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DATE RECEIVED
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I PERMIT EXPIRES
PERMIT
CITY OF EDMONDS
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NUMBER
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CONSTRUCTION PERMIT APPLICATION
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ADDRESS
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OWNER NAMEINAME OF BUSINESS
S�TEV&05 HEAuTtACAR4&_
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PLAT NAME/SUBDIVISION NO.
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LOT NO.
LID I
LID FEE S
LID r
MAILING ADDRESS
2-IG01 --I 0-bLAVE Wes r
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCIPAPP(oved
RW Permit Required
EXISTING PROPOSED
Street use Primil Requited
inspection Required
CITY ZIP
TELEPHONE
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41 Z.5 G7140 -L4 62,9
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REQUIRED DEDICATION
FT
Sidewalk Required
underground
Wiring required
NAME
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TELEPHONE
NAME uttp
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WA 1b0-rr7-A)G 4NQ5
ADDRESS
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CITY ZIP TELEPHONE
�)=xhA1%Lxf.-jWA HIS-4181-7500.
STATE LICENSE NUMBER EXPIR TION DATE C BY
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PROPERTY TAX ACCOUNT PARCEL NO.
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METER SIZE LINE SIZE NO, OF FIXTURES PRV REQUIRED
YES13 NO13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU SHORELINE OR ADBII I INSPECTION SEPA
REO'D COMPLETED I EXEMPT
OYES 13NO I
CA# ZONE SIGN AREA HEIGHT
WAIVER 13 ALLOWED PROPOSED ALLOWED , PROPOSED
STUDY 13 1 1 1
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OF DWELLING /V Iti SPECIAL INSPECTION
STORIES 4 1 UNITS REQUIRED 13 YES
DESCRIBE WORK TO BE DONE
REMARKS
FqeowL SX44 1L. Aob GE TECH REPORT
BY:
PawrAr.- 1-joT,.L (,,oLA WA--r&/L STRU TURALDESIGN
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Description
Plan Check
HEAT SOURCE LOTSLOPE% VESTED DATE
Building Permit
PLAN CHECK NO: Plumbing
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
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)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(q) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
CONSULTANT
OCCUPANT —
GROUP .2 2-_
OCCUPANT
LOAD
FEE Description
State Surcharge
City Surcharge
I) r)r) Base Fee
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FEE I I I r
*APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Fire Inspection Receipt #
EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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 Landscapelnsp. Tbtal Amt. Due f75. f
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt gat/
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 his/her Depulyi and Fees are paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED receipt Is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION -
WORKMEN'S COMPENSAT;5�NU RANCE AND RCW 18:27. OFFICIALS SIGNATURE DATE
ATURE(OWNE GENT DATE SINED (425)
Is 771-0220 ®RELISP DATE
EXT. 1333 j7p
A ENT16r4 STRUCTURE UNTIL
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-. CRIGINA FILE - YELLOW INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE
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DESCREPTION OF WORK TO BE INSPECTED IA)Y(
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A field inspection was conducted to. determine compliance -with appio ved.plans. Final approval
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denotes that there are no objections from the above signed Depai tment to. the, release of
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PERFQMIANCE BONDS and the granting of:
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GRANT FINAL PROJECTAPPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
Copy of . CONDITIONS *given to owner/contractor by inspector
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FAILED.FINAL INSPECTION OUTSTANDING ISSUES
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C3 Copy of CORRECTION NOTICE given to owner/contractor by inp*ect.or
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:ten1p:b1dg:fbrms:ocaPn,1 3!25/04
RECORD OF I NSPECTIONS