20050070.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PLAT NAME/SUBDIVISION NO
LOT NO.
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LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
fESCP Approved
RW Permit Required
Street use Permit Roq'd
EXISTING _.— PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICA11ON—_�.— FT
Underground
Winno required
METER SIZE
LINE SIZE
NCI� OF FIXTURES
PRV REQUIRED
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I YES 13 NO 13
REMARKS
OWNER/CONrRACTOR RESPONSIBLE, FOR.EROSION
CONTROL/DRANAGE
_11GIAEERING REVIETIED-ITT DAT1
PUBANSPEMON MQUIREI)
FIRE H§VIE"F= TO BE CLEANED OF DER,11�vl
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ICHECK
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REMARKS
DEMOLISH
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OTHER
GARAGE
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RETAINING WALL
FIRE SPRINKLER
CARPORT
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FIRE ALARM
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BOND
POSTED
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SETBACKS (Fr.)
SIDE HEAR
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DATE
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(TYPE OF USE, BUSINESS ORACT
EXPLAIN:
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OCCUPANT 117-2
GROUP
NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNITS
CRITICAL j
AREAS
NUMBER
SPECIAL INSPECTION
REQUIRED [] YES
JAREA
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
!PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
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ldf /Yj aa VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge 2
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
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
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SEPARATE PERMISSION.
Engr. Review
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uj PERMIT APPLICATION: 160 DAYS
IL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 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 HARMLFSS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
W ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
It
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 Landscapelnsp. Total Amt. Due
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NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION." Recording Fee Receipt #
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 APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Foos are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELAI ING TO FOR INSPECTION receipt is acknowledged It) space provided,
WORKMEN'S CCYAPENSATION INSURANC� AND RCW 18.27. 1
OFFICIAL SIG ATURE
Dj1E
SIGNAT E NER RAG NT) DATE SIGNED (425)
771-0220 RELEASED 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 CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL -FILE YELLOW- INSPECTOR
PINK -OWNER GOLD -ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
.MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
I'LEASE SIGN
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�NGINEERING DIVISION DAT
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A field inspection was conducted to determine compliance with -approved plans. Final approval
denote s that there are no ob ections 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
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 inpector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fonns.:oqaprA 3/125/04