20050680.pdfDATE RECEIVED
PERMIT EXPIRES
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7 USE PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB ITEr
ADDRESS 0-7653 C-!Q 5�7//
OWNER NAME/NAME OF BUSINESS W
Blueprint Project 210th LLC PLAT NAMEISUBDIVISION NO. LID NO.
MAILING ADDRESS LID FEE S
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?- 8226 212th St. SW PUBLIC RIGHT OF WAY cl �;rofl� ...... I required [3
0 Use Permit Roq'd 13
CITY ZIP TELEPHONE EXISTING - PROPOSED inspection Required 13
d9c;-776a-1245 Sidewalk Required E3
Eddmmonds , WA. 98026 REQUIRED DEDICATION- FT Underground
Wiring required
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES13 NO C3
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Carl J. Colson I I W
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
23623 20th Ave. North Lu
cITYBothell ZIP TELEPHONE
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WA. 980211 F425-806-3703
NAME CBIL
Smith.Fire Systems, Inc. ENGINEERING REVIEWED BY DATE
ADDRESS
3813 168th St.,SE, Suite
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FIRE REVIEWED BY
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Arlington, WA.
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STATE LICENSE NUMBER
EXPIRATION DATE
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SMITHFS1360T
11-02-06
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FRONT REAR
ALLOWED PROPOSED
FRONT
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ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REOID
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Description FEE Description FEE
Plan Check State Surcharge
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Building Permit
City Surcharge
Plumbing
Base Fee
PLAN CHECK NO:
VESTED DATE
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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Engr. Review
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Lu PERMIT APPLICATION: 180 DAYS
IL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, 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
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Total Amt. Due
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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Recording Fee
Receipt 9
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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APPLICATION
APPROVAL
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-
CALL
This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
A
SI TURE DATE
SIGNATURE (OWNER 0 GEN
DATE §IGNEO
(425)
771-0220
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ATE
ATTENTION
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
RIGINAL
NINK
)IILE - YELLOW INS
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CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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compliance ith Final approval
A field inspection was conducted to determine. w approved plans.
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G RANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WIT H CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy or CORRECTION NOTICE given to owncr/contractor by inpector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT AP PROVAL
Date Signature
s:ocal)rvl 3/25/04
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