20050703.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTIONPERMIT APPLICATION
OWNER NAMEINAM 7OF BUSINESS
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CITY ZIP
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NAME
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TELEPHONE
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PERMIT EXPIRES
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NUMBER 0—�O -t?
JOB SUITE/APT#
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PLAT NAME/SUBDIVISON NO. 7�
LOT N LID NO
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP tESCP Approved 13
RW permit Required 13
EXISTING PROPOZ nit Requited 0
9IR_E_MARS Street use Pee
I_tAL Inspecion Required 0
Sidewalk Requited 0
REQUIRED DEDIC bN 0." 13
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REMARKS LU
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STATE LICENSE NUMBER
EXPIRATION DATE
VARIANCE OR CU
SHORELINEORADB#
INSPECTION
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REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/RSIDE REAR
ADDITION
COMMERCIAI,
COMPLIANCE OR
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REMARKS
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NUMBER
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SPECIAL INSPECTION
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CONSULTANT
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CCUPANT
DESCNBE WORK TO BE DON -
REMARKS
GEOTECH REPORT
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Description
FEE
Description
FEE
Plan Check
Sta te Surcharge
HEATSOURCE
LOT SLOI
V ESTED DATE
Building Permit
00
City Surcharge
IbIM
.PLAN CHECK NO:
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK IN
BE DONE ON PRIVATE PROPERTY ONLY.
_j DONIMAIN (CURBS, SIDEWALKS, DRIVEWAYS,
I= SEPARATE PERMISSION.
OTED. THIS PERMIT COVERS WORK TO
ANY CONSTRUCTION ON THE PUBIC
MARQUEES, ETC.) WILL REQUIRE
Grading
Engr. Review
2
x PERMIT APPLICATION: SE
W
PERMIT LIMIT* SEE E(
SEE BACK OF PINK PERMIT
E ECDC 19.00.005(A)(5)
DC 19.00.005(A)(6)
!OR MORE INFORMATION
Engr. Inspection
U) 'APPLICANT, ON BEHALF OF HIS OR HER S
U)
'OUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
Plan Chk. Deposit
Lu IN INTEREST, AGREES TO INDEMNIFY, DE!END
_1
AND HOLD HARMLESS THE CITY OF
:E EDMONDS, WASHINGTON, ITS OFFICIALS,
IMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
co
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER
ATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. I!
SUANCE OF THIS PERMIT SHALL NOT BE
—
DEEMED TO MODIFY, WAIVE OR REDUCE At
Y REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CITY's ABILITY
'0 ENFORCE ANY ORDINANCE PROVISION.*
Recording F Be
Receipt #
22V
I HEREBY ACKNOWLEDGE THAT I HAVE READ 7
41S 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 i
ND STATE LAWS REGULATING CONSTRUC-
CALL
TION; AND IN DOING THE WORK AUTHORIZED "HEREBY.
NO PERSON WILL BE EMPLOYED
Building Official or hisihor Deputy: and Fees are paid. and
IN VIOLATION OF THE LABOR CODE OF THE
STATE OF WASHiNGTON RELATING TO
FOR INSPECTION
receipt i;yicknowl god in space provided
T
WORKMEN'S COMPENSATION INSURANCE AND
RCW 18:27.
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IGNKRE
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SIGNATURE (OWNER A ENT)! D F�SIGNED (425)
220 kREL -A
771-0
ATTENTIONZ EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 ir IRC110.
110104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDINC-TDrvisION
FIRE DEPARTMENT DATE
FROM:
PLEASE SIGN
ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE
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PLEASESIGN'
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PERMIT 49-60, _ADB# DATE INSPECTED. �5
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DESCRIPTION OF WORK TO BE INSPECTED
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.
F1 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
.3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL.
Date Si gnature
I:teinp:bldg:fonns:ocaprvI.3/25/04