20050692A.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STRUCTURAL DESIGN
VALUATION
Description. FEE Description FEE
Plan Check state Surcharge
HEAT SOURCE LOTSLOPE% VESTED DATE
Building Permit City Surcharge
PLAN CHECK NO- Plumbing Base Fee
335 Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK To
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
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W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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IL PERMIT LIMIT., SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
(A) Fire Review Plan Chk. Deposit
U) 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
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9 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
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
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0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISICi
9 Recording Fee Receipt #
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, 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 Foos are 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
WORKMEN'S COMPENSATION 12URANCE AND RCW 18:27.
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SIGNATU WEN Ct� DATE SIGNED (425)
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ATTENT111UN 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-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. ORIGINAL FILE YELLOW INSPECT R
PINK -OWNER GOLD - ASSESSOR
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FINAL PROJECT. APPROVAL FORM
TO:
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: —FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE
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PERMIT 6) ADB# DATEINSPECTED
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A field inspection was conducted to determine c ompliance with -approved plans. Final a ppro.val
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denotes' that there are no objections from the *above signed Depa n
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PERFORMANCE BONDS -and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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RE -INSPECTED OUTSTANDING'IS.SUES.- GRANT.FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbmis:ocaprv1 3/25/04