20030808.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINE5S.
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MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY
ZIP
PERMIT EXPIRES
USL/ PERMIT
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NUMBER
JOB
SUITEJAPT#
ADDRESS 7
PLAT NAME/SUBDIVISION NO7.
LOT No.
LID NO.
LID FEE S
7ESCP Approved
PUBLIC RIG14T OF WAY PER OFFICIAL STREET MAP
Rw Permit Requ�,Fedl
Street Use Perm RKd
EXISTING - PROPOSED
inspection Required
Sidewalk Required
REQUIRED DEDICATION- FT
Underoround
Whing required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PAV REQUIRED
YES13 NO C3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
NAMEF�/Ca
CBL N
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ENGINEERING REVIEWED BY DATE
ADDRES.Iii-t
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FIRE REVIEWED BY DATE
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CITY IP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE CH
VARIANCE OR CUI SHORELINE OR ADS# INSPECTIO�_ BOND
REO'D POSTED
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BEIRA REVIEW SIGN AREA HEIGHT
PROPERTXY CO PARGEL NO
LALLOWED I PR OPOSED
COMPLETE EXI ALL. ALLOWED
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NEW RESIDENTIAL
5
0 PLUMBING / MECH
OR
LOT COVERAGE Mj)04UIIl1MSIFTP&§'1 P PffBACKS (Fr.)
PW
ALLOWED PROPQ�EA ISIDE REAR
to
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ADDITION COMMERCIAL
COMPLIANCE
0 CHANGE OF USE
REMODEL MULTIFAMILY
3N
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PARKING LOT AREA I PLANNING REVIEWED BY DATE
REO`D PROVIDED
1
06
13 REPAIR GRADING
CYDS
[3 FENCE X
( _ FT)
REMARKS
DEMOLISH TANK
OTHER
GARAGE
.0 CARPORT [3 REINNINGWALL
ROCKERY
o FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE. BUSINE
L 'A/241 ) �,s
V-110.
CHECKE OCCUPANT
PE
'GROUP
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NUMBER NUMBER10F
OF DWELLING
CRITICAL 6VJ
AREAS
SPECIAL INSPECT] OCCUPANT
ON
STORIES UNITS
HUMBE 0
JAREA
REQUIRED [] YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG
P407 P 0�1 -1 9N f 3-
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7;;?W141( $
Description FEE Descriptlon FEE
Plan Check State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO:
VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DOME ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
Grading
I DOMAIN (CURES, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
3
SEPARATE PERMISSION.
1:
Engr. Review
2
5 PERMIT APPLICATION: ISO DAYS
CL PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED IVITHIN ISO DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
"APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
a EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp-
Total Amt. Due
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY THE CI7Y`8 ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt #
_J HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN 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
This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
WORKMENI=SATI $:J��CE �ND RCW 18.27.
OFje IG D�TE
IX4
(OWNER OR E
DATE SIGIOD
iA9
1"M
WED
771-0220
RELEA Y DATf
ATTENTION
Off 1333
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 YELLON- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
KMEWN
ENGINEERING DIVISION DATE,
ni"mcm
PLANNING DIVISION DATE
P RO T
JEc ki 6A/7- 0/—ti.ruz-
SITE ADDRESS-
e) 3 4'ro.0 ADB# DATE INSPECTED_Y_,J_Z-_-_0_'et_
PERMIT #1�_ 4—
PECTED USE
DESCRIPTION OF WORK TO BE INS
A fle a ducted to determine co Hance with -approved plans. Final approval
Id inspection W S con mp
release of
e signed Department to the
de no objections from the abov
notes that there are
E BONDS and the granting of
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED A4R0'V1 lce4-o
�El Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector .3 yj r OA-%,
FA
3.
RE -INSPECTED OUTSTANDING ISSUES -GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbrms:ocaprv1 3/25/04
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