20030400.pdfDATE RECE14
PERMIT EXPIRES
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CITY OF EDMONDS
PERMIT
NUMBER
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CONSTRUCTION PERMIT APPLICATION ADDRE
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ER NAMEINAME OF BUSINESS
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LSOTREET
fee-
LID FEE $
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15 ILING ADDRESS
TESCP APPCOV*d
TES
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IL RW permit Required
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
Sir. 64perm it Wd
=squired
CITY ZIP TELEPHONE
EXISTING — PROPOSED
REQUIRED DEDICATION—
Swowas, Required
UnderWound
FT Wiring roq *ad
S_ a M .1 1
S PRV REQUIRED
NAME
YES [3 NO 13
ADDREWS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTRO DRAINAGE
CITY ZIP TELEPHONE
NAME
ENGINEERING REVIEWED BY DATE
ADDRESS
TELEPHONE
FIRE REVIEWED BY
DATE tu
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CITY ZIP
.2G-48,3
VARIANCE OR CU
SHORELINE OR A sPECTION BOND
POSTED
N DATEj
STATE LICENSE NUMBER
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REO'D
YES 13NO $
MEED .1
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SEPA REVIEW
COMPLETE EXEMPT
SIGN A HEIGHT
ALLOWED PROPOSED ALLOWED PROPOSED
PROPERTY TAX ACCOUNT' PARCEL NO.
I
EXP I
NBACKS (Fr.) PROPOSED SETBACKS (FT)
REQUIRED Sk
PLUMBING MECH
NEW
LOT COVERAGE
ALLOWED PROPOSED
LIR SIDE REAR
FRONT SIDE REAR FRONT 2
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7RESIDENTIAL
COMPLIANCE OR
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COMMERCIAL CHANGE OF USE
ADDITION COMM
PARKINT__
LOT AREA PLANNING REVIEWED BY DATE
— I UL MILY
REM MULTIFAMILY 0 SIGN
16DEL M
REQ`D VIDED]
FENCE
GRADING
rl REPAIR DS 0 X_Fr)
REMARKS
0 OTHER
rl DEMOLISH 0 TANK
0 RETAINING WALL
Sel' RE SPRINKLER
GARAGE FIRE ALARM
CARPORT ROCKERY
( E OF USE. BUSINESS OR ACTIVITY1 EXPLAIN:
TYP
CHECKED BY
OCCUPANT'
F C N UCTIC ROUP
NUMBE R NUMBER OF CRITICAL
DWELLING Q__ AREAS
SPECtALINSPECTI N
AREA OCCUPA
LOAD
OF NUMB R
STOW UNITS
REQUIRED [] YES
DESCRIBE WORK TO BE DONE
REMARKS
S PER UBC 108/FINAL INSPECTION REaD
PROGRESS INSPECTION
VALUATION
$ 61b 10
D ascription
FEE Desciriptlon FEE
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-5%'-A
Plan Check
State Surcharge
as-Tlocc% L-3k;7V -A
Ex
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
— City Surcharge
STED DATE
PLAN CHECK NO.-()
P11wrking
r
Mechanical
.RMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERM IT COVERS WORK TO
THIS pF
pROpERTy ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
BE DONE ON PRIVATE
DOMAIN (CURSS, SIDEWALKS, DRIVEWAY S, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
pEnurrAPPUCATION: 180DAYS
I Y EAR. PROVIDED WORK IS STARTED WITHI" 180 DAYS
Engr. Inspection
IL PERMIT LIMM
SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review
plan Chk. Deposit
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Receipt #
IN INTEREST. AGREES AND
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY
Fire Inspection
ALL CLAIMS FOR DAMAG ES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscape Insp.
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Receipt #
0 NOR LIMIT IN ANY WAY
Recording Fee
I
I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATI101111 _13PROVAL
I HEREBY A CKNOWLEDGE THAT
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees we paid, and
TO COMPLY
THE OWNER. I AGREE E WO1* AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED receipt is acknowledged In $Paco provided.
TION; AND IN DOING TH RELATING TO FOR INSPECTION
[LVODE OF THE STATE OF W
IN VIOLATION OF THE LABO ASHINGTON
1 SIG E
WORKMEN'S COMPEN RANCE AND RCW 18.27.
DATE SIGNED
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NATURE (OWNER R AGEV
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ATTENTION
CTURE UNTIL It 91 INSPECTOR
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRU FILE YELLOW
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- PINK -OWNER GOLD -ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 COPIES GREEN - ACCOUNTING
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FINA*ROJECT APPROVAL FC&
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: C,—, FIRE DEPARTMENT DATE
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ENGINEERING DIVISION DATE—
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PLANNING DIVISION DATE—
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PROJECT
SITE ADDRESS -
PERMIT B # DATE INSPECTED (7 —532
DESCRIPTION OF WORK TO BE INSPECTED—������J-,�
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
PER—FORMANCE BONDS and the granting of:
/Y' GRANT FINAL PROJECT APPROVAL
GRAM PROJECT APPROVAL WITH CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
I -
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
Q Copy Of CORRECTION NOTICE given to owner/contractor by inspector
I .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Dat Si
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