20050385.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINEqb,4_,
MAILINGADDRESS
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CITY ZIP TELEPHONE
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NAME
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PERMIT EXPIRES
�ERMIT V
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PLAT NAME/SUBDIVISION NO. LOT NO LiD N6_
I LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved 13
RW Permit Required 0
_�OPOSED Street Use Permit Required
EXISTING Inspection Required
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REQUIRED D;DICATION FT
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METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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REMARKS
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GEOTECH REPORT
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STRUCTURAL DESIGN
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Description FEE Description FEE
Plan Check State Surcharge
H . EAT SOURC . E LOTSLOPE% VESTED DA TE Building Permit City Surcharg e /t
PLAN CHECK NO, Plumbing Base Fee
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Mechanical
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 Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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PERMIT LIMIT: SEE ECDC 119.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) OAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESSORS Fi re Review Plan Chk. Deposi
W IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
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4 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
X1 FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0 IFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due 6115
i DEEMED TO MOD
x 0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee Receipt 22
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building official or hisdher Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowle . dged . in space provided
,IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S Cylilift)SATION INSURANCE AND RCW 18:27. LFFIjV SIGNATURE 11 DA
DATE SIGNED (425)
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IT IS UNL5WFUL-; CCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- 0 NAL - F LE YEL INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC1110 I IRC110. K - 0 NER G D - ASSESSOR
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BY ENGINEERING
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FINAL PROJECT APPROVAL FORM
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbrms:ocaprv1 3/25/04
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date 'Signature
1:temp:b1dg:fbrMS:ocaprv1 3/25/04