20050681.pdfDATE RECEIV1,0
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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CITY ZIP TELEPHONE
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NAME
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ZIP
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NAME CBL N
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ADDRESS
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CITY ZIP TELEPHONE
18 '023 13bo - &;5,
STATE LICYNSE NUMBER EXPIRATION DATE WECKED
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PROPERTY TAX ACCOUNT PARCEL NO
NEW
151
RESIDENTIAL
ADDITION
COMMERCIAL
MIXED USE
REMODEL
muurIFAMILY
REPAIR
GRADING CYDs
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL.
ROCKERY
(TYPE OF USE, BUSINE R ACTIVITY) EXPLAIN
1:1 PLUMBING/MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( x
F1 OTHER
FIRE SPRINKLER
FIRE ALARM
PIRES
[PERMIT EX
PERMIT
NUMBER
JOB
ADDRESS
*7 -5 12 -�
SUITE/APT#$
PLAT NAMEISI 1BDIVISION NO.
LOT NO
LID NO
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LID FEE S
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
fL5CPApproved
0
RVV Pernul Requirml
Street Use Permil Requiled C3
EXISTING PROPOSED
Inspeclion Required E3
SKJowalk Requited E3
REQUIRED DEDICATION FT
Undergiound 0
Wrinn fi-nuired
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES13 NO13
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REMARKS
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OWNERJCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
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VARIANCE OR CU
SHORELINE OR ADS#
INSPECTION
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COMPLETED EXEMPT
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SIGN AREA
HEIGHT
WAIVERM
ALLOWED PROPOSED
ALLOWED PROPOSED
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STUDY 13
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LOT COVERAGE
REQUIRED SETBACKS (FT
PROPOSED SETBACKS (FT)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/RSIDE REAR
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PARKING
LOTAREA
PLANNING REVIEWED By DATE
REO'D PROVIDED
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REMARKS
t TYPE OF 7NS�TRUCTION I
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< GROUP
NUMBER NUMBER OF r__ * — - 1 :5
OF DWELLING SPECIAL kSPECTION CONSULTANT OCCUPANT
3 UNITS LOAD
STORIES
DESCRIBE WORK TO BE DONE REQUIRED DYES
REMARKS
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GEOTECH REPORT to
BY:
02ii rall.1-1 bvmf STRUCTURAL DESIGN
BY:
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOTSLOPE% VESTED DATE
Building Permit City Surcharge
PLAN CHECK NO:
Plumbing Base Fee
If 3
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
W
IL PERMIT LIMIT: SEE ECDC 19.00,005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
in - — — Z2
U' IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
a 2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt N V1111 2,12,0
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0-i DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due I)A e7 5-u
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION., - �K / .� —
Recording no Receipt # C9 —16 a.!�
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWHER, OR THE DULY AUTHORIZED AGENT OF This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his/her Deputy: and Fees are paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSATION RANCE AND RCW 118:27.
IGN It ATE
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ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- IGINAL - FIL YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 if IRC110. PINK -OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
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DATE:
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DESCRIPTION OF WORK TO BE INSPECTED sp�zl
A field inspection.was conducted to determine compliance with -approved plans. Final approval
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denotes that there are no objections from the above signed Department to the release of
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PERFORMANCE BONDS and the granting of:
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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Copy of CORRECTION NOTICE given to owner/contractor by iiipector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbmis:ocapn-1 3/25/04