20050505.pdfDATE RECEIVED
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L f PERMIT EXPIRESPERMIT
CITY OF EDMOND4LICATIONJA
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CONSTRUCTION PERMIT APPSUITE/APT#
ADDRESS 2 � / I q T
OWNER AE1 AM BUSINES
✓% NAMEISUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRES LID FEE 5
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zIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PP ApprovedO Z'S// I RW Pormn Rognit R - ❑sueol Uso Peand Requirod ❑CITY ZIP TELEPHONETING PROPOSED inspection Required ❑siduw�ih Required ❑IRED DEDICATION _ FT Wiring Underground ❑
Wrcm required ❑
NAME LREMARKS
LINE SIZE NO. OF FIXTURES PRV REQUIRED
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ADDRESS U 42 716Z4
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CITY ZIP TELEPHONE
STATE LICENSE NUMBER EXPIRATIO DATE LF&KE! DY VARIANCE OR CU SHORELINE ORADB# INSPECTION SEPA
REQ'D COMPLETED2` f !�— l r� .YES ONO
CA# ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. WAIVER ALLOWEQ PROPOSED ALLOWED PROPOSED
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Q NEW ❑ RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR O
COMMERCIAL COMPLIANCE OR z
1:1ADDITION El MIXED USE ❑ CHANGE OF USE z
REMODEL ❑ ' PARKING LOT AREA PANNING REVIEWED BY DATE
1:1 REMODEL REQ'D / g
MULTIFAMILY PROVIDED S 2%
[3 REPAIR ❑ GRADING CYDS ❑ ENCS X FT.) REMARKS
❑ DEMOLISH [:]'TANK —r ❑ OTHER
❑ GARAGE CARPORT ❑ ROCKERY RETAINING WALL FIRE ❑ FIREA ALARM
(TYPE 0 USE, BUSIN S OR ACTIVITY IN:
yd TYPE O S TIOy CppE GROOCCUP ��.' GROUP
NUMBER NUMBER OF.
OF / DWELLING ,, ll SPECIAL INSPECTION CONSULTANT OCCUPANT
STORIES UNITS N LOAD
REQUIRED YES
DESCRIBE WORK TO BE DONE
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VALUATION
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Description FEE Description FEE
Plan Check "J ,� State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE f
Building Permit. 0 112 City Surcharge •G
PLAN CHECK NO:.r/ Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO McChanICBI
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC
E DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS; MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
� Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Li
L PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Eflgf. Inspection
•APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
+r IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Y EOMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
= ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE V �-- --
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION'S
Recording Fee Receipt # X711
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION I
APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF is on
This application not a permit until signed by the
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL Building Official ti n is or Deputy: and Foos aro paid, and
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 FOR INSPECTION receipt is acknowledged in.space provided. �-
WORK OMPENSATION INSURANCE AND RCW 18:27. FF LS SIGNATU 4AIE
SIGNATOR (OER O NT): DATE IG ED (425e�)MIA I
"
771 -0620 R SED BY , DATE
ATTENTION EXT. 1333 -y
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL - !' G
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -FILE •YELLOW -INSPECT R
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC1091 IBC1101 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
- PLEASE SIGN
ENGINEERING DIVISION DATE' _
PLEASE SIGN
PLANNING DIVISION DATE i 2� OZ�ZOoS
.. PLEASE SIGN .
PROJECT ` `/ `�`� �/i2 �/� d�� / ki
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SITE ADDRESS C� 2"/
PERMIT #G—�,_D ADB# DATE INSPECTED �o X
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DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine compliance wqtCapproved 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
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
❑ Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL, INSPECTION OUTSTANDING ISSUES .
❑ Copy of CORRECTION NOTICE given to owner/contractor by iripector
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2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL.PROJECT APPROVAL
Date Signature
1: temp:bldg: forms:ocaprv13/25/04
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