20050679.pdfDATE RECEIV
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[PERMIT EXPI RES
CITY OF EDMONDS.
PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS
OWNERNAME /NAME OF BUSINESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO
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MAILING ADbRESS V
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LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET -OAP
EXISTING PROPOSED
REQUIRED DEDICATION FT
TESCPAppfoved
RW Permit Requited E3
Street Use Permit Required 13
inspection Required E3
Sidewalk Required [3
Undef9found E3
Wiring required
CITY ZIP
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TELEPHONE
NAME IF
METER SIZE LINE Sl NO OF FIXTURES PRV REQUIRED
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ADDRESS
YES13 NOO
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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CITY ZIP
TELEPHONE
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NAME
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ENGINEERING REVIEWED BY DATE
ADDRESS
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FIRE REVIEWED BY DATE
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CITY ZIP
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TELEPHONE
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VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
REQ'D
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STATE LICENSE NUMBER EXPIRATION DATE
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WAIVER 13
STUDY 13
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SIGN AREA
ALLOWED I PROPOSED
HEIGHT
ALLOWED , PROPOSED
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PROPERTY TAX ACCOUNT PARCEL.NO.
0 NEW RESIDENTIAL PLUMBING MECH
1:1
ADDITION COMMERCIAL COMPLIANCE OR
MIXED USE CHANGE OF USE
REMODEL MULTIFAMILY 0 SIGN
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT LIRSIDE REAR
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PARKING
REQ1D PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
5
GRADING FENCE
REPAIR CYDS ( — X —FT.)
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REMARKS
DEMOLISH TANK OTHER
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GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT 1:1 ROCKERY EP FIRE ALARM
(TYPE OF USE, BUSINESS 0 TIVITY)PPLAJN;
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TYPE OF rPNSTFJUCTION
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CODE
OCCUPANT
GROUP
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NUMBER NUMBER 0
OF DWELLING
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STORIES UNITS
SPECIACINSFkCTION
REQUIRED 13YES
CONSULTANT
OCCU)IKNT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT
BY:
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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
.01
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City Surcharge
PLAN CHECK NO-
7 3
Plumbing
Base Fee
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
j SEPARATE PERMISSION.
Engr Review
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PERMIT APPLICATION: SEE ECDC ig.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(r))
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
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'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
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Be
Rece,ipt #
APPLICATION APPkOVAL
This application is not a perrnit until signed by the
CALL Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
FOR INSPECTION
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 COMPENSAT !Wht�URANCE AND RCW 18:27.
OFFICIALS SIGNA DtitTE
(425)
I ATURE (OWNER 06 AGENif:
DATE SIGNED
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EIA�9968Y DATE
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
EXT. 1333
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 / IRC110-
GINAL . Fk YELLIAW 14SPECTOR
INK - OWV GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE
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FINAL PROJECT APPROVAI, FORM
TO:
DATE:.
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATIH
SH SIGN
ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE
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DESCRIPTION OF WORK TO BE INSPECTEDE( 1A.-k L
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A field inspection was conducted to determine compliance with a pproved plans. Final approval
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that there are no objections. from the above. signed Department to. the release of
PERFORMANCE BONDS aud the granting of
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GRANT FINAL PROJECT APPROVAL
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GF—ANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor* by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
R Copy Of CORRECTION NOTICE given to owner/contractor by inpector
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RE -INSPECTED OUTSTANDING ISSUES GRANTFINAL PROJECT APPROVAL
Date SignatUre
1:temp:b1dg:fbn-ns:ocaprv1 3/25/04