20050270.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEiNAME OF BUSINESS
MAILINGADDRESS
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STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PA ELNO.
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60 W274 60160
NEW
RESIDENTIAL 13 PLUMBING / MECH
ADDITION
COMMERCIAL COMPLIANCE OR
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MIXED USE CHANGE OF USE
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MULTIFAMILY 1:1 SIGN
REPAIR
GRADING CYDS FENCE
( x FT.)
DEMOLISH
TAW OTHER ,
GARAGE
CARPORT
RETAINING WALL FIRE SPRINKLER
ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER
NUMBER OF
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STORIES
UNITS
DESCRIBE WORK TO BE DONE
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PERMIT EXPIRES
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NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TLSCP Approved
RW Permit Required
Street Use Perrmt Required
EXISTING ____ PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION
FT
Underground
Mind required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YES 1:1 NOO
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING RE�
FIRE REVIEWED BY
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VARIANCE OR CU, SHORELINE ORADB# I INSPECTION01 SEPA
REO'D COMPLETED I EXEMPT
OYES ON
CA# ZONE SIGN AREA HEIGHT
WAIVER 13 ALLOWED PROPOSED ALLOWED PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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PARKI NG EA I PLANNING REVIEWED BY DATE
REQ'D PROV
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LEMARKS
OCCUPANT
GROUP
SPECIAL INSPECTION CONSULTANT OCCUPANT
REQUIRED 13 YES LOAD
REMARKS
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GEOTECH REPORT
BY:
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STRUCTURAL DESIGN
BY:
VALUATION
$
Description
FEE
Description
FEE
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Plan Check
State Surcharge
HEAT SOU RCE
LOT SLOPE0/6____
VESTED DATE
Building Permit
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City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
Mechanical
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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
2
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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
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-APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Fire Review
Plan Ch,k. Deposit
Fire Inspection
Receipt #
LandscapeInsp.
Total Amt. Due
Recording Fee
Receipt #
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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 COMPENSATI��RANCE AND RCW 18:27.
CALL
FOR INSPECTION
(425)
771-0220
APP ION APPROVAL
This application is not a porrinit until signed by the
Building Official of his/her Deputy: and Fees are paid. and
. receipt is acknowledged in space provided
Cl Ll 11 NATURE 1)
SIGNATURE (OWNER OR IV N T)
DATE S IGNED
RELEASED BY IDATt
ATTENTION .1 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 / IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM
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DATE:
MEMO TO: PERMIT COORDINATOR? BUILDING DIVISION
FIRE DEPARTMENTDATE
FROM:
PLEASESIGN
ENGINEERING DIVISION DATE—
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DESCRIPTIONOF WORK TO BE INSPECTED 7 4- SL_f'_�
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A field inspection was conducte d 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
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PERFORMANCE BONDS and the granting of:
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/CGRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH.'CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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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:f6rnis:ocaprv1 3/25/04