20050315.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION. PERMIT APPLICATION
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PLAT NAME/SUBDIVISION NO. LOTNO. LID NO.
LID FEE S
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Requited
Street Use Permit Rool'd
EXISTING - PROPOSED Inspection Requited
Sidewalk Required
REQUIRED DEDICATION- FT Underground
Winngrequired
METER SIZE LINE SIZE NO. OF FIXTUR�ES PRV REQUIRED
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REMARKS
OWNER/CONrRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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STATE LICENSE NUMBER EXPIRATION DAT VARIANCE OR SHOREIINEORADB# INSPE 'ON BOND
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SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TA4� �CCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
9,3900 D 02 t) EXP
NEW 5?'�JRESIDENTIAL 11 PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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PARKING LOT AREA PLANNING REVIEWED BY 5AE. 5
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REPAIR CYDS ( X FT) REMARKS
DEMOLISH TANK Ei OTHER k C4
GARAGE RETAINING WALL
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CARPORT ROCKERY FIRE ALARM
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CHECKED BY TYPE 0 CODE OCCUPANT
GROUP
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS SPECIAL INSPECTION AREA OCCUPANT
STORIES UNITS NUMBER REQUIRED [] YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REO'D
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VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCT-7 GLAZING % . LOT.SLOPE % Building Permit City Surcharge o o
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 Grading
:3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
I.- SEPARATE PERMISSION. Engr. Review
Ix PERMIT APPLICATION: ISO DAYS
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PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFX DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMI1 ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MOD117X WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
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NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,' Recording Fee __jTec7eipt #
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 APPLICATION APPROVA
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Foos are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WAS14INGTON RELATING TO FOR INSPECTION receipt Is acknowledged In Spec t provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 10.27.
"I OFFICIkLS IG Lfflf� DAW
AiURE DATE SIGNED (425)
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771-0220 RELEASEDU DX E
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 CERTIFI- ORIGINAL -FILE YELLOW. INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 * PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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06/12,12005 11:26 FAX
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TANK REMOVAL ENVIRON?
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SERVICES, LLC
P.O. -'B 0 X 77 552
SEATTLE, WA 98177,
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FINAL PROJECT APMV FORM
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION -
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A field inspection was conducted to determine compliance with approved plans. Final approval denotes that
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GRANT FINAL PROJECT APPROVAL
GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
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—RE-INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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