20050128.pdf1 9
CEIVED
CITY OF EDMONDS
E
CONSTRUCTION PERMIT APPLICATION
A
OWNER NAME/NAME OF BUSINESS
e— P
uj
z
MAILINGADDRESS
P
0
CITY ZIP
TEI.EPHONE/,---
Or
NAME
U
Ile
t:
ADDRESS
CITY ZIP
TELEPHONE
NAME
CB
o:
ADDRESS
0
CITY ZIP
ITELEPH ONE
lb
STATE LICENSE NUMBER EXPIRATION DATE
lll�� i .
.,0,0, �
, J�KED
/11
PROPERTY TAX ACCOUNT PARCEL NO.
W
NEW O<ESIDENTIAL PLUMBING MECH
ADDITION COMMERCIAL COMPLIANCE OR
MIXED USE CHANGE OF USE
REMODEL MULTIFAMILY SIGN
GRADING FENCE
0 REPAIR 13 CYDS ( x FT.)
1 7 OTHER
11 DEMOLISH —fTrTANK
E]GARAGE o RETAINING WA LL FIRE SPRINKLER
z
CARPORT ROCKERY FIREALARM
(TYPE OF USE, BUSINES��R ACTIVITY) EXPLAIN:
NUMBER
NUMbEFf OF
OF
DWELLING
0
STORIES
UNITS
DESCRIBE WORK TO BE DONE
HEAT SOURCE
LOTSLOPE%
VESTED DATE
PLAN CHECK NO:
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
w
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
U)
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
uj
_1
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2
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
01
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
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
WORKMEN'S COMPENSATIO AQRANCE AND RCW 18:27.
SIGN
DATE SIGNED
PERMIT EXPIRES
DERMIT
NUMBER
OB
DDRESS
SUITEiAPTU
LAT NAME/SUBDIVISION NO.
LOT NO
LID NO
I
LID FEE S
UBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApprovea 11
RW Permit Required 13
Street use Permit Reewiea 13
XISTING PROPOSED
Inspection Requited El
Sidewalk Roqui(ee E3
REQUIRED DEDICATION FT
underground [3
_FNO.
Waing requited [3
METER SIZE
LINE SIZE
OF FIXTURES
PRV REQUIRED
I
YESO No13 z
I
_ .
E
W
REMARKS Uj
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDIRAINAGE
0
z
Lu
h:117 MAR-911i7ki
CANK FU,_ IRF-HON11if
_m, (�
ENGINEERING REVIEWED BY ' DATE
!IRE REVIEWED BY DATE Lu
VARIANCE OR CU SHORELINE OR ADB# I INSPECTION I SEPA
REO'D COMPLETED I 1XIEMPT
13YES 13NOI
'A# SIGN AREA
ZONE HEIGHT
NAIVER 13 ALLOWED I PROPOSED ALLOWED PROPOSED
3TUDY 13 1 1 1 1
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
z
z
I — z
PARKING LOTAREA I PLANNING REVIEWED BY DATE 5
REQ'D . PROVIDED IL
REMARKS
CONSULTANT
REQUIRED 13YES
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
OCCUPANT
GROUP
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or hi0ior Deputy: and Foes are paid, and
receipt is acknowledged in space provided.
FAdIA'LU*NAT1JiE 11 DATF,
RELEASED BY
I T , TWN 14- 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-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 it IBC110 / IRC110.
PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
0
z
z
0
11
0
M
--i -n
0 M
C
M
0
0
0 C
M
M Z
() —1
C
0 -n
n
M M
0 —C/)
0 r-
0 M
C (1)
9 C/)
Q 0,
Z
X
z
-1
X
W
z
0
A
0.
M
FINAL PROJECT- APPROVAL FORM
TO:
DATE:
C
MEMO TO: PE C BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
KIASE.14GN/
—ENGINEERING DIVISION DATE
PLW13SION
PLANNING DIVISION DATE
z
nYASESIGN
PROJECT
M
?-2-4 0-Ig li-v cAj
3:
SITE ADDRESS
M
co
PERMIT B# DATE INSPECTED L
M
0
0
DESCRIP TION OF WORK TO BE INSPECTED
M
z
A,field inspection was conducted to determine final compliance with approved plans. Final approval
>
denotes that. there are no objections from the above signed Department to the release, of
cn
PERFORAIANCE BONDS and the granting of
o -n
-n ;d
>
M M
GRANT FINAL PROJECT APPROVAL
00)
Or-
0M
CW
(n
M 0
Z r
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
Q Copy of CONDITIONS given to ovvmer/contractor by inspector
z
CD
z
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0
a Copy of CORRECTION NOTICE given to, owner/contractor by inspector
M
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign,
ocaprvl.doc.l:temp:bldg:formsIO/OI