20050488.pdfFDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PROPERTY TAX ACCOUNT PARCEL NO.
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ADDITION
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MIXED USE
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REPAIR
GRADING CYDS
S�rDEMOLISH
TANK
GARAGE
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CARPORT
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(TYPE OF USE. BUSINESS OR ACTWITY�EXPILAIN
PERMIT EXPIRES
PERMIT
NUMBER
JOB
ADDRESS
PLAT NAMEGUBDIVISION NO. LOT NO�
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
REQUIRED DEDICATION FT
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REMARKS
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6 SUITE/APT#
LID NO.
LID FEE S
TESCPApp(oved E3
RW Permit Required 11
Street Use Permit Required 13
Inspirdion Requiren E3
SidaAalk Requifea [3
Underground E3
Wirmq requirrid 13
PRV REQUIRED
ANED (�FYDARISNOD
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WATER METER TO BE REMOVED OR
ENGINEERING FOVIEVE.111MIf F&I DATE
§EF, DEMOLITION INSPECTION
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FOR INSPECTION REQUIPE-mEONTS uj
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BY VARIANCE OR CU SHORELINEORADBO I INSPECTMIO SEPA
REQ'D COMPLETED I EXEMPT
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PLUMBING/MECH
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE REAR
COMPLIANCE OR
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NUMBER
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STORIES
NUMBER OF
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SPE16IAL INSPECTION
REQUIRED DYES
DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT
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STRUCTURAL DESIGN
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Description
Plan Check
HEAT S . OURCE
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VESTED DATE
Building Permit
PLAN CHECK NO: eZ .
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Plumbing
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
SEPARATE PERMISSION,
Grading
Engr. Review
PERMIT APPLiCATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
111111
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN')�NSATION INSURANCE AND RCW 18:27.
CALL
FOR INSPECTION
(425)
771-0220
MrsOWN 11 ER AG
ED/
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
OCCUPANT
GROt
CONSULTANT
OCCUPANT
I
LOAD
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FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or hisihor Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
UW57
RELEASED BY IIATE
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
LPLEASE SIGN
A-
,/77/ Z ENGINEERING DIVISION DATE_P,���.
_1__' PLFASIMIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT
SITE ADDRESS C2744 "0 W
PERMIT # 2-G& ADB#
DATEINSPECTED
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
El Copy of CORRECTION NOTICE given to owner/contractor by inpector
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