20020822.pdff
DATE RECEIVED PERMIT EXPIRES
USE, PERMIT Z.,
CITY OF EDMONDS zo fl-If- NUMBER
CONSTRUCTION PERMIT APPLICATION JOB �;C ( SUITEIAITI
ADDRESS
OWNER NAMEINAME OF RUSIN SS PILAT NAMEISUBDIVISIO LID NO,
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(TYPE OF USE. BUSINESS OR �ICTIV
NUMBER OF CRITICAL
OF DWELLING
UNIT. AREAS
NUMBER
STORIES 1 .1
DESCRIBE WORK TO BE DONE
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PLAN CHECK 7,,O� _( VESTED DATE
THIS P AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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a ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
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3 DOMAIN (CURBS. SJDEVVA�S, DRAIMAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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PERMIT APPLICATION: IN DAYS
PERMIT LIMIT I YEAR -PROVIDED WORK 15 STARTED WITHIN INDAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLIOANT, ON BEHALF OF His OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND .01. HARMLESS THE BY .
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EDMONDS , WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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L CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
rL ' C , , MIT. ISSUANCE OF THIS PERM SHALL NOT
'ROM THE ISSUANCE OF THIS PER IT TY ORDINANBC
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DEEMED To MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CI
0 B I T IN ANY W , Y THE on
0 NOR LIMIT IN ANY WAY THE CtTYS ASILITY TO ENFORCE ANY DINANCE PROVISION
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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REMARKS
OWNERICONTRACIOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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ENrINEERING REVIEWED By
FIRE REVIEWED By DATE
VARIANCE OR CU
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PROGRESS INSPECTIONS PER U13C 108/FINAL INSPECTION REO'D
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Description
FEE
—
Description
FEE
Plan Check
State
Surcharge
Built Ing Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk, Deposit
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Fire Inspection
Receipt It
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Total Amt. Due
Recording Fee
Receipt #
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL
BY fo I D G N
GIVEN IS CO SECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
a Ell LATUNG Cc ae�
" U NSTRUC CALL n "!a., �L
THE OWNER, To COMPLY WITH CITY AND STATE LAWS I REGULATING CONSTRUC- CALL -PU
'R'E 'LL BE 4, ED
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TION; AND IN DOING THE WORK AUTHORIZED THEREBY. No PERSON WILL BE EMPLOYED Badly: aad Fees are pa d. a
IN VIOLATI E e� Ii.E STATE OF WAS GTON RELATING TO FOR INSPECTION Sp
No I HIN J. iejidAdj
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WORKMEN'Soc.1011EN RGW 18121. WIC S SIOPUR
St N[)tTURE R) E A E IATE SIGNED 77 1 _0220
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20 IRAEASED BY DATE
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0 EXT 133
�IT WFPL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILE YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING
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FINAL PROJECT APPROVAL FQW4
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: _FIRE DEPARTMENT DATE —
ENGINEERING DIVISION DATE—
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PERMIT #,f —DATE INSPEC '0
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A field inspection was conducted to determine finalcomPpliance ith approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFO_RMANCE BONDS and the granting of: 0-n
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITII CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES 9
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date. Sign_
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