20000948.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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CITY ZIP? TSLEP 0 E
STATE LICENSE NUMBER
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PROPERTY TAX ACCOUNT PARCEL NO. -7-
/3 L/6 _ 00 2-- q 2-0-000,
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0 ADDITION COMMERCIAL C MPLIANCEOR
0 CHANGE OF USE
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PLAN CH, I ED DATE
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AUTHO IZES ONLY THE WORK NOTED. THIS PERMIT O.IEFS WORK TO
THIS PERMI E PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
BE DONE ON PER SIDEWALKS, DRIVE AYS, MARQUEES, ETC.) WILL REQUIRE
DOMAIN (CURBS, SEPARATEWERMISSION.
PERMIT APPLICA11 N: 180 DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 16D DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT ON 1EIIAL1 01 HIS OR 11111 SPOUSE, HERE, ASS10115 AN" 11CC11OR1
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WA HINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
S E. ARISING DIRECTLY OR INDIRECTLY
ALL CLAIMS FOR DAMAO ES OF WHATEVER NATUR
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT B
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANC
USE PERMIT
ZONE JO M.I..... ", x, oi;p I
'08 SULTDAPTO
ADDRESS 1?61V A/
PLAT NAMEISUBDIVISION NO
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LID NO.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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YES 0 No 0
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDR—
ENGINEERING -YEVO—DATE
FIRE REVIEWED BY DATE
VARIANCE 08 CU
SHORELINE OR ADS'
INSPECTION
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POSTED
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RECEIPT
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NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,
TOTAL AMOUNT DUE
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT AND THAT I AM THE OWNER, SOTRATHE DULY AUTHORIZED AGENT OF
LAWS RE
THEOWNER 'A.R�JT.COMPLY CITY -GULATINGCON$TRUC�
WITH
CALL
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THE STATE OF NGTON RELATING TO
WA'"'O
FOR INSPECTION
bpt I, .,k,mtedo.d �, 1p— F-fdod
'ON OF T ABOR CODE OF
IN VIOL AT HE L
WORKMEN,. CO.F ... ATI.N INSURANCE AND HOW 16.27,
F1 ALSSIGNA LEE DATE
01- I
DA E SIGNED
(425)
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771-0220
FELEAE1D.Y DATE
��_ENTION'
EXT1333
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL 08 A CERTIFI-
ORIGINAL - FILE YELLO - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
FAX
PINK -OWNER GOLD -ASSESSOR
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(211) 713-6092
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: —FIRE DEPARTMENT DATE-
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2��r_ENGINEERJNG DIVISION DATE__!_j___Z
PLANNING DIVISION DATE —
PROJECT
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SITE ADDRESS.
PERMIT 000 — A #
INSPECTED
DESCRIPTION OF WORK TO BE INSPEC
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:
Final approval of the described work
L11 GRANT FINAL PROJECT APPROVAL
__2GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
FINAL RISPECTION - OUTSTANDING ISSUES D
AUG 200,
C11Y OF 17�1
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3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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LOT 5LOPE: '1%
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RECORD OF INSPECTIONS
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DATE APPROVED
SETBACKS .....................
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PERMIT EXPIRES
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CITY OF EDMONDS 5 /2--NUMBER�
CONSTRUCTION PERMIT APPLICATION
JOB SUITEIAPTN
ADDRESS A/
-OWNER NAMENAME OF BUS NESS
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REMAAKS
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REV'& FEES
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMOND GTO N F E S� EMPLOYEES. AND AGENTS FROM ANY M.
IOTS
LANDSCAPIN
INSPECTION FEE
2 HFICIA
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TOTAL AMOUNT DUE
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APPLICATION APPROVAL
GIVEN S=T AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AD ENT OF
T PLY W1 M ITY AND STATE LAWS F,.ELlriN. CONETRUC.
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TION� AND , IN. .1KAUTH. ED ,w,pt is acknow a g.d I
THE LABOR CODE OF THE STATE OF WASHINGTON NG TO FOR INSPECTION
IN VIOLATION OF
WOR KNEELS COMPENSATION INSURAN09 AND RCW 18,27.
A U 8 1 DATE
SIG DATE SIGNED
7NATURF(OVA
WGN
71 A -Ull RELEASED By DATE
EXTI 333,
ATTENTION .
TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
IT IS UNLAWFUL
NSPECTIO PPROVAL OR A CERTIFI-
I N HAS BEEN MADE AND A
ORIGINAL - FILE YELLOW, INSPECI 0 R
A FINAL
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
FAX