20020573 (2).pdf4
DATE RECEIVED
—7
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PER
CITY OF EDMONDS
us PERMIT
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CONSTRUCTION PERMIT APPLICATION
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PLAT NAMEISUBDIVISION NO.
LID NO�
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LID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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CITY ZIP
EXISTING — PROPOSED
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REQUIRED DEDICATION— FT
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NAME
METER SIZE LINE .1 IIXTURES PRY REQUIRED
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ADDRESS
REMARKS
OWNERICONTRACT08 RESPONSIBLE FOR EROSION
O.TF.LBIRAWAGE
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FIRE REVIEWED BY
DATE
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STATE LICENSE UMBER EXPIRATION TE ON CK
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ALLOWED PROPOSED ALLOWED OPOSE1
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NEW [3 PLUMBING i MECH
LOT COVERAGE REQUIRED SETBACKS (FT PROPOSED SETBACKS (fl)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
0 ADDITION C MPUANCE OR
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CHANGE OF USE
0 REMODEL SIGN
PARKING LOT ARIA P G Revvi W GATE
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REMARKS
0 DEMOLISH [3 TANK [3 OTHER
GARAGE RETAINING WALL
[_1 RENEWAL
CARPORT _. ROOKERY.
(TYPE OF USE. BUSINESS OR ACTIVITY], EXPLAIN:
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CHECKED BY TYPE
to" 0 CUPA T
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—NUMBER N MSER OF CRITICAL
OF DWELL NO AREAS
PeC.ALE1�NSPf.T.R]AR1A
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TORIEG NITS' NUMBER
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LOAD
DESCRIBE WORqT0 BE DONE
REMARKS
PROGRESS INSPECTIONS EEtmc ioe/FINAL INSPECTION REaD
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DescrIptlon
FEE Description _ FEE
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Plan Cho k
HEAT SOURCE GLAZING % LOT SLOPE %
Building
VESTED DATE
PLAN CHECK NO:0 j
Plumbing
Mechanical
THIS PERMa AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
Recording Fee
OMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
City Surchal��-
PE�MFTAPPUCATI N: ISODAYS
PERMITUNIM1YEAR PnOVID D WORK IS STARTED WITHIN 180DAYS
Engr. Inspection
State Surcharge
SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICA ON BEHALF 0 . F HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTERETT, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
Receipt #
E WASHINGTON* ITS OFFICIALS, EMPLOYEES, 11 AGENTS FROM ANY All
DMONDS'
ALL CLAIMS FOR DAMAGE' 01 WHATEVER NATURE, AIIIING 111ICTIVY OR INDIRECTLY
Fire Review
'ROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
Fire Inspection
Total Amount Due
DEEMED TO MODIFY, WA VE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CIWS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
-
Landscapoinsp.1
Receipt #
I HEREBY ACKNOWLIE BE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVA
GIVE" IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
Thi , P0.6-i-m. .-ItianfloignIodbyth.
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL HE EMPLOYED
IN VIOLATION OF THE USDA CODE OF THE STATE OF WASHINGTON REILATING TO
B"Idl 'fid.—hialb., pWy: and Pool or, paid, Ind
FOR INSPECTION colpfl,acknowl godonspozopAAded.
WORKMEN'S COMPENSATIGI44NW�ANCE AND RCW L13.27.
0 1 SIGNATURE DATE
SIGNED
(425)TE
771-0220 D By DATEI
ATTENTION
EXT 1333
1 7//z11/_)J
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
- - - - — —
- ORIGINAL � FILE YELLOW - 11
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER COLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
DATE-.—V*49-
MEMiom: PERmrr COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE —
ENGINEERING DIVISION DATE-
-7
PLANNING DIVISION DATE—e=-"---7
PROJECT —
SITE ADDRESS
PERMrr# INSPECTED —
DESCRIPTION Or WORK TO BE INSPECTED
A field inspection was conducted to determine flnal compliance with approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
pE_RFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL ATM CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractorby inspector
1.
2.
3.
RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date— Sign_
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