20051038.pdft5 DATE RECEIVED
170
lo ,,o PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB ITE/APT#
ADDRESS -7
OWNER NAMEINAME 0 BUSINESS 21wle)l - 14)"'
PLAT NAMEISUBDIVISION NO LOT NO LID NO,
MAILING ADDRESS LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved [3
tlo RW Pnrind Requited [3
Street Use Permit Required [3
CITY ZIP TELEPHONE EXISTING PROPOSED inspection Requited E3
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REQUIRED DEDICA1 ION __ FT
S,dowalk Required 13
Unawgiound Q
Wiring inquired
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METER SIZE
LINE SIZE
NO, OF FIXTURES
PRV REQUIRED
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ENGINEERING REVIEWED BY DATE
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STATE LICENSE NUMBER EXPIRATION OATE
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STUDY 13
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ALLOWED I PROPOSED
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COMPLIANCE OR
ADDITION MIXED USE CHANGE OF USE
%L REMODEL MULTIFAMILY SIGN
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ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT URSIDE REAR
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PARKING
REO'D PROVIDED
LOTAREA
PLANNING REVIEWED BY DATE
GRADING FENCE
REPAIR CYDS X FT.)
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REMARKS
DEMOLISH F1 TANK E] OTHER
EG ARAGE RETAINING WALL FIRE SPRINKLER
l CARPORT ROCKERY FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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TYPE OF CONSTRUCTION
:LA- -VAA&�-
CODE
1101
OCCUPANT
GROUP
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OF
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NUMBER OF
DWELLING
UNITS IVA
SkICIAL INSPECTION
REQUIRED 13YES
CONSULTANT
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OCCUPANT
LOAD
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DESCRIBE WORK TO BE DONE
REMARKS
GEOTECH REPORT
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STRUCTURAL DESIGN
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VALUATION
$3 1000
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Description FEE
Description FEE
A A 40
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Plan Check svo
State Surcharge
HEATSOURC LOTSLOPE% b'ATE
Building Permit
City S I Urcharge
PLAN CHECK NO:
Plumbing
Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK To
Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
Grading
LE DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
IL 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
ILL! LESS THE CITY OF
_j IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARM
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
0: 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
Landscapelnsp.
1Y r%
Total Amt. Due -7
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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Receipt # Q940,;2)
Recording Fee
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 AGENT OF
This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL Building Official or histher Deputy: and Fees are paid, and
TION; AND
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR.INSPECTION
receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
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SIG E DATE
SIGNA R OR (2�� �T DATE SIGNED
(425)
771-02 20
REL
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AfT_MTION
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
GINAL - F YELLOW INSPECAR
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FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 if IBC110 It IRC110.
IN JE GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIE'S
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FINAL PROJECTAPPROVAL FORM
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DATE:
MEMO TO: ...PERMIT COORDINATOR, BUILDING DIVIS ION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISIONI)ATE
PLEASE SIGN
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PERM. ADB# DATE INSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED
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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
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GRANTPROJECT APPROVAL WITH CONDITIONS NOTED
[I Copy of CONDITIONS given to owner/coniractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fonns:ocaprv1 3/25/04