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. PERMIT
CITY OF EDMONDS NUMBER 970110
CONSTRUCTION PERMIT APSul E
OWNER NAME: NAME OF Ails—IN/E $,ADDRESS
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S2S 75 Sr. l,J •IC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved ❑
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INO ______REQUIREDDEDICATION__—__ Slreel U!e PermllRReOu1NK1OSED smewelk Reav�rae ❑
NAME
METER SIZE I LINT: SIZE NO OF n%TUBES PRV REQUIRED
YES ❑NO❑
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CITY ZIP TELEPHONE NUMBER
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STATE LICENSE NUMBER EXPIRATION DATE
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NEW
RESIDENTIAL
PLUMBINGIMECH
ADDITION
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SIGN
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WIM POOL
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❑ ROCKERY
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OR CU PLANNING REVIEW 11 DATE
—FEET HEIGHT LOT COVERAGE
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BY TYPE Of CONSTRUCTION CODF.777
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LESS INSPECTIONS PER USC 108
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NUMBER OF
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AREAS A�q_
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m STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLANI
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FINAL INSPECTION REQUIRED
VALUATION
FEE
PLAN CHECK FEE
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BUILDING
HEAT SOURCE
GLAZING
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Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
STORM DRAINAGE FEE
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
"Applicant. on behalf of his Or her spouse, heirs, assigns and
ENG. INSPECTION FEE
successors in interest, agrees to indemnity, defend and hold
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harmless the City of Edmonds, Washington, its officials,
aemployees.
and agents from any and all claims for damages of
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Whatever nature, arising directly or indirectly from the Issuance
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
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nor I —it in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
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provision."
I hereby acknowledge that I have read this application; that the
ATTENTION
APPLICATION APPROVAL
inn ormation given is correct; and that I am the owner, or the duly
Buthorized agent of the owner. I agree to comply with city and
THIS PERMIT
This application is not a permit until
state laws regulating construction; and In doing the work authoriz•
AUTHORIZES
THE
signed by the Building Official or his/her
ed thereby, no person will be employed In violation of the Labor
ONLY
WORK NOTED
Deputy; and fees are paid, and receipt is
Code the State of Washington relating to Workmen's Compensa•
acknowledged in space provided.
lion ns rance and W7.
INSPECTION
SG AIUPF. IOIVNE AGE DATE SIGNED
SrT s a .�� ,
DEPARTMENT
CITY OF
OFF s ATUPE 0 T/Ey Z
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EDMONDS
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CALL FOR
ELEASED Y DATE
ATTENTION
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
��� _OwLCwO ORIGINAL — File YELLOW — inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTION 109
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PINK — Owner GOLD — Assessor
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TO: Permit Coordinator, Building Division'~
FROM: AFIRE DEPARTMENT
ENGINEERING DIVISION
PLAN,N,INNG DIVISION
OWNER ADDRESS IS025 ?&
PERMIT# 7o I c7 ADB# INSPECTED ON Q JI %
A field inspection was conducted to determine compliance with approved plans.
Final approval denotes there are no objections to the granting:of:
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Occupancy for the building Performance Bonds may be released
Maintenance Bonds may be released Landscaping is approved
2f Other inspected L)$'r A4*JWO'VAA6,
PASSED FIRST INSPECTION - CONDITIONS NOTED
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FAILED INSPECTION - OUTSTANDING REQUIREMENTS -'RECALL FOR INSPEC ION
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OCCUPANCY APPROVAL DATE 2 Z -f B
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FAILED FIRST INSPECTION -DATE B
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RE -INSPECTED - APPROVED BATE BY
RE -INSPECTED - FAILED DATE BY
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