20051072A.pdf7DZTE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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STATE LICENSE NUMBER
EXPIRATION DATE
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PROPERTY T/& ACCOUNT PARCEL NO.
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COMPLIANCE OR
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CHANGE OF USE
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MULTIFAMILY
ATIGN
REPAIR
GRADING FENCE
CYDS ( X FT.)
DEMOLISH
TANK
OTHER
GARAGE
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CARPORT
ROCKERY
FIRE ALARM
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PERMIT EXPIRES
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NUMBER
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PLAT NAMEISUBDIVISION NO
LOT NO,
LID NO,
LID FEE $
PUBLIC RIGHT Or WAY PER OFFICIAL STREET MAP
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RW Permit Required
Street use Permit Requited
EXISTING PROPOSED
inspection Required
Sidewalk Required
REQUIRED DEDICATION FT
Undingtound
ftritig required
N IETER SIZE
LINE SIZE
07 F FIXTURES
PRV REQUIRED
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YES 13 NO13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED 13Y DATE
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FIRE REVIEWED BY DATE
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INSPECTION
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LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LJRSIDE REAR
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PARKIN
LOTAREA
PLANNING REVIEWED BY DATE
REO'D
PROVIDED
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REMARKS
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TYPE OF-CONSTRICTIIN
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NUMBER NUMBER OF
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STORIES UNITS
SPE�CIAL fINSPECTION
REQUIRED 13 YES
CONSULTANT
OCCUPANT
LOAD
DES [BE WORK TO HE DONE
REMARKS
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GEOTECH REPORT
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STRUCTURAL DESIGN
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VALUATION
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Description
FEE
Description
FEE
Plan Check
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State surcharge
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
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OAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Y
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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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.6
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
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Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED]
IN VIOLATION OF THE LABOR CODE OF TH STATE OF WASHINGTON RELATING TO
WORKMEN'S COM PEN SATIPI94U RANC5,��CW 18:27.
CALL
FOR INSPECTION
(425)
771.n99A
APPLICATION APPROVAL
This application 15 not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid. and
receipt is acknowledged in space provided.
0 1 IA S SIGNATURL DATE
SIGNATUM (0
DATE SIGNED
AT11E_NTION 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 / IBC110 if IRC110.
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ORIGINAL - FILE YELLO\Ai - INSPEt-TC
PINK -OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
To:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION.
-FROM: FIR-E DEPARTMENT DATE
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DESCRIPTION OF WORK TO BE INSPECTED
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A field inspection Was conducted to determine compliance. with pproved 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 and the granting.of
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GRANTPROJ ECT APPROVAL WITH CONDITIONS NOTED
01 Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor -by inpector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tcmp:.b1dg:fonns:ocaprv1 3/25/04
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