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[PERMIT EXPIRES Wj1414_,C n
CITY OF EDMONDS
PERMIT
NUMBER C6�7K
JOB SUITE!APT#
ADDRESS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
PLAT NAME/SUBD;VISION NO.
LOT NO.
LID NO,
LID FEE S
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TESCPApprovea E3
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MiP RW Permit Required 0
Street Use Permit Requited 0
EXISTING PROPOSED Inspection Required C3
Sidewalk Required M
Underground E3
REQUIRED DEDICATION FT Mimi) required 0
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES13 NOM
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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ADDITION CHANGE OF USE
MIXED USE
REMODEL MULTIFAMILY SIGN
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
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PARKING
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LOTAREA
PLANNING REVI I EWEDBY DATE
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REMARKS
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DEMOLISH TANK
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GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
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(TYPE OF USE, MINESS OR ACTIVITY) EXPLAIN:
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CODE
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NUMBER
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NUMBER OF
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UNITS
SPECIAL INSFIECTION CONSULTANT
REQUIRED DYES
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT
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STRUCTURAL DESIGN
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VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building Permit
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City Surcharge
PLAN CHECK NO:
3
Plumbing
Base Fee
L77
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Engr. Review
SEPARATE PERMISSION.
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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 I OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
u IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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E EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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cc ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
E FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
3 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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Fire Review
Plan Chk. Deposit
Fire Inspection
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Receipt 0
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Total Amt. Due
7"
Recording Fee
Receipt #
t97101^33
CALL
FOR INSPECTION
(425)
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771 0220
EXT. 1333
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his1hor Deputy and Fees are paid, and
receipt is acknowledged in space provided
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'S COMPENSATION INSPRANCE AND RCW 18:27.
OFWL;T�IRE DATE
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—6164)NATURE (OWNER OR
NT):
DATE SIGNED
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EASE
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DATE
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A "rCKITInIlitill
IT I� UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL lr ON
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- _7XARIGI - YEj_LOW - INSPEcrOR
L ILE
pl� * O�NERDLD - ASSESSOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 if IBC110 I IRC110 \ P
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
NIENIO.TO: PERNII ILDING DIVISION
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FROM: FIRE DEPARTN4ENT DATE
PLEASESIG�
ENGINEERING- DIVISION DATE
HEASC SNN
PLANNING DIVISION DATE
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PERMIT # 05-.02(2-- ADB# DATE INSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED
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A field inspectio -i(h a
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denotes that there are no objections from (he abo*,%,e signed Department.to flie release of
PERFORMANCE
BONDS and the,granting of:
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GRANT FINAL PROJECT APPROVAL
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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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0 Copy of CORRECTION NOTICE given to owncr/contractor by hipector
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RE -INSPECTED IG ISSUES NT FINAL PROJECT APPROVAL
OUTSTANDIN -GRA
Date Signature
1Aemp:b1d_g:fbmis:0Capn-1 3!25/04