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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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REMARKS
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DATE
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APARTMENT SIGN REGO PROVIDED
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REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTIO�
VALUATION
PLAN CHECK FEE
HEATSOURCE LOT SL PE 1�
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PLAN CHECK NO:
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MECHANICAL
,:[—T.,.PE.R...�T
AUTHORIZES ONLY THE GORK NOTED. THIS PERMIT COVERS IORKTO
E E ON PRIVATE PROPERTY NLY. ANY CONSTRUCTION ON THE PUBLIC
SIDEWALKS.DRIVE AYS. MARQUEES, ETC.) WILL REQUIRE
'CLF.S, IRE
SEPARATE PERMISSION.
GRAGINGIFILL
5 ESURCHARGE
S.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFO MATION
13
;APPLICANT. ON BEHALFQF HISOR HER SPOUSE. HEIRS. AEStGNSANDSUCCESGRS
N NTEREST, AGREES TO :NDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, TSOFFICIALS� EMPLOYEES, AN[
LL CLAIMS FOR DA AGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
A E
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMEDTO MODIFY. WAIVE OR REDUCE ANY REOUIREME�TOF ANYCITYORDINANC
R I I
NOR LIMIT IN ANY WAY THE CITY S ABILITY To ENFORCE ANY ORDINANCE P 0110"
LANDS ING
IECTIoN FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
RECEIPT
RECI
I.EFEBY ACKNOWLEDGE THATI HAVE READ THIS APPLICATION: THATTHE INFORMATION
GIVEN IS Co RECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT 01
THE OWNER, -I AGREE TO COMPLY WITH CITYAND STATE LAWS REGULATING CONSTRUC-
TION.ANDINDOINGTHEW RK AUTHORIZE11 THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LA o R CODE OF THE STATE OF WASHINGTON RE 'ATING To
WORKMEN Spq��NSATION INSURANCE AND ROW 18.27,
APPLIdATION APPROVAL
T ppj..OS S p._1 -d 11911d by th,
CALL Otfib,.; ., h.11hll DIP.tY, A�d FOOS w. O.,d
FOR INSPECTION
OFFICIALS SIGNATURE DATE
DATE SIGNED
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(425)
771-0220
E SE"Y
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-m
EXT 333
771-0221
CATE OF OCCUPANCY HAS BEEN GRANTEE). UBC SECTION 109
FAX
PINK-O.NEF GGLD-ASSESSOR
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE-
-PLANNING DIVISION DATE-1-L
PROJECT- ��"Lsnr�,
SITE ADDRESS AL,-,
PERMIT #,'k2g-4L12,—ADB# )aj INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
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:
inal approval of the described work
------- Yerformance, Bonds associated with the project may be released
__,�—GRANT FINAL PROJECT APPROVAL
_GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
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----JAILED FINAL INSPECTION - OUTSTANDING ISSUES
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. RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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FIRE REVIEWED BY DATE
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SEPA REVIEW SIGN AREA HEIGHT OPOSED
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PROP TYTAX ACCOUNTPARCELNO. Ip
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COMPLIANCE OR IVA
ADDITION C3 COMMERCIAL CHANGE OF USE
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REPAIR [3 GRADING YQS PENCE X _ FID
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CHECKED BY TYPE OF ONSTRLCTI.N G CUP
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NUMBER N "IE111 SPECIAL INSPECIOR AREA
DWELLING 'AREAS LOAD:,
OF NUMBS REQUIRED 0 YES
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DESCRIBE WORK TO BE DONE EMARKS
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVER WORK TO
BE DONE ON PHWATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
OR "'G"'LL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
STATE EURC-AR-E
T
:1 SEPARATE PERMISSION,
2 PE MIT APPLICATION: 180 -AYS
1.
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN UID DAYS
SEE BACK OF PINK PERMIT FOR MORE INF DRMATION
LUrINSPEC, NFE
0 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, A �SIGNS AND SUCCESORS
A LESS THE CITY OF
IN INT2RE.STAA�GR%ETC`No. NOEl'IF'Fl. DEFEND AND HOLD H RM
I N
L N
INSPECTION FEE
2 ED .NO W HN :T . CIALS.EMPLOYEES ANDAGENTS FR ANYAND
PLAN CHECK DEPOSIT
COM
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY RINDIRECTLY
FROM TIE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PER.lT SHALL NOT BE
I OEEMEOjTO MODIFWYAWIAUE OR REDUCE ANY PEOUIREMENT OF ANY CITY ORDINANCE
PROVISION'
TOTAL AMOUNT DUE
RECEIPT
L)
N.RL. 'NAN, CITYS ABILITY TO ENFORCE ANY ORDINANCE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INI.RMATION
APPLICATION AP VAL
GIVEN IS CORREC THE DULY AUTHORIZED AGENT OF
T. AND THAT I A THE OWNER. OR
CITY AND STATE LAWS REGULATING CONSTRUC
CALL
Tin 1pplll�ltl -1 - I PO mll U-1 I �19"ld by IhR
1,111h., o,p,: 'y lZF001 "', p,,d. aM
THE OWNER. I AGREE TO COMPLIWITH
TIOKANDIND ING THE WORK AUTHORIZED THEREGY, NO PERS NWILLBEEMPLOYE-
S1.1d.,,o Otf,P.I .1
.�kl.dg. . p—ld.d,
N OLAT OF THE LABOR CODE OF THE STAT OF WASHI NGTON RELATING TO
I VI ION
FOR INSPECTION
DATE
WORKMEN'S COMPENSATION INSURANCE AND RCW 1B.27. OFFICIA S IGNATURE
DATE SIGNED (425)
SIGNATURE (OWNER OR AD
I-?, ovrlr� 771-0220 AELEASE54Y
EXT 333
1 ATTENTION E OR OCCUPY A BUILDING OR STRUCTURE UNTIL I, 4t
IT IS UNLAWFUL TO US 771-0221
ppROVAL OR A CERTp- ORIG-161- FILE YEL18W_i�'SPEC�54 I
A FINAL INSPECTION HAS BEEN MADE AND A SECTION 1 o9 FAX PINK.oWNER GOLD ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC x-