20050696.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
l9 941,, Forest jow 1)R. lvr
NAME
ADDRESS
NAME
i /COO
Y ' V
CITY .
STAT
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TELEPHONE
)� r� PERMIT EXPIRES a
PERMIT (lI /,(Q
NUMBER `--((
JOB SUITE/APT#
ADDRESS
PLAT NAM EISUBDIVISION NO, LOT NO. LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApprovod E3RW Permit Regwred ❑
Street Use Permit Regr.rred ❑
EXISTING PROPOSED _ Inspection RogwuM ❑
Sidewalk Roqueed ❑
REQUIRED DEDICATION FT Underground E3
-- Weinrequired ❑
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
l7
YES 17 NOD =
rr
w
REMARKS w
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
L7
i�
CBLa E PRESENT FOK
Go . V ENGINEERINC}REYI�VyEQt��I REMOVAL, TE
/ FIRE REVIEWED BY �� ��'' II DATE w
ZIP TELEPHONE x Z
EXPIRATION DATE I fVHECDBY VARIANCE OR CU SHORELINE OR ADB0 INSPECTION SEPA O
REQ'D COMPLETED EXEMPT - 0
YES 13 NO
PARCEL NO.
CAN ZONE SIGN AREA HEIGHT _
WAIVER 0 ALLOWED PROPOSED ALLOWED PROPOSED
1 LJ `�"'' �" STUDY 0 0 =
,RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) Q M
�\ ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR C O
❑ COMMERCIAL COMPLIANCE OR 0
❑ CHANGE OF USE
❑ Mai 0
MIXED USE PARKING LOT AREA PLANNING REVIEWED BY DATE g
❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
=M
❑ GRADING ❑ FENCE M Z
CYDS ( X FT.) REMARKS Q —)
KTANK ❑ OTHER D Z
❑TAINING WALL FIRE SPRINKLER N
ROCKERY ❑ FIRE ALARM 1
OR ACTIVITY) EXPLAIN: t 0 M
r A, TYP�FCONSTRUC14 CODE GROUP
I
NUMBER OF
OF DWELLING ( SPE AL INSPECTION CONSULTANT OCCUPANT i m M
STORIES UNITS ` LOAD
REQUIRED YES O 0
DESCRIBE WORK TO BE DONE
• REMARKS z C N
GEOTECH REPORT m t (71 (�
CIA
' T C� �I �� STRUCTURAL DESIGN
BY:
VALUATION
$ ) z
Description FEE Description FEE 2
44
Plan Check State Surcharge Z
HEAT SOURCE LOT SLOPE% VESTED DATE T.
0
Building Permit City Surcharge —1
0
PLAN CHECK NO: PI b' Base Fee i M:
Um Ing
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC Grading
E DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
SEPARATE PERMISSION.
Engr, Review
u PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
16 PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engf. Inspection
•APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
IN INTEREST• AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
I 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 Landscape Insp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
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 Fees are paid; and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO p
WORKMEN'S COM ATION INSURANCE AND RCW 18:27, O IC L G TU DAT
SIG R (OWNE A ENT): DATE GNE (425)
Ile 771 '0220 RELEASE Y DATE
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- ORIGINAL -FILE YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110• PINK -OWNER • GOLD - ASSESSOR
1ma PRESS HARD = YOU ARE MAKING 4 COPIES
[j NEW
❑ ADDITION
❑ REMODEL
❑ REPAIR
❑ DEMOLISH
❑GARAGE
CARPORT
7ItL!LT:I
TELEPHONE
)� r� PERMIT EXPIRES a
PERMIT (lI /,(Q
NUMBER `--((
JOB SUITE/APT#
ADDRESS
PLAT NAM EISUBDIVISION NO, LOT NO. LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApprovod E3RW Permit Regwred ❑
Street Use Permit Regr.rred ❑
EXISTING PROPOSED _ Inspection RogwuM ❑
Sidewalk Roqueed ❑
REQUIRED DEDICATION FT Underground E3
-- Weinrequired ❑
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
l7
YES 17 NOD =
rr
w
REMARKS w
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
L7
i�
CBLa E PRESENT FOK
Go . V ENGINEERINC}REYI�VyEQt��I REMOVAL, TE
/ FIRE REVIEWED BY �� ��'' II DATE w
ZIP TELEPHONE x Z
EXPIRATION DATE I fVHECDBY VARIANCE OR CU SHORELINE OR ADB0 INSPECTION SEPA O
REQ'D COMPLETED EXEMPT - 0
YES 13 NO
PARCEL NO.
CAN ZONE SIGN AREA HEIGHT _
WAIVER 0 ALLOWED PROPOSED ALLOWED PROPOSED
1 LJ `�"'' �" STUDY 0 0 =
,RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) Q M
�\ ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR C O
❑ COMMERCIAL COMPLIANCE OR 0
❑ CHANGE OF USE
❑ Mai 0
MIXED USE PARKING LOT AREA PLANNING REVIEWED BY DATE g
❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
=M
❑ GRADING ❑ FENCE M Z
CYDS ( X FT.) REMARKS Q —)
KTANK ❑ OTHER D Z
❑TAINING WALL FIRE SPRINKLER N
ROCKERY ❑ FIRE ALARM 1
OR ACTIVITY) EXPLAIN: t 0 M
r A, TYP�FCONSTRUC14 CODE GROUP
I
NUMBER OF
OF DWELLING ( SPE AL INSPECTION CONSULTANT OCCUPANT i m M
STORIES UNITS ` LOAD
REQUIRED YES O 0
DESCRIBE WORK TO BE DONE
• REMARKS z C N
GEOTECH REPORT m t (71 (�
CIA
' T C� �I �� STRUCTURAL DESIGN
BY:
VALUATION
$ ) z
Description FEE Description FEE 2
44
Plan Check State Surcharge Z
HEAT SOURCE LOT SLOPE% VESTED DATE T.
0
Building Permit City Surcharge —1
0
PLAN CHECK NO: PI b' Base Fee i M:
Um Ing
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC Grading
E DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
SEPARATE PERMISSION.
Engr, Review
u PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
16 PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engf. Inspection
•APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
IN INTEREST• AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
I 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 Landscape Insp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
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 Fees are paid; and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO p
WORKMEN'S COM ATION INSURANCE AND RCW 18:27, O IC L G TU DAT
SIG R (OWNE A ENT): DATE GNE (425)
Ile 771 '0220 RELEASE Y DATE
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- ORIGINAL -FILE YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110• PINK -OWNER • GOLD - ASSESSOR
1ma PRESS HARD = YOU ARE MAKING 4 COPIES
FINAL PROJECT APPROVAL FORM
A � TO:
DATE: ,
MEMO TO: PE I 00 , BU LDING DIVISION
FROM: FIRE DEPARTMENT DATE
(LE XSC SIGN
ENGINEERING DIVISION DATE
.. PLF.A.SI: SIGN ...
PLANNING DIVISION DATE
YIEASF SHIN
PROJECT.
SITE ADDRESS
PERMIT #
D `� �9 (p ADB# DATE.INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED P✓1�Jl l SSl 6-v��
A field inspection was conducted- to determine compliance with -approved plans. Final approval
denotes than there 'are no objections from the above signed Department to, the release of
PERFORMANCE BONDS and the granting of
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
❑ Copy of CONDITIONS given to owner/contractor by inspector
I:
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
❑ Copy of CORRECTION NOTICE given to owner/contractor by inpector:
I..
2.
3.
REINSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
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