20050910.pdfDATE RECEIVED
[PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
OWNER NAME/NAME OF Bust S
7 A 4f PLAT NAME/gUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS LID FEE $
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
0 IZA -Aa 1U Street Use Permit Roq'd
CITY ZIP EXISTING — PROPOSED Inspection Required 13
Sidewalk Required [3
ITELEPHONE REQUIRE* DEJiCATIOW, FT Underground
0 -772— '1, �I; wiring required CI
14AME METER WE S,[�,,..YNE SIZE, NO. OF fixTURES PRV REQUIRED
OF D
Wm NO C3
C%
�;Kllt -PF
ADDRESS REMARKS L:A 1) _D AT z
x OWN ER/CONTFIR91QR FA&PYN"LtOOR EROSION CONTROODRAINAGE 8
C3 Z
Lu
CITY ZIP----- ITELEPHONE 0 WATER METER TO BE RPMnVPn on
BIB WITH AVB INSTALLEID
HOSE
NAME.. CBLN L)UMP AT APPROVED DUMP srm oNLy
t�j ENGINEERING SWEI)IMOLITION INSPECnON DATE
m ADDRESS '4r Y-7( CHECKLIST ON BACK OF JOB CARD
N ft"tIIIt1!I1IrjMjL4DATE
2Z-7 bt4t-dZ-� AL/(?, Vbv,44( FIRE REVIEWED BY
CITY ZIP TELEPHONE
0
VARIANCE OR CU SHORELINE OR ADBI I INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE !;W REO'D POSTED
I OYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
ALLOWED , PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE , EXEMPT ALLOWED , PROPOSED
E XP
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
NEW 13 RESIDENTIAL 1:1 PLUMBINGIMECH ALLOWED PROPOSED FRONT SIDE REAR FRONT QRSIDE REAR
z
COMPLIANCE OR
ADDITION COMMERCIAL
13 CHANGE OF USE
K_CC PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY 13 SIGN REO'D PROVIDED
REPAIR GRADING FENCE
El f y ns 13 ( X FT) REMARKS
El OTHER
,P<DEMOLISH TANK
z 0 GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT El ROCKERY FIRE ALARM
(TYPE OF USE, B ACTIV" EXPLAIN: CHECKED BY TYP F CONSTRUCTIO;N77CO E. OCCUPANT
9 GROUP.
0
NUMBER NUMBER OF CRITICAL / IV
OF DWELLING. AREAS SPECIAL INSPECTION AREA OCCUPANT
UNITS NUMBER REQUIRED LOAD
0 STORIES I
7 DESCRIBE WORK TO BE DONE� OYES 0
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REO'D
51 73, -74-10 .51=
VALUATION
$
DescrIption F�E Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
a DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
12. PERMIT LIMIr I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
.'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFX DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
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 Landscapelnsp. Total Amt. Due
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
x Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPRO%fkL
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 This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION .f aceipt Is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
QMFjS gSIGNATURE DATE
DATE SIGNED 0=1
SIGN [OWNE1 R (4A6%Fj I
771-0220 RELEA66(dy tDA3t
EN?1ON E)ff 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILARNAL
INSPECTION HAS BEEN MADE AND AHIJHUVALUt-i A Uth I iRGA i E Or 000u- ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
z
0
1
0
M
--I -n
CD
M
M
0
—10
0 C
M
M Z
jC) —i
C z
co
0 _n
n
--i
M M
0
0
0 M
C= Cn
K C/)
Q 0
Z
--I
X
z
Cn
z
0
0
M
ROJECT APPROVAL FORM
FINAL F
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DfVISION
FROM: FIRE DEPARTMENT DATE—
PLrASESIGN
ENGINEERING DIVISION DATE
dwr. 90N k--'
z
0
PLANNING DIVISION. DATE
0
PLEASE SIGN
M
P ECT Arl I
ROJ
SITE ADDRESS-
C M
MO
PERMIT #-10 EYA1_6_ADB# DATE INSPECTED_J�
0
-1 0
0 C
MM
DESCRIPTION OF WORK TO BE INSPECTED
MZ
C z
A field inspection was conducted to determine compliance with -approved plans. Final approval
Cn
denotes that there are no objections from the above signed Department to the release of
0 _n
PERFORMANCE BONDS and the granting of:
-n
M M
XGRANT FINAL PROJECT APPROVAL.
0 Ui
0
0 M
C
C/)
MCI).
MO
Z.r.-
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
>
0 Copy of CONDITIONS given to owner/contractor by inspector
z
co
z
0
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0
M
0 Copy of CORRECTION NOTICE given to owner/contractor.by inpector
2.
3.
RE -INSPECTED OUTSTANDING -ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
henip-bidg-fomwocaprvi 3/25/04