20050103 (2).pdfDATE RECEIVED . PERMIT EXPIRES
LM
USE
CITY OF EDMONDS ZONE NUMBER OrVIS—bl)
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
0 /
NESS
OWNER NAMEINAME OF Dust
04, ^ � i I li�� PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
M 161AILING ADDRESS
W
zo
CITY
NAME
ADDRESS
CITY
cI-
LID
ZIP TELEPHONE
ZIP ITELEPHONE
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 13
RW Permit Requand 0
Suarrit Use Permit Roq'd 0
EXISTING — PROPOSED
Inspection Required E3
Sidewalk Required E3
REQUIRED DEDICATION— FT
Underground
Wiring required 13
METER SIZE
LINE SIZE
OF FIXTURES
PRV REQUIRED
7*
YES C3 NO 13
z
REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE a
z
1W
NAME CBL#
ENGINEERING REVIEWED BY DATE
M ADDRESS
0 c4t.-\
\ Ci('5LN L40 P E" FIRE REVIEWED BY DATE uj
CITY ZIP TELEPHONE Ir
r oaI� I a: I
0 (05 -
VARIANCE OR CU SHORELINE OR ADEIII INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE D B REO'D POSTED
OYES ONO IS
L10 AREA
rr, P-594d SEPA REVIV.&, HEIG
Tnxik_c-� 7 HT
PROPERTY TAX ACCOUNT PARCEL NO. T., QPOSED ALLOWED PROPOSED
Z' MOW, 4
? /ro
pp/
a (19 6 oo EXP
41141165W'(Toy;
LOT COVERAGE iRffv ROPOSED SET13ACKS (FT.)
NEW ESIDENTIAL PLUM13ING MECH ED FROO ONT UR SIDE REAR
ALLOWED PROPOS REA
COMPLIANCE OR
ADDITION. COMMERCIAL OR
CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED B"Y DATE 5
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED a.
REPAIR GRADING FENCE
CYDS El ( X FT) REMARKS
OTHER
DEMOLISH 200TANK El
oGARAGE RETAINING WALL E] FIRE SPRINKLER
CARPORT El ROCKERY FIRE ALARM
0
R (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
M CHECKED BY ITY MECO ICTION C E OCCUPANT/e
NTZ GROUP 3
NUMBER NUMBER OF CRITICAL
0 OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
I I—V LOAD
STORIES UNITS NUMBER REQUIRED [] YES
DESCRIBE WORK TO BE DONE
REMARKS z
PROGRESS INSPEC71ONS PER UEC 108/IBC109/IRC109 FINAL INSPECTION REQ'D
oAa,2 aoj
.11 J V L�U_'t_' VALUATION
AL�u
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
0
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
z
0
i
0
M
—1 -n
M
M
0
0
0 C
M
M Z
_z
X
W
o -n
n�
M M
0 C-1)
0
0 M
C W
rh' 0)
M 0
Z
3:
z
W
z
0
i
0
M
I
FINAL PAOJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PE 0 ING DIVISION
FIRE DEPARTMENT DATE—e
FROM:
ENGINEERING DIVISION DATE
PLEASE SIGN
z
0
PLANNING DIVISION DATE
0
PLEASE SICM
R1
PROJECT Pit L
Is 0
C/)
0 M
C
SITE ADDRES
0
PERMIT # 05 Ic)3 ADBk_DATE INSPECTED Z-
0
0'C
X M
DESCRIPTION OF. WORK TO BE INSPECTED z9 e--r0---- 55-1 d--� C)
M Z
CE
A field inspection was conducted to determine final compliance, with approved plans. Final approval
2:
Cn
denotes that there are no objections from the above signed Department to the release of
0 -n
.
PERFORMANCE BONDS and the granting of
nm
>
x
M M
0 V5
0
()/A�RANT FINAL PROJECT APPROVAL
0 M
C
rJ)
C/ WP e P /I
Q C"
z
i
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
>
z
c3 Co y of CONDITIONS given to owner/contractor by inspector
P.
X
z
0
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
M
u Copy of -CORRECTION NOTICE given to owner/contractor by inspector q
.2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
1P
Date S'
ocaprvl.doc.l:teipp:bldg:formsIO/OI