20050046.pdfFDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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PROPERTY TAX ACCOUNT PARCEL NO.
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NAMEISUBDIVISION NO.
LOT NO,
LID NO
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LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApprovod 13
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RW Permit Required
Sireet use Perme Required 13
EXISTING PROPOSED
Inspixijon Required Q
Sidewalk Required E3
RE061RED DEDICATION FT
Underground 13
Wiring requifed E3
METER SIZE
LINE SIZE
NO. OF FIXTURES
. PRV REQUIRED
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE uJ
VARIANCE OR CU SHORELINE OR ADEW I INSPECTIONJ SEPA
REQ'D COMPLETED I EXIMPT
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CA# ZONE SIGN AREA HEIGHT
WAIVER ALLOWED PROPOSED
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STUDY 13 L
PLUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
COMPLIANCE OR z
CHANGE OF USE
PARKING LOTAREA PLANNING R VIEWED BY DATE
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NUMBER
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NUMBER OF
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SPECIAL INSPECTION
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DESCRIBE WORK TO BE DONE
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Description
Plan Check
HEAT SOPRCE
LOT SLOPE%
VESTED DATE
Building Permit
PLAN. CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
2
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT., SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
OAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
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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 MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Fire Inspection
Landscapelnsp.
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT;AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
CONSULTANT
THE OWNER; I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL
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
WORKMEN'S COMPENSATIO
'PiTRANCE AND RCW 18:27.
SIGNPr)JRE (OWNER OR ENT): DATES G ED (425)
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FEE
OCCUPANT
LOAD
Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or hisihor Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
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:)EELCIAL,S SIGIJATUF�E TE
ED BY DATE
.ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. PINK -OWNER GOLD - ASSESSOR
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
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GARY HAAKENSON
CITY OF EDMONDS. MAYOR
121 5TH AVENUE NORTH EDMONDS, WA 98020 (425) 771-0220 FAX (425) 771-0221
Website: vwvv.ci.edmond�.Wams
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building -Engineering
June 29, 2005
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Golf Saviil� Bank-
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K. Shairrick, Retail Of ICCI
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650521 -eet SW, Suite 6
Mountlake Teri -ace, WA 98043
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Re: Demolition Frozen Fund Account 2366870,-Suinmet 234"
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Street SW.) Edmonds, WA
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Deal Sir oi- Madam:
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-eb ase $2,000.0 1-0111 the ab ve referenced
Edmonds 1 0 r 0
Tile City or lei authorizes the rele,
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Demolition Bond.. All interested City departments have approved the'releasP of tile
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Demolition Bond..
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Sincerely,
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Marie Harrison
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Senioi Perrilit Coordinator
Cc: Applicant
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1j"N11,11V DST, S/M a ster Let te rs/ izel case [lerlbrniance02/01
1r16orpo,i -ated August 11, 1890
Sister Citv - Hekinan.:Ja*Dan
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FIRE DEPARTNIF NT'DATE
FROM.
PLEASE SIGN
LEA113 SIGN
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PERMIT # ADB# DATE INSPECTED
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DESCRIPTION 0 F WORK TO BE INSPECTED 2 _0
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field inspection was conducted to determine compliance with -approved plans. Final approval
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denotes that. there are no objections . from the. above signed Department to the relea
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PERFORMANCE BONDS a d the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRAN T PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION OUTSTANDING ISSUES
El Copy of CORRECTION NOTICE given to owner/contractor by inpe.ctor..
2.
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RE -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date Signature
1:ternp:.b1dg:fomis:ocaprv1 3/25/04