
PROJECT C- C,
SITE ADDRESS- a sl')
PFRWT O_L��:��'.ADB#______PATE INSPECTED-1610—k-6
DESCRIPTION OF WORK To BE INSPECTED —
A field inspection was conducted to determine compliance with approved plans. Final approval denotes that
there arc no objections from the above signed Department to the granting of:
___�__Finai approval ofthe described work
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
______yAILED FINAL INSPECTION - OUTSTANDING ISSUES
I .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
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ATE RECEIVED
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CITY OF EDMONDS
PL
CONSTRUCTION PERMIT AP ICATION
OWNER NAMENAME OF BUSINESS
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ZIP FTEIEIIH.�E
NAME
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PERMIT
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ADDRESS REMARKS 9
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TliM PERMIT lIJTR.EIlEl CILI THIS WORK N.TEB. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTIOC.ON THE PUBLIC
RIVEWAY MAFtOUEES,ET IWILLREQUIRE
GRADINGIFILL
DOMAIN (CUBES. SIDE"'SKEND IS PERSIISSION.
RA
STATE SURCHARGE
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF 0, HIS O�,, ,ER IPEONUDIE SL.,,.BS
bE � 11IRS. ASS�IGN� AN()
NO HOLD HARMLE3S THE CITY OF
EN..,NSIECTION FEE
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AL CLAIMS . A AGES HA VER NATU.E.A.ISIN.DRE
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PLAN CHECK DEPOSIT
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TO ENFORCE ANY ORDINANCE PRO"
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YW I I C I S E, III
0 F N AN A HE I I A L
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
E AND THAT , AM THE OWN% SOTAT,.E GUSLY AUTH RIZED AGENT OF
GIVEN "CORR CT
E LAW REGULATING CONSTRUC-
CALL
appi. a p,,,,i unt,l 11pla by Ino
h,,Iho, DeD.ty and F,oS 11, P.1d. and
THE OWNER I AGREE To COMPLY WTH CITY AN
TION� AND IN DOING THE WORK AUTHORIZED THEREBY. NO P EPSON WILL BE EMPLOY E
INSPECTION
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING Too
FOR
DATE
WORKMEN$ COMPENSATION INSURANCE AND RCW 113.21�
(425)
0 AFICIAbN7
,!A tj _ 0
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771 -0220
ELE ,E D By I
ELE
DATE
EXT 333
ATTENTION
T IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
- INSIECTOR
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFF
Ol
RIGINAL FILE YELLOW
GOLD ASSESSOR
TE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER