20020558.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER EXPIRATION LOATl
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PROPERTY TAX ACCOUNTPARCEL NO.
-�-<q 5 / 0C)D 00 110
0 NEW R SIDEITII t- 0 PLUMBING / MECH
0 ADDITION 0 COMMERCIAL o GOMEL ANCE OR
CHANGE OF USE
0 REMODEL 0 APARTMENT 0 SIGN
C3 REPAIR E] GRACING GE 0 'ENDS
X 11H
0 DEMOLISH -N. OTHER
o GARAGE r-1 RETAIN 0 RENEWAL
CARPORT EGCXErWAU,
r (TYPE OF USE, BUSINESS OR XPLAIM
NUMBER
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�"IUMBER
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STORIES
DWELL FIG
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DESCRIBE WORK TO BE DONE ib
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PERMIT EXPIRES
USE PERMIT
ZONE A NUMBER
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ADDRESS
PLAT NAM EISUDDIVI SION NO. LOT 10 LIll 111,
LID FEE S
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RE�SCF'pF1
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EXISTING -- PROPOSED —
REQUIRED DEDICATION— VT
ME NO, OF FIXTURES PRV REQUIRED
YES 0 NO 0
OWNERICONIPACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
FIRE REVIEWED BY DATE
oYRDOQ 1POSTED
ES ONO
SEPA REVIEW SIGN AREA HEIGHT
CONIPL-111 I EXEMPT A—ED I PROPOSED ALL.-ED PROPOSED
FxP I
LO COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (7.1
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE HEAR
_77ARKING EDDY DATE
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r -HECKEDBY ITYPEOF�ONST CTION DBU
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.-._lALol.NSPE.T.R JARIA OCCUPANT
REQUIRE M YES I LOAD
PLAN CHECK FEE
HEAT SOURCE GI-AZINO I LOT SLOPE I BUILDING
PLAN CHECK NO: PLumINNG
MECHANICAL
THIS PERMIT AUTHO IZE$ ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO _
BE DONE ON PRIVATE PROPERTY ONLY� ANY CONSTRUCTION ON THE PUBLIC GRADING/FILL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICAOR N: 180 DAYS
ERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN GIG DAYS
P R ENG� REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. INSPECTION FEE
;APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
N NTEIREST, AGREES ro:NDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING
DMONDS. WASHINGTONL ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
s I E.MC BS �W S ' IS IN INSPECTION FEE
ALL C".' 'OF M CTLY
LLCt_AIMS FOR DAMAGES OF WHAI EVER NATURE, ARISING DIRECTLY OR INDIES
F.01 T I IJA NIS OF THIS PERMIT. ISS ANCE OF THIS PERMIT SHALL NOT LAN CHECK DEPOSIT
RoM THE 'SS.
I _ _ H __ WAIVE FANYCtTYORDINANGE
ROINANCE PROVISION.'
TOTAL AMOUNT DUE IN
RECEIPT
CEWT`,�&,�
I HEREBY ACKNOWLEDGE THAT� HAVE READ HIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRE T. AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT 05
THEOWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC CALL
TION, AND IN ()DING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATI N OF THE LAEB,ODE HE STATE OF ASHINGTON RELATING TO FOR INSPECTION
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lKMEN E Go"PENIS NEU NCE AND RCVV 18 27,
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VGH o"Nl� EN" - - - 7�TE B71E. (425j
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W� WJ2 771-0220
APPLICATION APPROVAL
B�'j Thl—PPI-I'll— A pa,mit G,Id llpod hy thl
dPq Offii 11 h,�hll Dl.plt':.Ild FIll — Tlld� -d
OFFICIALS SIGNATURE DATE
RELEASED BY
ATTENTION EXT 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- OFRGINAL� FILE YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK, OWNER GOLD -ASSESSOR
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PINAL PROJECT APPROVAL -FORM
TO:—
DATE:—
mEmo To: PERMIT COORDINATOR, BUI1,DING, DIVISION
FROM: FIRE DEPARnENT DATE-!E— (- _07-
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE—
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PERmr I r#-'12 ADB# -DATE INSPECTED,!����
DESCRIPTION OF WORK TO BE INSPEcTEDILS= eu^q g g / AEC -t- CA0
A field inspcFtion 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
Q Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a 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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SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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