20050958.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NA iE/NAME OF BUSINESS
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NAME
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PERMIT
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PLAT NAME/SUBDIVISION NO. I LOT NO LID NO
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ADDITION
MIXED USE
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MULTIFAMILY
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CHANGE OF USE IT
PARKING LOT AREA PLANNING REVIEWED BY
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NUMBER
NUMBER OF
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SPECIAL INSPECMN
CONSULTANT
OCCUPANT
STORIES
UNITS
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LOAD
DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT
BY:
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STRUCTURAL DESIGN
BY:
VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT S_0URCE
LOT SLOPE916
VESTED DATE
Building Permit
City Surcharge
-1
PLAN CHECK NO:
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY7HE 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
c7n
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR 114DIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapeinsp.
Total Almt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION..
Recording Fee
Recei pt it
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 AGE14T OF
This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRLIC-
CALL
Building Official ur his1her Deputy: and Fees ire 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
recep acknowl . edged in space pryvided
WORKPIN'S
COMPEN URANCE AND RCW 18:27.
IALS AT E
ATE
DATE
(425)
LE'
SlGtt
E NEIR AGEN
DATE SIGNED
771-0220
_RELEAskD Bi I
DA1
AT N T!pf4 EXT. 1333
IT IS UNLAW UL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW -INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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FINAL PROM �,CTAPPROVAL FORM
TO:
MEIN40'ro: PEI�-MIT COORDINATOR, BUILDING DIVISION
FROM: FIR-F DEl.l'AR.TN4ENTDAT -E
17-,NGIN.EERING DIVISION D/N1,11-1, a
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PLANNING DIVISION DATE
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A field inspection %v I as conducted to determine compliance with -approved plans., Final. 1.1pproval
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denotes that there are no objections from the above signed Department to the release, of
PERFORN/lANCEMONDS and the granting of:
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GRANT FINAL PROJE CT. APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTE D
0 Copy or CONDITIONS given to o.wner/coiltractor by inspector
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FAILED FINAL. INSPECTION - OUTSTANDING ISSUES
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0 Copy of C01tREi CTION NO'HCE given to owner/contractor by inpector
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-CT APPROVAI
R-E-INSPECTI D OUTSTANDING ISSUES - GRANTNNAL PROJE
Date Signature
l:temp:bldg:rorms-ocaj)rvl 3/25/04