20050813.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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Description
FEE
Description
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Plan Check
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Building Permit
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PLAN CHEVO;,
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Base Fee
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THIS PERMIT AUTHORIZES ONLY THE WOAK NOTED, THIS PERMIT COVERS WORK TO
Mechanical
Grading
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BE DONE ON PRIVATE PROPERTY ..LT. ANY ... STR TION ON THE PUBIC
UCETC.)
D..M.01 ICURBI, 11DE—LIKS. DRIVIEWAYS. MARIIIII BE, WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19,00.005(AKS)
Engr. Review
Engr, Inspection
IT LIMIT.
PERM PINK P SEE ECDC HIL00.005(A)(6)
SEE BACK OF ERMIT FOR MORE INFORMATION
-APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
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Fire Review
Plan Chk. Deposit
IN INTE EST AGREES 10 'NOE"" 'FY A ROLE BE THE CITY .1
B FR
...ONR.' WASHINGTON, ITS FFICI2.BF..`PL0yN-`ES. AND=�E OM ANY AND
Fire Inspection
Receipt #
AL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
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FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT CIS
BRANNAN E
Landscapeinsp.
Total Amt. Due
DEEMED TO FY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY
Moo'
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROWS ON
- -
Recording Fee
Receipt #
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APILMATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
Th" appronjor, n, ob a 119hed by the
THE OWNEFL I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
Sunding Offic,al or h1sa,11 Deputy: and Fees bond, and
TIOH;AND DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN STAY
OF THE E OF WASHINGTON RELATING TO
FOR INSPECTION
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IN VIOLATION OF THE LABOR CODE
WORKMEWSCOMPEHSATIO�PURANCE AND RCw III: .
0 NA DATE
at ORE DATE SIGNED
(425)
771-0220
IFIEL Day 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-
ORIZNAL - FILE - YELLOW �INSPE(!TOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 I IRC110-
PINK -OWNER - GOLD � ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
To: WAei e
DATE: bt'W�%'
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: DEPARTMENT DATE
ENGINEERING DIVISION DATE
-PLANNING DIVISION DATE
PROJE
SITE ADDRESS
PERMIT #_��S I �.ADB#_________________DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine pliance with approved plans. Final approval
denotes that 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
0 Copy of CONDITIONS given to owner/contractor by inspector
I
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE-FNSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tenip:b1dg:fonns:ocaprv1 3/25/04
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