20051123.pdfI I I DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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PERMIT EXPIRES
PERMIT
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PLAT NAME/SUBDIVISION NO.
LOT NO,
LID NO.
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LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TLSCI1 Approved
RlV Permit Requited
Street U50 Permit Requited
EXISTING PROPOSED
inspection Required
S.dtiAalii Required
REQUIRED DEDICATION FT
Underground
Wiring eq,wea
METER SIZE
LINE SIZE
NO OF.FIXTURES
PRV REQUIRED
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REMARKS
OWN ERICONTR ACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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PUBLIC WORKS REVIEWED BY
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REPAIR GRADING CYDS
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DEMOLISH TANK
OTHER
GARAGE RETAINING WALL
FIRE SPRINKLER
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FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
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FRONT URSIDE REAR
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PLANNING REVIEWED BY DATE
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REQ Li I PROVIDED
REMARKS
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DESCRIBE WORK TO BE DONE Ll
SPECIAL INSPECTION CONSULTANT OCCUPANT
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REMARKS
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STRUCTURAL DESIGN
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VALUATION
Description FE E Description FEE
z1zHEAT SOURCE LOT SLOPEPo VESTED DATE Plan Check state Surcharge
I I — Building Permit City Surcharge
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 PUBLIC
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
_j SEPARATE PERMISSION. Grading
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
W Engr. Review Recording Fee
PERMIT LIMIT. SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection Plan Chk. Deposit
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
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Lit IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Fire Review Receipt
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M EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Fire Inspection Total Amt Duo IOLA, d.��
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION." Landscape Insp. Rocoipt 4
1 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 CALL it, 1101.1 poffilif linh, Sol 'Iflod Ily Itit,
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- th-IlLity anti ri-11s,11111 J1,00 .111(i
REBY. NO PERSON FOR INSPECTION 011" " or 111" "(if
TION; AND IN DOING THE WORK AUTHORIZED THE WILL BE EMPLOYED 1144-114 Nit( kilo Aled(pid In bria(i) plo"(1 ... I
IN VIOLATION OF THE LABOM CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN S COMPENSAYWItURANCE AND RCW 18:27. (425) 01 1 ICIAL5 SIGNAI LAIL YAIL
SIGNATURE I DATE SIGNED /
771-022200 ley 7
7117 j FA
EXT. 1333
AT I I=N I IUN
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 I IFIC110.
6/05 PRESS HARD - YOU ARE MAKING 4 COPIES
01flUsINAL I ILL VtLLOW INSPLCTOH
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FINAL� PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE_� 0. C
PLEASESIGN
ENGINEERING DIVISION DATE
PLFASE SIGN
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PLANNING DIVISION DATE
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PROJECT 7' Z �Z:
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PERMIT # 02, ADB# DATE INSPECTE . D
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DESCRIPTION OF WORK TO BE INSPECTED
A ft . eld in' spection was conducted to. determine co mpliance with -approved 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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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signawre
1:1emp:b1(1g:ronns:ocaprv1 3/25/04