20010849.pdfD.T RECEIVE.
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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ING ADDRESS
I TELEPHONE
NAME
ZIP
NAME
PERMIT EXPIRES
US'
DIE
PEM'MIETR'�5
123e NU
JOB S ITEJAIT-
ADDRESS All,-;
PILAT NAMEISURDIVISION NO
LOT 10.
LID NO.
LID FEE
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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EXISTING - PROPOSED-
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REOUIRED DEDICATION- FT
METER SIZE
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REMARKS
OWNERCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
MARSHAL
PRESENT FOR
W6T LE '
ENGINEERING IANK I -ILL. flLiVlUVAILV,"VJMuN$Mr_
I ADDRESS!? 86,A 3 /_�� _4'
FIRE REVIEWED BY DATE
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VARIANCE OR CU
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STATE LICENSE NUMBER DATE I IED BY
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SERA REVIEW
COMPLETE I EXEMPT
EXP
SIGN AREA
ALLOWED I PROPOSED
HEIGHT
ALLOWED I PROPOSED
PRO?0?� AC PARCEL NO,
0 NEW
f9l RESIDENTIAL
PLUMBINGIMECH
LOTGOVERAGE
ALLOWED PROPOSED
REOUIRED SETBACKS (PT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT)
FRONT UPSIDE REAR
COMMERCIAL o C PLIANCEOR
C3 AUDITION 0 CHANGE OF USE
- PA R
LOT AREA
PLANNING REVIEWED BY DATE
0 REMODEL [3 APARTMENT SIGN
REDD
IKING
PROVIDED
[3 REPAIR 0 GRADING CYDS 0 PENCE
X PT)
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CARAGE RE
0 GARP.RT RGTAINIRNYG WALL 0 RENEWAL
CK
ACTIVITY) EXPLAIN:
TYPE OF USER;3!SSOR
AlW 44 7AIVIk
CIECKEDBY
ITYPEOFOONSTFIUCTION
10
C7, CCUPAN�C '5
GROUP
I -WU.7ER NUMBERCI
CR ITICAL
AREAS
IAL
SPEC JCN
PAN
OGCUPAN
DWILLIN 3
U
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NUMBER
JAREA
RED UIRE JECTIOR
LOAD
DEjrRIBE WORK TO BE DONE
REMARKS
3
Fl�
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
9-
P
&
VALUATION
FEE
PLAN CHECK FEE
HEATS URCE G vic�% LOT SLOPE %
BUILDING
PLAN CHECK NO: I-STED DATE
MECHANICAL
THIS PERMIT AUTHORIZES ..I THE WORK NOTED. THIS PERMIT COVERS WORK TO
!Z BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADiNGIFILL
DOMAIN (CURBS, SIDE WALKS, DRIVEWAYS. MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
-S-TA-T E SU RCHARGE
PERMIT APPLICATION: 160DAYS
PERMIT LIMIT. i YEAR - PROVIDED WORK IS STARTED WITHIN In DAYS
ENG, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE. HEIRS. AS SIGNS AND SUCCESORS
ENG. INSPECTION FEE
;APPLICANT.
N HTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANYAND
INSPECTIONFEE
ALL CLAIMS FOR DAMAGESOF WHATEVER NATURE. ARISING 0 RE- - - ' -
SHALL NOT BE
RECEIPT
FA THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT
OM FY.WAIVEOR REDUCEANY REQUIREMENT OF ANY CITY ORDINANCE
DEEMEDTOMODI
TO ENFORCE ANY ORDINANCE PROVI SIC.."
PLAN CHECK DEPOSIT
RECEIP/
NOR LIM IT IN ANY WAY THE C ITY'S ABILITY
TOTAL AMOUNT DUE 515
.
1,14EFEBY ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION. THAT THE INFORMATION
APPLICATION APPROV L
IVEN IS CORRECT. AID THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
STATE REGULATING COHSTRUC
TI,., -I - - F-1-I �'. - .d t,l
CALL
T LAWS
HECV�NEA I AGREE TO COMPLY WITH CITY AND
T.01, AID IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
RELATING 0
.
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FOR INSPECTION 10"fl 11 1-1-12"92 '22-ce P"do"
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
_
DATE
WORKMEN S COMFENSATIO�MRANCE AND RCW 18,27
Nll R'C�r
DAI�7
OFFI ALS SIGNATURE
(425)
771 0220 1
RELEASED By DATE
A17ENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILE YELLOW -INSPECTOR
BEEN
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX PINK - OWNER GOLD - ASSESSOR
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FINAL ROJECT APPROVAL FORM
TO:_
DATE: —
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE1L--91--Q—L—
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE —
PROJECT IS 7-
SITE ADDRESS
PERMrr#_20.d_L,:��.ADB#__________PATEINSPECTE�D/�--��-1--,C�
DESCRIPTION OF WORK TO BE rNSPECTED-UT4
A field inspection was conducted to determine final 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
TED
T APPROVAL WrM CONDITIONS NO
GRANT PROJEC
u Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
U Copy of CORRECTION NOTICE given to owner/contractor by inspector
I
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date_ Sign
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