20050322.pdfDATE RECEIvED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
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PERMIT EXPIRES
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PLAT NAME/SUBDIVI SION NO.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
_TESC P Approved
RW Permit Required
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Street use Permit Required
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EXISTING PROPOSED
inspection Required
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Sidewalk Required
REQUIRED DEDICATION _FT__
underground
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METER SIZE
LINE SIZE
NO. OF FIXTURES
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REMARKS
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REUARKS
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TYPE PF CONSTRUCTION
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OCCUPANT
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DESCRIBE WORK TO BE DONE
REMARKS
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VALUATION
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DescriptioWnFEE
Description FEE
Plan Check
State Su rcharge
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HEA1 E VESTED DATE
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Building Permit
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City Surcharge
(3AS
PLAN CHECK NO:
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
ETC.) WILL REQUIRE
Grading
9 DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES,
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SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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PERMIT LIMIT. SEE ECDC 19.00.005(A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Revie w
Plan Chk. Deposit
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Ui IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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ITS OFFICIALS, EMPLOYEES AND AGENTS FROM ANY AND
Fire Inspection
Receipt # .�"/ 0 7
IM
2 EDMONDS, WASHINGTON.
"t ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. AW�ING DIRECTLY OR INDIRECTLY
* FROM, THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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Total Amt. Due
* DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
* NOR LIMIT IN
x
Recording Fee
. Receipt #
IHER I EBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
This application is not a permit until signed by the
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR
TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
Building official or hisihor Deputy: and Foes are paid, and
THE OWNER. I AGREE
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
OF THE STATE OF WASHINGTON RELATING TO
receipt is acknowledged in space provided.
FOR INSPECTION
IN VIOLATION OF THE LABOR CODE
WORKMEN'SCOMp SATIONINSUZNCEANORCW_18:27.
0 F1 A SIGNATU ))ATE
OW R - AGEN DATE SIGNED
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LSIGNATUR
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771-0220
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EXT. 1333
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ATTENTION
IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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IT DE AND APPROVAL OR A CERTI-
A FINAL INSPECTION HAS BEEN MA 9 1 IBC110 / IRC110.
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RIGINAL - Ft E -INSPECTOR
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FICATE OF OCCUPANCY HAS BEEN GRANTED.
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FINAL PROJECri'APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENTDATE
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ENGINEERING DIVISION DATE-12,
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DESCRIPTION OF WORK TO BE INSPE CTED
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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
0 Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES.
El Copy of CORRECTION NOTICE given to owner/contractor by- inpector
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RE-fNSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:teii1p:b1dg:forms:ocaprv1 3/25/04