20050197.pdfa.
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEiNAME OF BUSINESS
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NAME
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PERMIT
NUMBER
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JOB SUITE/APT#
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PLAT NAME/SUBDIVISION NO. LOT NO, LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved
RW Patmil Required E3
Street Use Permit Required 13
EXISTING PROPOSED Inspection Required [3
Sidowatk Required 0
REQUIRED DEDICATION FT Undergiound [3
Wiring mquircid 0
METER SIZE LINE SIZE FIXTURES PRV REQUIRED
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CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR EXPLAIN:
TYPE CODE OCCUPANT
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NUMBER
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NUMBER OF
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SPECIAL INSPECTION
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REMARKS
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STRUCTURAL DESIGN
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VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
LOTSLOPE%
VESTED DATE
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Building Permit
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City Surcharge
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PLAN CHECK NO:
Plumbing
Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
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
Landscapelnsp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION AP
"RovAL
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 A LITHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or hisihor 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 COMPENSATION INSURANCE AND RCW 18:27.
OFFICIALS SIGNATURE DATE
SIGNATURE (OWNE GEN
DATE SIGNED
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771-0220
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R E. In E D U-*" DATE
W.A/4
ATTNTION V 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 / IBC110 / IRC1110. ORIGINAL - FI E YEI I OW IN 413
PINK -OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
ARTMENT
DEP DATE.
FROM:. —FIRE
PLEASE SIGN
ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE
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DESCRIPTION OF WORK TO BE INSPECTED At
A field inspection was conducted to determine compliance with -approved plans. Final approval
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denotes that there are no, objections from the above signed Department to th e release of
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PERFORMANCE BONDS and the grantingof
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GRANT FINALPROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
ET 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:fb=%:ocaprv1 3/25/04