20050474.pdfDATE RECEIVED
V17 7 [PERMIT EXPIRES
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB ADDRESS SUITE/APT#
OWNER NAMEINAME OF BUSINESS L`i ! ✓ _LC) D 4 ��d
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a 12A O 1Al��t� �� i r �jD3 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved E3
RW Permd Required ❑
Street Use Permit Required ❑
CITY ZIP TELEPHONE EXIST114G PROPOSED inspection Required ❑
Sey.� G(y •� , i - Sidewalk Required ❑
iM �s W Ar i D 1 ( r i/� �1� 6;�Lo i6 ✓ '/ ��.� Underground ❑
` REQUIRED DEDICATION AFT _ Mind required ❑
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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-t PROPERTY TAX ACCOUNT PARCEL NO. CA# ZONE SIGN AREA HEIGHT
J ���� �I3o �U3� �00 STUDY OWAIVE0' �•'1/r,r ALLOWED PROPOSED ALLOWED PROPOSED
NEW RESIDENTIAL PLUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR t7
❑ COMMERCIAL COMPLIANCE OR z� IJ�i, ,L1-� ✓ Z
1:1ElADDITION CHANGE OF USE rYvv V7 rJ z
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❑ REMODEL ❑ MULTIFAMILY El SIGN RE9;D PROVIDED 116
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1:1 REPAIR ❑ G$AD
CYOS ❑ FENCE Z
L� ( X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
zCARPORT ❑ ROCKERY ❑ FIREALARM
I (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
� � ,CJ� Th G' 1 TYPE OFCVTPUCTION ODE OCCUPANT
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oNUMBER NUMBER OF
OF DWELLING SPECIAL INSPECTION CON5ULTANT OCCUPANT
OSTORIES UNITS LOAD
DESCRIBE WORK TO BE DONE REQUIRED YES
REMARKS i
GEOTECH REPORT
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BY: If
VALUATION
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Description FEE Description FEE
Plan Check ��? State Surcharge 62r
HEAT SOURCELOT SLOPE% VESTED DATE
Building Permit `- City.Surcharge
PLAN CHECK NO: Plumbing Base Feewin
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical
t BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC
ZDONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
t SEPARATE PERMISSION.
�Engr. Review
w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00,005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
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 #��
41 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
= FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE /f f
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee . Receipt#
1 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
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 Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27,
(Mon
S SIGNAT E DATSIGNATURE (OWNER OR ENT): DATE SIGNED (425) •; '2-(¢.��\S �a4a, 771-0220 ATE
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-.
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 I IBC110 I IRC1109 ORIGINAL -FILE •YELLOW -INS
PINK -OWNER •GOLD -ASSESSORSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MENTO TO: P T O IN UILDING DIVISION
FROM FIRE DEPARTMENT DATE.15- G
neAS[ 451ENGINEERING DIVISION DATE
PLANNING DIVISION DATE
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PROJECT-wc
SITE ADDRESS
PERMIT #2 ?� ADB# DATE INSPECTEDII 7Ia�
DESCRIPTION OF WORK TO BE INSPECTED
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
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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