20050231.pdfDATE RECEIVED PERMIT EXP RES
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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STATE LICENSE NUMBER EXPIRATION DAIE CHECKED BY
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PROPERTY TAX ACCOUNT P7RCEL NO.
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2 7-03 L 4002/4S7
NEW RESIDENTIAL PLUMBING ir MECH
ADDITION COMMERCIAL COMPLIANCE OR
MIXED USE CHANGE OF USE
El REMODEL MULTIFAMILY SIGN
GRADING FENCE
REPAIR 930 CYDS ( X FT.)
DEMOLISH TANK OTHER
GARAGE Ei RETAINING WALL FIRE SPRINKLER
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(TYPE OF USE., BUSI SS OR ACTI ITY) EXPLAIN;
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ADDRESS 102 q /71
PLAT NAMEISUB DIVISION NO, LOT NO. LID NO,
I LID FEE
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESC
RW P:=Dd 13
Street Use Permit Required E3
EXISTING PROPOSED inspection Required E3
Sidewalk Required 13
REQUIRED DEDICATION FT underground E3
wrino required 13
METER SIZE LINE SIZE T__NO. OF FIXTURES PRV REQUIRED
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REMARKS LU
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWE BY DATE
FIRE REVIEWED BY DATE U1
VARIANCE OR CU SHORELINE OR ADBI I INSPECTION SEPA
REQ'D COMPLETED EXEMPT
13YES 13NO I I
CA#. ZONE SIGN AREA HEIGHT
WAIVERA ALLOWED I PROPOSED ALLOWED , PROPOSED
STUDY 13 1
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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REMARKS
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OCCUPANT
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STORIES
DWELLING
UNITS
SPECIAL INSPECTION
REQUIRED.
CONSULTANT
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REIR�Kt
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
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Description
FEE
Descriptio . n
FEE
Plan Check
State Surcharge
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building Permit
City Surcharge
CHECK NO:
Plumbing
Base Fee
Mechanical
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.
Grading
Engr. Review
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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
Engr. Inspection
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
Plan Chk. Deposit
.0 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
Receipt #
25q13_3
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C( ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp.
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 APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTIRLIC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
Building Official or his/her Deputy: and Foes 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 (OWNER OR AGENT):
DATE SIGNED
(425)
771-0220
R—ELE—,s&6Y 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 CERTI-
ORIGINAL -FILE - YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 if IRC110.
PINK -OWNER - GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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NOTICE: I I F THE DOCUMENT IN THIS FRAME IS LESS CLEAR THAN THIS NOTICE
IT IS DUE TO THE QUALITY OF THE DOCUMENT.
MICHAEL R. THOUAG I J.
GAMTOPOLO KARAGGK
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FINAL PROJECTAPPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
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DESCRIPTION OF WORK TO BE INSPECTED
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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
0: Copy of CORRECTION NOTICE given to owner/contractor by inpe.ctor
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RE -INSPECTED OUTSTANDING ISSUES - GRANTFINAL PROJECT APPROVAL
Date Signature
1:temp:b1d9:f6rms:ocaprv1 3/25/04