20051128.pdf[PERMIT EXPIRES
DATE RECEIV ED [2111
PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB
ADDRESS
OWNER NAMEINAME OF BUSINESS �_5713 Aa
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MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved 0
0 'Afftec. lval?nq RW Permit Required 13
Street Use Permit Required 0
CITY ZI TELEPHONE EXISTING PROPOSED Inspection Requited 13
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Siduwal� Required [3
73- 3 REQUIRED DEDICATION FT Underground 13
F'�GI%IDS Wjonq required C3
NAME METER SIZE LINE SIZE FNO. OF FIXTURES PRV REQUIRED
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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STATE LICENSE NUMBER EXPIRATION DATE VARIANCE OR CU SHORELINE ORADB# INSPEC�ION SEPA
CHECKEOPY REO D COMPLETED EXEMPT
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COMMERCIAL COMPLIANCE OR z
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PARKING LOT AREA I PLAN14ING REVIEWED BY DATE 5
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED
GRADING E] FENCE
REPAIR CYDS ( — x FT.) REMARKS t-IRE MARSHAL
13 DEMOLISH TANK E3 OTHER tAU," I 13EME—SENT FOR
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OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
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f a IV-4 Description FEE Description FEE
RACE 'irstecor4 Plan Check State Surcharge
HEATSOURCE LOTSLOPE% VESTED DATE
Building Perrhit City Surcharge
CHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
I- BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Engr. Review
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
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_j 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 C
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. Total Amt. Due
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee Receipt 0
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPRfOV9L
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application is not a pernist until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his/nor Deputy and Foesnru paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt isacknowledgeg in spaco provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENS�!�RANCE AND RCW 18:27.
i F I e MT-S/)s I URE DATE
OWNER AGENT DATE SIGNED 1425) 1 -2T I I A I'D'
C' Id 771-0220 RJ�LFAUQJ ` IWEI
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- ORIGINAL -FILE YCLLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1109 It IBC110 I IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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FINAL.PROJECT APPROVAL FORM
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FROM: FIRE DEPARTNIENT DATE
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ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE
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PERMIT # 0�)'5- - _ADB#_ DATEINSPECTED
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DESCRIPTION OF WDRK TO BE INSPECTED AS�f LA-cC cZ -7—
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A field inspection was conducted to determine compliance with approved plans. Final approval
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denotes that there are. no objections from (he above signed, Depirthlent to lbe release of
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PERFORMANCE BONDS and the orantin gof:
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G' RANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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opy of CONDITIONS given
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F.AILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpcctor
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
I:temp:bIdg:fbmis:ocapn-1 3!25/04
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