20050700.pdfDATE RECEIVED PERMIT EXPIRES
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PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPTI
ADDRESS
OWNER NAX,1NAM7F BUSINESS 1-7 110 Ly L L
PLAT NAMEISU BDIVI SION NO. LOT NO. LID NO
LID FEE S
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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STATE LICENSE NUMBER EXPIRATION.DATE, I CHf,,CKELD BY REQ'D COMPLETED EXEMPT
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PROPERTY TAX ACCOUNT PARCEL No.
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
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PARKING LOTAREA PLANNING REVIEWED BY DATE 5
13 REMODEL MULTIFAMILY SIGN REO'D PROVIDED
GRADING ED FENCE I
0 REPAIR CYDS ( � X FT.) REMARKS,
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Description FEE Description FEE
Plan.Check State Surcharge
HEAT SOURCE LOTSLOPE% VESTED DATE _75 o
. I Building Permit City Surcharge
HECK NO: Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr, Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Fire Review Plan Chk. Deposit
U) *APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
LU 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 #
w LY OR INDIRECTLY �a I �00
< ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECT
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due o
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
1 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION., Receipt #
Recording Fee J I
I 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 aperin,j enjil signed by thu
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or hisinor Del)tft and rous are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED receipt is acknowtodgtid in spart, Plovidt'd
IN VIOLATION OF THE LABOR CODE QF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S 90"SATION INSURAMa AND RCW 18:27. DATE
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=G G N 1) DATE IGNED (425)
. 11 7j/ /0 - 0220 PRELLAS BY) _V DATE
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EXT. 1333
ATTENTIOW
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL,
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- C.RIGINAL FILE YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC.11091 IBC110 / IRC110. PINK -OWNER GOL D - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM
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DATE:
.MEMO TO: PE
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FROM:
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FIRE DEPARTMENT DATE
LASESIGN
ENGINEERING DIVISION DATE
PIEMV SIGN
PLANNING DIVISION DATE:
PIEMESIGN
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A field inspection. was conducted to determine compliance ii p n . Fhml approv.
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denotes that there are no objections from the above signed Department to the release of
PERFORAIANCE BONDS and the granting of:.
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
Copy of CONDITIONS given. to o%Npner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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Copy of CORRECTION NOTICE given to owner/contractor by inpector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fomis:ocapr%-1 3/25/04.
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