20050892.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNCR NAMEINAME OF BUSINESS
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STATE LICENSE NUMBER E P RATION DATE I 2S&SKED BY
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PROPERTY TAX ACCOUNT PARCEL NO
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El ADDITION MIXED USE
REMODEL MULTIFAMILY
REPAIR GRADING CYDS
DEMOLISH [;rTANK
GARAGE c3 RETAINING WALL
CARPORT ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER NUMBER OF
PERMIT EXPIRES WIP,
PERMIT
NUMBER
JOB
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SUITE/APT#
ADDRES��,
PLAT NAMEiSUBDIVISION NO.
LOT NO.
LID NO.
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LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Appt(ived
13
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RVw Permit Required
Street Use Permit Required
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EXISTING PROPOSED
Inspection Required
E3
Sidewalk Required
13
REQUIRED DEDICATION
FT
Underground
Wainq requited
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 NOD
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED 13Y 1 11 1L_
MIUST BE
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DATE
FOR
FIRE REVIEWED 13Y Mpi .71M.
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VARIANCE OR CU SHORELINE OR ADB# INSPEC�ION SEPA
REQ D COMPLETED I EXEMPT
1E3YES 13NOI
CAN ZONE SIGN AREA HEIGHT
WAIVER C1 ALLOWED PROPOSED ALLOWED , PROPOSED
STUDY 13
1_01 COVERAGE REQUIRED SE rBACKS (FT.) % I
PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
COMPLIANCE OR
CHANGE OF USE I
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PARKING IDEDJ LOT AREA I PLANNING REVIEWED BY DATE
SIGN REO'D PROV
FENCE
OTHER
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FIRE SPRINKLER
FIREALARM i
OCCUPANT
GROUP
OF
DWELLING
SPIECIAL INSPECTION
CONSULTANT
OCCUPANT
STORIES f
UNITS
REQUIRED 13 YES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
LOT SLOPE'/9
VESTED DATE
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS. SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Engr. Inspection
PERMIT LIMIT: SEE ECDC 19.00,005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
n "APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
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Fire Review
Plan Chk. Deposit
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.0 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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E EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
x ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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* FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF T141S PERMIT SHALL NOT BE
* DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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Recording Fee
Receipt
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 a permit until signed by the
THE OWNER. I AGRK- To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
Building official or hisiher,Deputy. and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged in space provided
WORKMEN'S COMPENS=��NCE AND RCW 16:27.
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OFFICIALS SIGN TURE DATE
sl E(WNERot�o DATE SIG ED
(425)
771-0220
RELE�StDBY D&E
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 I IRC110-
PINK -OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
NIEMO TO: PERNIIJ\COOR T R, BUILDING DIVISION
FROM:
A
FIRE DEPARTN4ENT DATE
L E ASE iZiN
ENGINEERING DIVISION DATE
PLEAS1, SIGN
PLANNING DIVISION DA'rE
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A. field inspection was conducted to determine com pliance with approved plans. Fin..al approvill
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denotes that there are . no objections from the above sioned Department, to the release of
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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 owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDINIG ISSUES
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Copy of CORRECTION NOTICE given to owner/con tractor by'inpector
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RE-INSPECTED.OUTSTANDING ISSUES - GRANT. FINAL PROJECT APPROVAL
Date Signature,
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