20050259.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAM�/NAME OF BUSINESS
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PERMIT
NUMBER 1124
PERMIT EXPIRES
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Description
Plan Check
HEAT i SOURCE LOTSLOPE% VESTED DATE
Building Permit
PLAN CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp.
DEEMED
IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
--
NOR LIMIT
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
0 ncf%y AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
CONSULTANT
FEE
GIVEN IS Uv f
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF,11JE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKM E2ATION INS= AND RCW 18:27.
- ___ - - _ � 111111�
SI TUR
T�j NE DATE SIGNED (425)
'!% �0, 05 771-0220
OCCUPANT
LOAD
Description FEE
State Surcharge
City Surcharge k2
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
1 Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building official or his/her Depuly'and Feesare paid. and
receipt is acknowledged in space provided
ATTEWON 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. UBC1091 IBC110 / IRC1110.
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ORIGINAL -FILE YELLOW -INSPECTOR
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F1 I NAL PROJECT APPROVAL FORM
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DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: -FIRE DEPARTMENT DATE
PLEASESIGN
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DESCRIPTION OF WORK TO BE INSPECTEI)4� /I f- -Z'ied
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A field inspection was con ducted to determine compliance with -approved plans. Final approval
denotes that there are no objection s from the above signed. Department to the release of
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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El Copy of CORRECTION NOTICE givento owner/contractor by inpect.or
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RE -INSPECTED OUTSTANDING ISSUES.- GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:forrw:ocaprv1 3/25/04