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1,PERMIT EXPIRES _442�L
CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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PLAT NAMPSUBDIVISION NO. NO, L 0 No,
MAILING ADbRESS
L�17 FEE$
PUBLIC IGHT OF WAY PER OFFICIAL STREET MAP
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EXISTING — PROPOSED $mfl-nH-q -a
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REQUIRED DEDICATION— W ,g e3r.a
NAME
METER SIZE LINE PRV REQUIRED
YES 13 No 0.
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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NAME
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FIRE REVIEWED BY DATE
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VARIANCE OR CU SHORELINE OR ADS# INSPECTION I ps.")
STATE LICENSE NUMBER FIX 27;LNE 11D By RE.k aSTED
ffift*-14�7 1 2 — E3yE$ 0
SEPA REVIEW SIGN AREA HEIG
Q,PROPEPTAXq7 ROELNO.
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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EXP 4 11
NEW PLUMBING I MECH
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Ft.)
ALLOWED PROPOSED FRONT SIDE BEAR FRONT LIR SIDE REAR
ADDITION C MPLIANCE OR
CHANGE OF USE
PARKING LOT
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REPAIR CYDS ( X Fn
REMARKS
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(TYPE OF USE, BUSI14ESS OR ACTIVITY) EXPLAIN:
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NUMBER 0
NUMBER CRITICAL
OF DWELLING' AREAS
SOECIAL !NSPECTOR JAAEA
STORIES UNITS NUMBER
REQUiREDrtn Y. I I
REMARKS
PROGRESS INSPECTIONS PER UBC 11081FINAL INSPECTION REO'D
ALUAT'ON $
V VAWATION $
FEE
— Description
FEE
Plan Check
H LOT
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FDoscription
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TSTED DATE
PLUM I
Plumbing
_"Op,
Mechanical
THIS PERMIT AUTHORIZES ONLY THE ORK NOTED, THIS PERMIT COVERS WORK TO
,O.o
5 DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
-TC.)
Grading
Recording Fee
WILL UIE
DOMAIN (CURBS, SIDEWALXS, DRIVEWAYS aEQU
SEPARATE PERMis`8A1ONU"S"`
Engr. Review
City Surcharge
PER ITAPPLICATION: 1SdOAYS
,4�
PERMIT LIMIT. I YEAR PROVIDEDWOR I&STARTEDWITHIN ISODAYS
Engr. Inspection
State Surcharge
SUE 13ACK OF PINK PERMIT FOR MORE INFORMATION
'APILI-NT,
Traffic Mitigation
Plan Chk Deposit
ON BEHALF 01 HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Review
Receipt #
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FO DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire
FROM THE ISSUA CE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED MODIFY, WAIVE OR REDUCE ANY OF ANY CITY ORDINANCE
Fire Inspection
Total Ainunt Due
TO REQUIREMENT
NOR LIMIT tN ANY WAY TH CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscapainsp.1
--TReceipt #
I HEREBY AVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN is M THE OWNER, OR THE DULY AUTHORIZE AGENT OF
THE OWN WITH CITY AND STATE LAWS REGULATING CONSTRUC.
TION; AND ORIZED THEREBY. NO PERSON WILL BE EMPLOYED
CALL
Bull This apals"On isma a. permit until"Igned by the
Ing Oracle .1 hisiho, opray: and Fees are paid. and
IN VIOLATIO E OF THE STATE OF WASHINGTON HEWING TO
FOR INSPECTION,
—ripti-On—ledomim.p, ... pldad�
WORKMEN'S 0 N AlkNICE AND RCW nIZ7.
—SIGNATURE
OFFICIALS SIONATU DATE
W E E 0 E SIGNED
(425)
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0/
771-0220
76E�IGEDBY AIE
M 1333
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 - n4spErrioR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
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FE I *,L PROJECT APPROVAt'"'ORM
TO:
DATE:
MEMO TO: PERM COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE
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___YLANNING DIVISION DATE—
PROJECT—Y-ILAY4
SITE ADDRESS 114 3!� pme- �J
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PERmrr ADB#,.--DATE TED z
DESCRIPTION OF WORK TO BE INSPECTED
A fleld inspection was conducted to determine linal 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
gv\(,ro m4W p6M�� fh-,rWt In po.w. has bem
GRANT PROJECT APPROVAL WMI CONDITIONS NOTED
o Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractorby inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date�__ Sign
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