20040773.pdfM USE
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CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION SUITE APT
OWNER NAME OF BUSINESS TADORESS,,� q-1 / (109 40e�
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING REQUIRED DEDfCA`TION
TESCP Approved 0
RW Permit Rertijited 0
Street Use Pprmil Req d 0
CI I y ZIP
MaICK05 01 R,70;0%
TELEPHONE NUMBER
ML9
020b.510
PROPOSED
Inspection Required 0
Sidewalk Required 0
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NO OF FIXTURES PRV REQUIRED
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ENGINEERING MEMO DATED REVIEWFD BY
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TELEPHONE NUMBER
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FIRE MEMO DATED REVIEWED BY
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LICENSE NUMBER riON
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ALLOWED PROPOSED
COMPLETE EXEMPT
Legal Description of Property - includd ail —easferne—n—Vs
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REMARKS
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Parcel NO. C-2
ElNEVV NQ RESIDENTIAL PLUMBING
1:1 ADDI FION 1:1 COMMERCIAL El MECHANICAL
EIREMODEL 1:1 APT BLDG. SIGN
CHECKED BY
TYPE OF CONSTRUC TION
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DEMOLISH WOODSTOVE SWIM POOL
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SPECIAL INSPECTOR
REQUIRED
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OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 305
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NUMBER
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NUMBER OF CRITICAL.
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DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
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FINAL INSPECTION REQUIRED
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VALUATION
FIE E
FEE
PLAN CHECK FEE
BUILDING
HEAT SOURCE
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PLUMBING
Plan Check No.
MECHANICAL
GRADINGIFILL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewelks,
driveways, marquees, etc.) will require separate permission.
U9VIRCHARGE
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SMX��GE FEE
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work is Started Within 180 Days
NSPECTION FEE
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"Applicant. on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify. defend and hold
harmless the City of Edmonds, Washington, its officials,
employees. and agents from any and all claims for damages of
whatever nature. arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
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' mo d,iify, waive or reduce any requirement of any city ordinance
nor mit in any way the City's ability to enforce any ordinance
provision."
TOTAL AMOUNT DUe
1 11
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1k h mcknnwled n that I have read this annlication; that the
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information given is correct; and that I am the owner, or the duly
ATTENTION
APPLIGAIIUN APPROVAL
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
This application is not a permit until
state laws regulating construction; and in doing the work authoriz-
AUTHORIZES
THE
signed by the Building Official or his/her
ed thereby, no person will be employed in violation of the Labor
ONLY
WORK NOTED
Deputy; and fees are paid, and receipt is
Code of the State of Washington relating to Workmen's Compensa.
tion Insurance and RCW-J.8.27.
INSPECTIC'.
acknowledged in space provided.
SIGNATUR NER 0
DA T E NED
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CITY OF
EDMONDS
D A—,
CALL FOR
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ATTENTION
INSPECTIO N
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
BEEN MADE AND APPROVAL OR
771-0220
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UNTIL A FINAL INSPECTION HAS
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3
PINK — 0.-. - r- GOLD -- Assessor
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FINAL PROJECT APPROVAL FORM,
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DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: t,;z FIRE DEPARTMENT DATE
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ENGINEERING DIVISION DATE z
PLEASESIGN 0
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PLANNING DIVISION DATE M
PLFASE SIGN
PROJECT 7-
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SITE ADDRESS M 0
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PERMIT 2: M
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DESCRIPTION OF WORK TO BE INSPECTED (2-1"�'SrZ
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A field inspection was conducted to determine compliance with -approved plans. Final approval 'cn
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denotes that there are no objections from the above signed Department to the release of n;U
ORMANCE BONDS and the granting of >
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GRANT FINAL PROJECT APPROVAL K Cn
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED z
0 Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES M
Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fonns:ocaprv1 3/25/04