20050711.pdfDATE RECEIVED
St 6 "'_) -1 - [PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER'
JOB leITEIAIT"
CONSTRUCTION PERMIT APPLICATION ADDRESS-2
OrEIR NAMEINAME OF BUSINESS \Nv
a U\ r Ck- k PLAT NAMEISUBDIVISION NO. NO LID NO,
MAILING ADDRESS T"T LID FEE S
L) PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved
r7 Cc: A Lo RW Permit Requited
4 stmetuse Permit Requited
CITY Z?� 4TELEPHONE EXIST114G PROPOSED In5puction Requited
Sidewalk Requited
qUIRED DEDICATION FT underground
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NAME METE LINE SIZE NO. OF FIXTURES PRV REQUIRED C)
YES 13 NO CI
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION S
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_j PROPERTY TAX ACCOUNT PARCEL NO. CA# ZONE SIGN AREA. HEIGHT
WAIVERI i,Vill ALLOWED PROPOSED ALLOWED PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
NEW RESIDENTIAL PLUMBIN G I MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
COMMERCIAL COMPLIANCE OR
ADDITION 1 2
CHANGE OF USE 1 2
El MIXED USE PARKING LOTARE ANNING REVIEWED BY DATE_
13 REMODEL MULTIFAK41LY SIGN REC'D PROVIDED T
[3 REPAIR GRADING CYDS. _ZFENCt) X -4-1 FT.) REMARKS _011,kL�A
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GEOTECH REPORT
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Description
Plan Check
HEATSOURCE
LOTSLOPE%
VESTED DATE
Building Permit
PLANCHECK NO:
Plumbing
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)
PERMIT LIMIT. SEE ECDC 19-00.005(A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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&APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
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IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
V FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
No R
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
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IN VIOLATION W HE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FORINSPECT111
WORKMWo M EN'S INSURANCE AND RCW 18:27.
.9111101PINFATION
TURE(bWNEORAGENT):
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DATE SIGNED
(425)
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt#
APPLICATION APPROVAL
This application is not a permit until signed by [he
Building official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in spice provided.
k f IF I U49d.110 RELaVED BY Oat h 's
ATTENTION EXT. 1333
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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. UBCiO9 i IBC110 I IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
'FROM: FIRE DEPARTMENT DATE
PLEASESIGN
ENGINEERING DIVISION DATE /IWO
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of CORRECTION NOTICE given to owner/contrac.tor, by inpector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:ternp:b1dg:fbrms:ocaprv1 3/25/04