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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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7-1 PERMIT EXPIRES 1�114
USE PERMIT
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NUMBER
T.B SUITEIAFTN
ADDRESS
PLAT NAMEISURDIVISION NO. I LOT NO U NO.
LID FEE S
PUBLIC RIGHT OF Y PER OFFICIAL STREET MAP T E Sll:.lFlRlZql 11-
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METER SIZE I LINE SIZE I N.�OIFIXTURES P REQUIR
Y. NO
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAIMAGe
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REVIEWED1 TE
ENGINEERING 0 1!
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FIRE REVIEWED BY DATE
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INSPECTI N
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STATE LICENSE NUMBER EXPIRATIONDATE CHECKEDBY .
SERA REVIEW
COMPLETE I EXE"'
EXP
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ALLOWED PROPOSED
HEIGHT
ALLOWED -.P.SE.
FRI ACCOUNT PARCEL NO.
6"A '7 /5 _�T '19 F
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RESIDENTIAL 0 PLUMBING / MECH
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APARTMENT [3 SIGN
GRADING CYGS o (FENCE
13 X _ FT)
0 TANK 0 OTHER
C] ',',ETAININYG WALL RENEWAL
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LOT COVERAGE
ALLOWED PROPOSED
3 5,y. /60,2
REQUIRED SETBACKS (FT)
FRONT SIDE REAP
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PROPOSEDSETBACKS(
FRONT IJR SIDE REAR
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PARKING
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 2
VALUATION
PLAN CHEGK FEE
HEAT S OURCE
BUILDING
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PLAN CHECK NO: 111STED DIE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CURBS. SIDEWALKS, DRIVE AYS, MARQUEES, ETC.) WILL REQUIRE
`PERMISSION.
SEPARATE
STATE SURCHARGE
MIT APPLICATION: 180 DAYS
KIS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
P
PERMIT LIMIT. 1 YEAR ' ROVIDED WOR
SEE BACK OF PINK PERMIT FOR ORE INFORMATION
ENG. INSPECTION FEE
SAP
-AP LICANT. ON BEHALF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
HOLD HARMLESS THE CITY OF
IN IPTEREST, AGREES TO INDEMNIFY, DEFEND AND
N No
2 COMO DS.WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FRO. ANYA
INS�E
ALI.CLAIMSFOR ARISING DIRECTLY OR INDIRECTLY
DAMAGES OF WHATEVER NATURE,
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FROM THE ISSUA CC OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
Mo E
9 DEEMEDTO DIlY, WAWEOR REDUCE ANY REQUIREMENTOF ANYCITIORDINANC
PLAN CHECK DEPOSI'll,
C NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE AN ORDINANCE PROVISION.-
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TOTAL AMOUNT DUE IR
4T4/ 76"
I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION; THAT THE INFORMATION
I
A7P�l AT APPROVAL
GIVEN I S CORRECT, AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
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THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS R E UILATING CONSTRUC-
RE WI L BE EMPLOYED
CALL
BuIl D p.ty: Fll. .1. Dlld
ION.ANDIND ING THE WORK AUTHORIZED THEREBY. NO FSON
CODE OF THE STATC OF WASHINGTON RELA71NG TO
FOR INSPECTION
P� R'P.
IT N VIOLATION OF THE LABOR
WORKMEN'SCOMPENSATI NIHSURANCEANDRCWIB.21
OFF ALSSONAT-JR DATIE
lIGN]UR �IOWOE RA
(425)
771-0220
ABED Y ATE
A77ENTION
EXT1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL. INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE YELLOW IN ECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
5198
FAX
PINK - OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:—
DATE: —
MEMO TO: pERNUT COORDINATOR, BUILDING DIVISION
FROM: --------- FIRE DEPARTMENT DATE-
4T&d��ENGINEERING DIVISION DATE��
PLANNING DIVISION DATE—
PROJECT —
SITE ADDRESS. q3 3 27"
ATE.INSPE T
PERWT # INSPE T
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______—PA'M,INSPF
DESCRIPTION OF WORK TO BE INSPECTED —I
A field inspection was conducted to determine compliance with approved plans. Final approval denote I a that
there are no objections from the above signed Department to the granting of:
_______-Final approval of the described work
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
I
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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