20050709.pdfDATE R L)
ECEIVED(-f PERMIT EXPIRES
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PERMIT
CITY OF EDMONDS NUMBER c* W
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
OWNqPjNAMEJNAME OF BUfIN[SS ADDRESS 13 L1
PLAT NAMEISUBDIVISION NO, LOT NO LID NO
MAILING ADDRESS LID FEE S
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z PUBLIC RIG14T OF WAY PER OFFICIAL STREET MAP f ESCP Approved [3
0 LL/ RW Permil Requilrid E3
K la ST stfeel Use Pirmid Required 13
CITY ZIP TELEPHONE EXISTING PROPOSED inspixtion Required [3
Sidewalk Required E3
REQUIRED DEDICATION FT Undefigiound
�71 lWirinq required
NAME METER SIZE LINE SIZE NO� OF FIXTURES I PRV REQUIRED
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STATE LICENSE NUMBER EXPIRATION DATE BY VARIANCE OR CU SHORELINE OR ADS4 INSPECTION SEPA
REQ'D COMPLETED EXEMPT
10144V. Wit C3 YES C] NO
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PROPERTY TAX ACCOUNT PARCEL NO.
WAIVERE3 ALLOWED , PROPOSED ALLOWED , PROPOSED
uU STUDY 13
0 NEW RESIDENTIAL PLUMBING ir MECH LOT COVERAGE REQUIRED SET13ACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
COMMERCIAL COMPLIANCE OR
ADDITION CHANGE OF USE I
MIXED USE I
PARKING DATE
LOT AREA
El REMODEL MULTIFAMILY SIGN REQ'D I PROVIDED
MUST $E PRESENT FOR
REPAIR GRADING FENCE — .. .. . . I _ .
CYDS El X FT.) REMARKS I MINn. 1-ILL, htMOVAL, UP CAF
DEMOLISH `TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
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(TYPE OF USE, BUSINESS OR A�DVITY) EXPLAIN:
Typmnr Coj'j CTION OCCUPANT
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DESCRIBE WORK TO BE NE
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GEOTECH REPORT
BY:
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BY:
VALUATION
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE T SLOPE% VESTED DATE
Building Permit City Surcharge
T_70 T
PLAN CHECK NO: Plumbing Base Fee
L 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
DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
W
IL PERMIT LIMIT. SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) OAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
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Lij IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
F9 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 Amt. Due SS
a DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' r,
x Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMAT16N 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 Foes 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 LABOI"ODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSAT=B,DRANCE AND RCW 18:27.
OFFICIALS SIGNATURE DATE
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GNA I __ liER 0 A ENT): (425)
�E (OWN DATE IGNE
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Ala op 771-0220 RELEASED BY 'DAI It
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 if IBC110 / IRC110. PINK -OWNER - GOLD - ASSESSOR
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: P IT
ATOR, BUILDING DIVISION
FROM:
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FIRE DEPARTMENT DA E
ENGINEERING DIVISION DATE
PIFASE SIGN
PLANNING DIVISION DATE
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SITE ADDRESS,--
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PERMIT # 05-- 70Y DATE INSPECTED ((-7 tor
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DESCREPTION OF WORK TO BE INSPECTED UST: Sy I a
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A field inspection was conducted to determine compliance with.approved plans. Final appro-val
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denotes that there are - no objection's from the above signed Department to the release. of
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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
Copy of CONDITIONS ghren to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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El Copy of CORRECTION NOTICE giv*en to. owner/contractor by hipector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
I:tehip:bldg:fomis:ocapn,13/25/04