20050063.pdfPERMIT EXPIRES
'USE PERMIT
CITY OF EDMONDS ZONE NUMBER �7
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CONSTRUCTION PERMIT APPLICATION JOB
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4710 CA
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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EXISTING PROPOSED In
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REMARKS
OWNER/
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ENGINEERING REVIEWED BY
FIRE REVIEWED BY
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LID NO.
LID FEE S
ESGP Approved 0
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trent Use Permit Raq'd E3
spection Required CI
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PRV REQUIRED
YES 13 NO 13
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STATE LICENSE NUMBER
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ADDITION
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COMPLIANCE OR
CHANGE OF USE
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REO'DPA PRGOVIDED
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CYDS 1:1 ( — x FT)
REMARKS
DEMOLISH
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0 OTHER
EGARAGE RETAINING WALL FIRE SPRINKLER
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CARPORT ROCKERY
FIRE
(TYPE OF USE. BUSINESS OR ACTIV" EXPLAIN:
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OCCUPANT
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NUMBER.
OF
NUMBER OF
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CRITICAL
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NUMBER
SPECIAL INSPECTION
JAREA
OCCUPANT
LOAD
STORIES
UNITS
REQUIRED 1:1 YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/IBC109/ IRC109 FINAL INSPECTION REO'D 9
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VALUATION
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Description
FEE Description FEE
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Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
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Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
ul PERMIT APPILICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Endr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) "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
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection 2z-
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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X FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
!3 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CIrY ORDINANCE
Landscapelnsp.
Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.0
Recording Fee
If Receipt # zqv
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPI
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 arc paid, and
IN VIOLATION OF THE LABQW-OQDE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
WORKMEN'S CW 18.27.
"��NSATle, INSU�ANCE AND R
OFFICIA] S S NAT FE DATE
OWNLERR EN DATE IGNID
(425
771-0220
RELEASED BY DAT$
ATTENTION
EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADEAND APPROVALOR A CERTIFICATE OF OCCU-
PANcy HAS BEEN GRANTED. UBC109/IBCI10/IRC110.
ORIGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER - GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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A field inspection was conducted to.determine final compliance with approved plans.. Final approval
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denotes that there. are no objections from the above signed Department to the. release of
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PERFORMANCE BONDS and the granting of
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given. to owner/contractor.by inspector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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