20050271.pdfDATE RECEIVED �41
PERMIT EXPIRES
CITY OF EDMONDS
PERMIT
NUMBER
7
JOB
ADDRESS
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CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
PLAT NAME/SU BD IVI SION NO.
LOT NO
LID NO,
MAILINGADDRESS
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
Rw Panna Required
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PROPOSED
Street Use Permit Required
inspection Required
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TELEPHONE
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REQUIRED DEDICATION
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Sidewalk Required
Underground
Wiring required
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NAME
METER SIZE LINE SIZE NO. OF FIXTURES
PRV REQUIRED
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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STATE LICENSE NUMBER EXPIRATION DATE Y D
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PROPERTY TAX ACCOUN4PARCEL NO. WAIVER 13 ALLOWED i PROPOSED ALLOWED , PROPOSED
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PLANNING REVIEWED BY DATE
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VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
LOT SLOP�7__�
VESTED DATE
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT VERS 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
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
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 ANYWAYT HE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Fire Review
Plan Chk. Deposit
Fire Inspection
'E�
Receipt #
Landscapelnsp.
Total Amt, Due
Recording Fee
Receipt #
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 COMPENS RANCE AND RCW 18:27.
CALL
FOR INSPECTION
(425)
771-0220
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy and Fees are paid, and
receipt is acknowledged in space provided.
OffJCIALS T RE D TE
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SIGNATURE (OWNER OR NT):
DATE SIGNED
LEAS -Fr) NY — 'DATE
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC11110-
10104 . PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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FROM: FIREDEPARTMENT
PLEASE SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
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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 froth the above signed Department to 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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GRANT,PROJECT APPROVAL WITH CONDITIONS NOTED
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FAILED FINALINSPECTION - OUTSTANDING ISSUES
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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:tcmp:b1dg:fbrms:oc�prv1 3/25/04