20020430.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
[ER NAMEINgME OF BUSINESS
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PERMITEXPIRES .. RES 0U
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ZONE NUMBER [��!L-_(,��'1,3
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PLAT NAMEISUBDIVISION NO. LOT NO,
LID/N�O�.T•
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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EXISTING PROPOSED
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NO. OF FIXTURES
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTHOUOflAINAOE �p
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ENGINEERINGREWEWEDBY DATE
ADDRESS
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FIRE REVIEWED BY DATE
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STATE LICENSE NUMBER
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SIGN AREA
ALLOWED PROPOSED
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ALLOWED PROPOSED
EXP .
❑ NEW
RESIDENTIAL
❑ PLUMBING/MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE HEAR
PROPOSED SETBACKS (FT.)
FRONT UR SIDE REAR
❑ ADDITION
❑ COMMERCIAL
❑ CHANGE OF USE
❑ REMODEL
❑ MULTIFAMILY
❑ SIGN
REO'o AR PROVIDED KING
LOT AREA PLA�NSNIN[G�LREVIEWED BY DATE
t ifi.. �v�ARSHAL
❑ REPAIR ❑ GRADING CYOS ❑ FENCE X�FT)
REMARKS i
MUST BE PRESENT F1�QH�p�}
❑ DEMOLISH yn•, TANK
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❑ CARPORT
RE SPRINKLER
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tFYPE OF USE, BUSINESS Off""ACTIV EXPWN:
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SPECIAL INSPECTION
AREA
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DESCRIBE WORK TO BE
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DONE
NUMBER
REQUIRED ❑ YES
LOAD
PER UBC 108/FINAL INSPECTION REO'D
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Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
= DOMAIN ICUPBS, SIDEWALKS,DRIVEWAYS, MARQUEES, ETC.I WILL REQUIRE
Grading
SEPARATEPERMISSION.
s
S PERMIT APPL CATION: 100 DAYS
Engr. Review
PERMITLIMm 1 YEAP-PROVIDEDWOHKISSTARTEDWITHIN INDAYS
Engr. Inspection
SEE BACK OF PINY. PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONOS, WASHINGTON. ITS OFFICMLS, EMPLOYEES, AND AGENTS FROM ANY AN O
Fire Inspection
Receipt #_
ALL QAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscape insp.
/
Total Amt Due 1/�l
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt # <�
I HEREBY ACKNOWLEDGE THAT I HAVE HEAD THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT: AND THAT I AM THE OWNER. UR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUG
GALL
Tals aPPlicalldnis net s permit until elgnstl by the
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING 'FO
FOR INSPECTION
6u11ding 011atisl a, Insets, Deputy: and Fees ere paid. and
ecsin is sakn-lang.e dispels provided.
WORKMEN'S COMPENSATIO gURANCE AND RCW 18.27,
OFFICIALS SIGNATURE DATE
SIGNAT (OW ER OR GEN DATE G
h
'
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F (1-022®
RELEASED 0Y DAT
ATTENTION
EXT 1333
-------
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL FILE YELLOW - INSPECTOR
PINK -OWNER GOLD -ASSESSOR
04102 PRESS HARD -YOU ARE
MAKING 5 COPIES GREEN • ACCOUNTING
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR BUILDING DIVISION
FROM: i4 C IRE DEPARTMENT DATE J"2- C Z
ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE
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PROJECT n/Ddtllr47
SITEADDRESS k`� z-q OG-Y/t_p/c 1/%4/ fJ2
PERMIT #_%9 D 2 — 6 t f 3 D ADB# DATE INSPECTED 2::.-�7_ Z.
DESCRIPTION OF WORK TO BE INSPECTED � f� U A,1-, le lAl-�,E
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
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
o Copy of CONDITIONS given to owner/contractor by inspector
I.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
❑ Copy of CORRECTION NOTICE given to owner/contractor by inspector '
1.
2:
3.
RE -INSPECTED OUTSTANDING ISSUES -GRANT FINAL PROJECT APPROVAL
Date Sign
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