20051027.pdfDATE RECEIVED
PERMIT EXPIRES
IUSE db CITY OF EDMONDS ZONE NUMBIEF, -14, a
CONSTRUCTION PERMIT APPLICATION JOBy /� _ SUITE/APT#
ADDRESS �r (_�LLI I -1 \1 LAN L
OWNER NAME/NAME OF BUSINESS I f
F E.SI E `'� E I \ I� ML.E PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
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CITY ZIP TELEPHONE EXISTING PROPOSED Inspection Required Q
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STATE LICENSE NUMBER EXPIRATION DATE CH VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
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�ERTY TAXA ACCOUNT PARCEL NO. _ )'�'/ COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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COMPLIANCE OR z
1:1ADDITION COMMERCIAL❑ CHANGE OF USE Z
PARKING LOT AREA PLANNING REVIEWED BY DATE a
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED
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REPAIR GRADING CYDS ( X FT) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER
Z ❑GARAGE RETAINING WALL (F'Ig�$pp� LER
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D (TYPE OF USE; BUSINESS OR ACTIVITY) EXPLAM:
i /�Li_I CHECKED BY F O CT` N CO OCCUPA r
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NUMBER NUMBER OF CRITICAL
OF1_ DWELLING AREAS A SPECIAL INSPECTION AREA OCCUPANT
O STORIES T UNITS NUMBER �•� REQUIRED ❑YES LOAD
DESCRIBE WORK TO BE DONE
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REMARKS
1 3 u I \ ES 1 D L..I �I7 1 /-�L f"- I I ` C. S�,�I� I N I �,�� PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D S
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Description FEE Description FEE
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Plan Check State Surcharge tJ
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
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Gradin
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
SEPARATE PERMISSION.
s Engr, Review
¢ PERMIT APPLICATION: 180 DAYS
M PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS�O ✓
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS 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 Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY _
= FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landsca a Ins Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE P p• C`
x NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt {t
I , , ,,BY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GhVaN 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- CALLThis 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 aro paid, and
IN VIOLATION OF THE LABO DE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged In space provided,
WORKMEN'S COMPENSATI SU NCE AND RCW 18.27.
OF C L SIGNATU E AA DAT[
SIGNATURE (OWNER OR N V DATE SIGNED (425) I •�i-
l.i`t�LG,l1 771=0220 REL A Y D T
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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 CERTIFI- ORIGINAL - FILE •: YELLOW - IN ECT R
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
.09/03 PRESS HARD =YOU ARE MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION - r
FROM: C `-`. FIRE DEPARTMENT DATE�O�'-� `r d J�
PLEASESIGN.
ENGINEERING DIVISION DATEPLEASESIGN
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PLANNING DIVISION DATE
PLEASESIGN -
PROJECT./? two C/
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PERMIT # r2d� (�—_ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED C d ✓% �- �UCr� %�!�
A field inspection was conducted to determine compliance with 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 ,� L
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GRANT PRO JECT APPROVAL WITH CONDITIONS NOTED .
❑ Copy of CONDITIONS given to owner/contractor by inspector J
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
❑ . Copy of CORRECTION NOTICE given to owner/contractor by inpector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
I:temp:bldg:forms:ocaprvl 3/25/04
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