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CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
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CITY ZIP TELEPHONE EXISTING _ PROPOSED Inspection Required O
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NAME METER SIZE LINE SIZE NO, 0 1XTIJRES PRV REQUIRED
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ADDITION MIXED USE ❑ CHANGE OF USE •,5ez I 47, 7 5 l � �� , 3 z "ll n
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REMODEL ❑11 SIGN REO'D PROVIDED o.
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Description FEE Description FEE _
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HEAT SOURCE LOT E°/ VESTED DATE r 0
Building Permit City Surcharge �
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PLAN CHECK NO: 2 — �= n
✓ ? � % I � Plumbing Base Fee � I fT1
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
t- BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
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SEPARATE PERMISSION. Engr. R@VIEW
LU PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
Deposit
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rn "APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan p �
w IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
f EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt 11
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 Landscape Insp. Total Anil. Duo
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION'*
Recording Fee Receipt N
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL f
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
This application is not n Pdnnd until ni0ndd by the I
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 CALL Building Official or h n hur Dnpufy and rod4 +vd paid and
IN VIOLATION OE, THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION rouuld's neknowlnd0od in spans {truwdud
WORKMEN' NSATION INSURANCE AND RCW 18:27.
OFF I LS SIGN pAl
SIGNATURE WNER R EN ): DATE SI NED _ (425)
771-0220 Rfa
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- oRIGiNnI •1UI! YEILOW INSPCCTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 / IBC110 / IRC110. PINK - oWi GOLD • ASSESSOR
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ADDITION FOR: MATT t TRAGIE
DOU6LA5 51TE`�'LAN
21021 PIONEER WAY
EDMOW5, WA 88026 PROJECT INFORMATION
FINAL PROJECT APPROVAL FORM
To:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING► DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
<1�=� ENGINEERING DIVISION DATE
PLANNING DIVISION DATE
PLEASE SIGN J�
PROJECT
SITE ADDRESS, -Ozz
PERMIT # ,ZCG(f :-i — ADB# _DATE INSPECTED! /S 0ter
DESCRIPTION OF WORK TO BE INSPECTED / C r P24.
A field inspection was conducted to determine compliance with -approved, plans. . Final approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION OUTSTANDING ISSUES
O Copy of CORRECTION NOTICE given to owner/contractor by inpector:
I.
2: . .
3.
RE -INSPECTED OUTSTANDING ISSUES -.GRANT FINAL PROJECT APPROVAL
Date Signature
I:ternp: bldg: fornis:ocaprv1 3/25/04
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