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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMB
PERMIT EXPIRES
PERMIT
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PLAT NAME,iSUBDI
LOT NO
LID NO
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LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
IESCP Approved
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RW Peand Required
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EXISTING _.— PROPOSED
street Use Permit Required
Inspection Required
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13
Sidewalk Required
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REQUIRED DEDICATION
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Urtleripound
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Vifiring required
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METER SIZE
SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO C1
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE 0
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STUDY 13
ALLOWED , PROPOSED
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LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
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FRONT L/RSIDE REAR
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COMPLIANCE OR
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REPAIR CYDS ( x FT.) REMARKS
DEMOLISH TANK OTHER -T.
GARAGE RETAINING WALL FIRE SPRINKLER
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ISAN
(TYPE OF USE. BU SS OR ACTIVITY) EXPLAIN.
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GROUP
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DESCRIBE WORK TO BE DO E REQUIRED 13YES
GEOTECH REPORT
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Description
FEE. Description FEE
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Plan Check -7
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HEAT SOURCE LOTSLOPE% VESTED DATE
Building Permit
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City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
THIS PERMIT AUT=NLY THE WORK NOTE16. 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
ad PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
0. PERMIT LIMIT. SEE ECDC 19.00.005(A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FO R MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
Plan Clik. Deposit
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_1 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
FROM ANY AND
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS
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Fire Inspection
:V� 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
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Total Amt. Due ,N4
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0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt # M6-g-A, I
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 COMPIENSATIQN INSURANCE AND RCW 18:27.
OFF�FI SIGN E DATE
U I, NER DATE SIGNED
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771-0220
REL S[ BY DATE
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IT IS UNLAW1 SE R OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTI AS BEEN MADE AND APPROVAL OR A CERTI-
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CRIG&/FILE - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 It IRC110.
PINK -OWNER - GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
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DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM:_ -FIRE DEPARTMENT DATEjg�`o
PLEASESIGN
ENGINEERING DIVISION DATE
PLEASESIGN
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denotes that there are no 'Objections from the above signed Department td. , the release of
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PERFORMANCE BONDS and the granting, of:
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GRANT FINAL PROJECT APPROVAL
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECTAPPROVAL
Datc Signattire
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PER -MIT COORDINATOR, BUILDING DIVISION
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PLEASE SIGN
ENGINEERING DIVISION DATE'
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PERMIT 41-16766 — (22 6; 0 D CZ
ADB# DATE INSPECTE
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DESCRIPTION OF WORK TO BE INSPECTED
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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 the release of
PERFORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL, WITH CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of CORRE C I TION NOTICE given to'owner/contracto,r.. by'inpector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FfNALPROJECT APPR.OVAL
Date. Signature w
1:tenip:b1dg:forn1s:0caprv1 3/25/04