20050914.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNEnA,MEE,., NESS
/NAME OF BUSIN
MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY ZIP TELEPHONE
PERMIT EXPIRES
USE PERMIT
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NUMBER
JOB V. I
ADDRESS
6"-4-,f a
PLAT NAMEISUBDIVISION NO, 1.01 NU
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TIESCP Apprmed
Aw Permit Required
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Street use Permit Req'd
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EXISTING — PROPOSED
inspection Required
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Sidewalk Required
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REQUIRED DEDICATION— FT
underground
wiring required
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METER SIZE
LINE SIZE
N.O. OF FIXTURES
PRV REQUIRED
YES NO C3
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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NAMEAtiM" CBL #
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L6r> lu P, -co I ENGINEERING REVIEWED BY DATE
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ANCE OR Cb ORELINE OR ADB# INSPECTION BOND
STAT% LICENSE NUMBER EXPIRATION DATE CMECtED BY REO'D POSTED
I It [3YES ONO S
&DVA 1%] F P *4qe?::t> & -6 _- - 0' BEIRA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
ul 70 Al2
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NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LiR SIDE REAR
COMPLIANCE OR z
2r ADDITION Bl� COMMERCIAL 1:1 CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE
1:1 REMODEL MULTIFAMILY El SIGN REG' PROVIDED
REPAIR GRADING FENCE
CYDS I x FT) REMARKS
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DEMOLISH 1:1 TANK E] HER
z 1:1GARAGE RETAINING WALL IRE SPRINKLER
CARPORT 1:1 ROCKERY EErFIRE ALARM
(TYPE OF USE BUSIMS OR ACTPArO EXPLPIN.
rL CHECKED BY C NSTRUCTION C07E OCCUPANT
I>Y TrIE-of UP
NUMBER NUMBER OF CRITICAL GRO 2=
OF DWELLING AREAS SPECIAL INSPECTIOV JAREA OCCUPANT
o STORIES UNITS NUMBER. REQUIRED []YES LOAD
DESCRIBE WORK TO 13E DONE
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RE01D 9
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VALUATION
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit City Surcharge
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PLAN CHECK Nfl- VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
CL PERMIT LIMI11 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 7
IN INTEREST, AGREES TO INDEMNIF� DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
49 -2
W ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY 9-z
7- FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE ej e,)
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
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NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION." Recording Fee Receipt #
2� / 41
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION W1PPLICATION APPROVAL
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- This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Olficial or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENS
�IANCE AND RCW 18 1 .27. OF�91,A4 SlqaTURE T
SIGNATUR (OWNER DATE SIGNED (425)
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L_121;1 alt. - 771-0220 REI!EASED BY __9ATE7—
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ATTENTiON Off 1333 10 /J�s
IT IS UNLAWFUL TO USEbR OCCUPY A BUILDING OR STRUCTURE UNTIL I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 04GIN I -FILE - YELLOW-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 OWNER - GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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FINAL PROJECT'APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
'FROM: FIRE DEPARTMENT DATE —Z-
PLEASESIGN
ENGINEERING DIVISION DATE
PLEASESIGNI.
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PLANNING DIVISION DATE
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PLEASE SIGN
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PROJECT 4 4 14 C
SITE ADDRESS
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PERMIT #,7 �60 S —0 ADB# DATE INSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine compliance with -approved plans. Final approval
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denotes that there are no objections from the above signed Department. to the release of
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PERFORMANCE BONDS andthe granting -of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES.
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0 Copy. of CORRECTION NOTICE given to owner/contractor by inpector
3.
RE -INSPECTED. OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tenip:b1dg:forms:ocaprv1 3/25/04