20050103.pdfDATE RECEIVED . PERMIT EXPIRES
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TESCP Approved 13
RW Permit Requand 0
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EXISTING — PROPOSED
Inspection Required E3
Sidewalk Required E3
REQUIRED DEDICATION— FT
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METER SIZE
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PARKING LOT AREA PLANNING REVIEWED B"Y DATE 5
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DESCRIBE WORK TO BE DONE
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PROGRESS INSPEC71ONS PER UEC 108/IBC109/IRC109 FINAL INSPECTION REQ'D
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % 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
1= 13E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 Grading
:3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
1= SEPARATE PERMISSION.
a Engr. Review
% PERMIT APPLICATION: 180DAYS
IL PERMIT LIMIT 1 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 HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection 9 Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM T HE ISSUANCE OF IHIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE LandscapeInsp. Total Amt. Due
DEEMED TO MODIF� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- q7
Recording Fee Receipt It
I 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.
WORKMEN'S COMPENS=RANCE AND RCW 18.27. OFFICIALS S19NATURE DATE
SIGN URE (OWNER JGN�D (425)
7;/Q� C)e "Ir O"Qax �LS, 771-0220 RELEA Ll
ATTENTION E)ff 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR ACERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC10 9/IBCJJO/IRC110. PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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FINAL PAOJECT APPROVAL FORM
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DATE:
MEMO TO: PE 0 ING DIVISION
FIRE DEPARTMENT DATE—e
FROM:
ENGINEERING DIVISION DATE
PLEASE SIGN
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A field inspection was conducted to determine final compliance, with approved plans. Final approval
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PERFORMANCE BONDS and the granting of
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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