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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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CITY ZIP TELEPHONE
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NAME
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C ADDRESS
FPERmIT EXPIRES
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ERMIT`
UMBERJOB
SUITEIAPT#
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AT NAMEISUBDIVISION NO. LOT O LID NO
LID FEE S
UBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved E3RW Permit Required ❑
Street Use Permit Required 13XISTING PROPOSED Inspection Requited C3sidewalk Required [3EQUIRED DEDICATION __ FT Underground ❑
Wifing required ❑
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES13 NO O z
W
REMARKS W
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE 0
FOKco co .3:;Af `'� ?16 7 ENGINEERING REVIEWED Q REMOVAL, ORTCr�P
ADDRESS TANK F'�` r
�p FIRE REVIEWED BY DATE w
ITY ZIP TELEPHONE S R "�` LL
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STATE LICENSE NUMBER EXPIRAT ON DATE C t CK B VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
j� % A REQ'D COMPLETED EXEMPT
C 6C / a D (! D d r� I] YES 13 NO .
CA# ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. WAIVER O ALLOWED PROPOSED ALLOWED PROPOSED
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❑ NEW 5T RESIDENTIAL1:1PLUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
COMMERCIAL COMPLIANCE OR z
❑ ADDITION MIXED USE ElCHANGE OF USE _
PARKING LOT AREA PLANNING REVIEWED BY DATE g
❑ REMODEL 1:1MULTIFAMILY ElSIGN REQ'D PROVIDED IL
❑1:1CYDS
GRADING
REPAIR ❑ FENCE X FT.) REMARKS
❑ DEMOLISH TANK OTHER
_ ❑GARAGE RETAINING WALL LJ FIRE SPRINKLER
CARPORT ROCKERY ❑ FIRE ALARM
CL (TYPE OF USE, BUSINESS OR ACTIVITY) t AIN:
/ AILIJ�TYPE T U ON CODE OCCUPANT
07'SqS-N Gf GROUP
GNUMBER NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSUL NT OCC NT
p STORIES UNITS LOAD
-� REQUIRED 13YES
DESCRIBE WORK TO BE DONE
J REMARKS z
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\ GEOTECH REPORT
^ BY: m
L C ~� w /k �+. I STRUCTURAL DESIGN
BY:
VALUATION
I/Piv J t e1, -Piws $
44 Q/i'1 W a '- Description FEE Description FEE
Q dui Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical
t BE DONE ON PRIVATE PROPERTY ONLY..ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION. Engf. ReVIBW
W PERMIT APPLICATION: SEE ECDC 19.00,005(A)(5)
o. PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
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
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection 15Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
= FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROV L
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER, 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL This application is not a permit until signed p the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or acknowledged
edgediDeputy: and Foes are paid, and
IN VIOLATION OF THE R CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S COMPENSATM. SURANCE AND RCW 18:27,
OFWI
GATE
SIG (O NER O AGENT DATE SIG D (425) . 1 `--1 •-•�`�
l 'd
�L� ! O� 771 0220 :RELEDATE
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•
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 I IBC110 I IRC110. ORIGINAL -FILE YELLOW INSPECTOR
PINK •OWNER •GOLD -ASSESSOR
110104 PRESS HARD - YOU ARE MAKING 4 COPIES
FINAL PROJECT APPROVAL FORM
DATE:
MEMO TO: PE 1 00 I ING DIVISION
FROM: FIRE DEPARTMENT DATE
/LEASE SUM
ENGINEERING DIVISION DATE
P1 VASE SIGN
PLANNING DIVISION DATE
nEAsc suN
PROJECT /44 C'S UAAJ i
SITE ADDRESS EE t S'_` czlwo
PERMIT #0� _ s,o
t � ADB# DATE INSPECTED
DESCRIPTION OF WORK TO RE INSPECTED Vs r D�cca�,•.� isr � �✓i ✓�
A field. inspection was conducted to determine compliance i0th-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
❑ Copy of CONDITIONS given to owner/contractor by inspector
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