20020928.pdfy
PERMIT EXPIRES
le, V
CITY OF EDMONDS
USNE URM T
US E PE
Zo
Zo N
P M
CONSTRUCTION PERMIT APPLICATION
JOB SUITE PT#
OWNER NAMEINAME OF BUSINESS
PLAT NAMEISUBDIVISION
NO. LOVNO�
LON
MAILING AD ESS
LID FEE $
L
�141 A '."'n L 00
2 1 uw h iclivium(A QC(
Nall. RIGHT 01 WAY PER F1i.IA1 STREET MAP
CITY P
QZI �UILEPHONE
se..
EXISTING — PROPOSED
els Iseen A
nee -led E3
C!
S2W
DEDICATION— FT
NAME
METER SIZE
PAY REQUIRED Us
nREQUIRED
YES C3 NO Cl
AG.IIESG
REMARKS
NER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP ITEL.I..NE
NAME
___Tc5L'
I/ 7z5'
ENGINEERING REVIEWED By DATE
AD1111111
.-TY ZIP,
TELEPHONE
MAE REVIEWED By DATE
z
STATE LICENSE NUMBER
I
VARIANCE OR CLI
IMOIELINIOIAOBI
1111MICTION
BE 0
ION
OSTED
I (ol V—rk-ss
I
13yes ONO
S
BE PA FIEV"Y" SIGN All HEIGHT
A
is
ERTYTAX A CO PA.—
.MM__E
COMPLETE EXEMPT
FALLOWED
ALLOY 11P.SE. AL
So ",
.WED , PROPOSED
P
NEW
RESIDENTIAL
0 PLUMaINGtMECH
LOT COVERAGE
PROPOSED
REQUIRED SETBACKS (FT.) PROPO
FRO SIDE HEAR FRONT
ED SETBACKS (FT.)
UR SIDE HEAR
-4
3:
0 ADDITION
COMMERCIAL.
C MPUANCE OR
0 CRANGEOFUSE
se
RR
C:
0
PA KING
R LOT
A
PLANNING REV[ EVIED BY
DATE 1
rin
-1
0
MODEL
E] MULTIFAMILY
SIGN
Bea 0
1 MACY IDED
G.
,
a
REPAIR GRADING CYOS n FINII
X_ Fit
REMARKS
rn
DEMOLISH TANK HER
M z
2
z
RETAIN No WALL
o GARAGE 0 ROOKERY R
CARPORT FIREALA
>
3:
ITYPE OF BUSINESS OR ACTIVITY) EXPLAIN:
7/
CHECKED BY
M��CTION
1��CUPANT'6
CUP
0 -n
ss
NUMBER
OF
NUMBER OF
IS
-EILIN �A.EA�;E
C Tr A'
SP.C4AkEIN.PE.MON
OOCUPANT
in
a
STORIES 10,
UNITS
A 'tlA
JAREA
REQUIR [I YES
LOAD
MITI
DESCRIBE wo
Is
al
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
A,
0 'M
a co
9 On
PRO
VA LUA T 0 N
VALUATION
$
"Ic 'on
Description
in
FEE
Description
FEE
k
Plan Check
P A Ch
state Surcharge
HEAT SOURCE
LOT SLOPE Is
in
Building Permit
City Surcharge
z
rMechanical
PLAN CHE?
STED DATE
Plumbing
0
C
III
THIS PERMIT AUTHORIMS ONLY Tire WORK NOTED. THIS PERMIT COVER. WORKTO
t:
2
BE DONE ON PRIVATE PROPEITFY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
To ) WILL .....
OOUAIN (CURDS, SIDEWALKS, DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMiSSION.
PER IT APPLICATION: IN DAYS
ngr. Revim
E gr I
PERMIT LIMIT, I YEAR - PROVIDED WORK IS STAKED WITHIN JUG DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT, ON BEHAL F IRS 08 HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES To INIIIIAN111. DEFEND All. HOLD HARMLESS Till CITY OF
Fire Review
Plan Chk. Deposit
EDMONDS , WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS OF F HATEVER I NATURE ARISING DIRECTLY OR INDIRECTLY
FORDAMAGESO W
FROM THE ISSUANCE THISPERMIT. SSUANCi OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscape Insp.
,
Total Amt. Due
NOR LIMIT IN ANY WAY THE CUTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT AND THAT AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
T E OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC�
CALL
T "dil signed by me
%% �11
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 TO
FOR INSPECTION
Ad G d in. . I �Z% . be 1"..'P'. Y: An, III Fee. . 1. P. I d, . P d
Inspe,apneelded.
WORIMENS COMPINIATI NCE AND CW 1&2
N
2
7A72 0
RE7SED BY
ATTENTION
E 13 3
1
I BE OR OCC A BUILDING OR STRUCTURE UNTIL
IT IS UNLAWFUL TO I
'M�1611 k'A1
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 GOUD�ASSESSOFI
GREEN - ACCOUNTING
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
FINAL PROJECT APPROVAL FORM
TO._
DATE:
MEMOTO: 1;� UUMING DIVISION
-
Prk
7cor "+I
FROM: FIRE DEPARTNIENT DATE�
ERINGDIVISION
ENG DATE_
z
0':
41%
PLANNING DIVISION DATE-
0
PROM
SITE, ADDRESS
M
0,
PERMIT # INSPECTED
oc�
10,
DESCRIPTION OF WORK TO BE INSPECTED-----�.��
2
A field inspection was conducted to determine final compliance with approved plaus. Final approval
0
denotes that there are no objections from the above signed Department to the release of
PERFORMAMC—E BONDS and the granting of
M M
00)
0
0 Fn
GRANT FINAL PROJECT APPROVAL
0
M-
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
z
ci Copy of CONDITIONS given to owner/contractor by inspector
z
04
M
FAILED FINAL INSPECTION OUTSTANDING ISSUES
c3 Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date_ Sigq_
ocaprvl.doc.l:ten�:bldg:formsIO/OI