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110 4TH AVE N_Redactediiiiiiiiiiiiii 14622 110 4TH AVE N CITY F EDMONDS DEPARTMENT OF BUILDINGS CERTIFICATE OF OCCUPANCY UNIFORM BUILDING CODE SECTION 307 110 4th Avenue North At Occupancy established by this certificate: Building Permit Number No. Units - Type Const. ,V-N 950350 No. Stories Basement Floor Load signs in place (per Sec. 2.3o8 U.B.C.) — Capacity signs 29 posted (per Sec. 3302(c) U.B.C.) Floor load and room capacity signs, when required, must remain posted at all times. Owner of Building Jack Beal Address 827 Cary Road, Edmonds THE WINDSOR GARDEN TEA ROOM HAS BEEN INSPECTED AND APPROVED AS COMPLYING WITH THE REQUIREMENTS OF THE UNIFORM BUILDING CODE AS ADOPTED BY THE CITY 1994 EDITION, FOR THE GROUP AND DIVISION OF OCCUPANCY AND THE USE FOR WHICH THE PROPOSED OCCUPANCY IS CLASSIFIED. Issued this 16th day of August 19 95 CHIEF BUILDING OFFICIAL By (�� X� This certificate shall be posted in a conspicuous public area and shall not be removed, mutilated or obscured and shall be main- tained in legible condition at all times. Any change of occupancy requires a new certificate. OF EUM rti Ce'ficate ®f ®-ccua tic -. v Building Division Inc. 189� " This certificate is issued in accordance with the requirements of Section 111 of the 12 International Building.Code certifying that at the time of issuance this structure was in compliance with the applicable provisions of _the codes and. ordinances of the city regulating construction and use of buildings. Description: 11 -Change of Use - Occupant: RE/MAX DIRECT REALTY Permit No: BLD20130944 Site Address: 1.1.0.4TH "AVE N, EDMONDS Parcel No: 004344001011'00 Construction Type: , . - Occupant :Load:. " -9 Owner: ANN-M�I AVISTURNER._ -Occup'hcV'Group`B 1122''EMERALD HILLS DR EDMONDS,WA 98020-2945 11/22/2013 in Official Date Issued POST IIV-{A CONSPICUOUS PLACE STREET FILE Of eb oub I . r'= DEPARTMENT OF BUILDINGS . ,PER UNIFORM BUILDING CODE SECTION 109 Occupancy established by this B Maximum Qccupant.Load R6orft capacity signs Owner of Building: Ann Turner " ,;: M1,::« teas E THE Cinderella's HAS BEEN INSPEC 'Ppl UNIFORM BUILDING CODE AS ADOPTED Bi. Ai ! Cl 1f FO PROPOSED OCCUPANCY IS CLASSIFIED. Issued this Dwelling Units: **N/A** hype fonstruction:. V N posted at 2003 No. Stories: 1 Baserhent: No 1002) S OF THE 1997 EDITION OF THE AND THE USE FOR WHICH THE BY: This certificate shall be posted In a conspicuous public area and shall not be removed, mutilated or obscured and shall be maintained in legible condition at all Ilmes. Any change of occupancy or use requires a building pentdt and a new Certificate of Occupancy Issued by the City, of Edmonds Building OMclal. 0000.0000000 TY of EDMONDS BESS LICENSE APPLICATION ` - �` LICENSE NO. Civic center • Edmonds, Washington m A AL FEES City C,,& Phone 775.2525 PENALTY AFTER FEB. 15 INSTRUCTIONS: ❑ HOME OCCUPATION $10.00 (A) . ADDITIONAL $5.00 LASS YEAR ut. EFFE . gFASG. uc. No SPEC • All items must be completed � SMALL BUSINESS RECEIPT NO. DATE a10 PRINT a, or application will not be ac- $15.00 (B) ADDITIONAL $7.50 cepted; IN SPEC. BOX ❑ Business with 10 or ■ 1 FOR ISSUE OF • Sign and return application FEE PT - PENRLTV P40 CORRECT EO more employees ADDITIONAL$25.00' ❑ with fee. Renewals received JILA -' LC ACTION. $50.00 (C) after February 15 must pay ❑ NEW APPLICATION (LA) penalty In addition to fee. ® RENEWAL (LB) NEW BUSINESSES AFTER - - ❑ CHANGE (LC), JULY 31, 112 FEE. - (PLEASE MAKE ANY NECESSARY CHANGES) 'O 'DELETE (LD) NAME OF FIRM I BUSINESS PHONE NO. OF EMPLOYEES LOND, PAUL K MD 774-4175 MAILING ADDRESS - NATURE OF BUSINESS 4•yy-,. ry //U-{(-'�'Lt-(Te A!' PHYSICIAN W EDMONDS • 14A 93020 - - OVJIIVCJJ AIJUNtOO / - /L IRU VIIJUAL AN II'Immo it VVNrVRA11 Vtl L9`»YJ-i/O" CLbK. fi (S) (P) (C) u OWNERS NAME - HOME ADDRESS L U N D PIC 19024 94TH AV H II_ HOME P}10NE R i 4- 5 ® EMERGENCY NOTIF I, (PLEASE LIST TWO) (2) NAME A TELEPHONE LI. : L- WASHINGTON STATE TAX NOJ!5Jeli i /-fi— Za- APPLICANT'S SIGNATURE C,'%cb g"�IX-r.:: to a NIP( .' DO NOT WRITE BELOW THIS LINE STAFF REVIEW: FILL IN LAND USE CODE, UFIR. NUMBERS, ZONING, ETC. CHECK APPROVAL OR DISAPPROVAL, DATE, AND SIGN. IF DISAPPROVAL, PLEASE COMPLETE "COMMENT" SECTION. ROUTE TO NEXT DEPARTMENT ON LIST. c.. PLANNING DEPARTMENT DATE 1'S 'p7 S LAND USE CODE ZONING CODE ❑ APPROVE f1SAPPROVE SIGNATURE Ea-D.LwL• �© CONDITIONAL USE PERMIT COMMENTS A O O m BUILDING DEPARTMENT - DATE vi -7 / Buildin ❑ APPROVE 6 DISAPPROVE, /J 0 ❑ Hotel/Motel W SIGNATURE Pew -ITT t, - O,Apt. Bldg. (A) �// ��� /_� ,,tt'� , � Ii 15K11 ]Ib1T 7y( Office Bldg, (0) 'COMMENTS: l 15W 2EI.I.,iI )% :TTkIAL. JL1f7YnA( 6SrtN'9 jj Occupancy El Restaurant W) rG�roup ❑ Hosp/School urs Home (H) CAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS; STUDENTS) w-id2 ❑ School (S) . E DEPARTMENT - DATE - U.F.I.R. APPROVE 1([` DISAPPROr SIGNATURE ® rTT/F71 II / I LLL�J7GJ APPROVE ❑ DISAPPROVE DATE //�4 I - SIGNATURE'. PUBLIC WORKS DEPARTMENT - Q�PPROVE ❑ DISAPPROVE. DATE Z" /- SIGNATURE COMMENTS: PI CAC= PCTI1pM Tr! r4TV r.1 COIN, 1� loo,� AMENITIES.DESIGN-BOARD f. October 9, 1978 A special meeting of the Amenities Design Board was called to order by Acting Chairman Warren LaFon at 12:10 P.M. in the Library Conference Room. PRESENT ABSENT STAFF PRESENT Warren LaFbn Chauncey Wight John LaTourelle, Director Perry Spanfelner Jack Christofferson 'Greg Selvidge Community Development Dept. David Kinderfather Nancy Luster, Ken Mattson Associate Planner Mary Lou Block, Assistant. City Planner Jo Ann Fischer, Recording Secretary AGENDA ADB-4-78 MARLOW S. BUMPUS - Review of elevations at 19916 76th Avenue West (RD) The Board reviewed the originally approved elevations and the re- visions to those elevations. Mr. Bumpus stated that the entire building, including siding and the roof, were approved using earth tones in Olympic stain. Mr. LaFon asked Mr. Bumpus to submit color samples to the Planning Division for approval. Mrs. Nancy Luster informed him .that color'samples should be provided for each member of the Board if this approval were to be placed on the consent a- genda. MR. SPANFELNER MOVED, SECONDED BY MR. KINDERFATHER, TO APPROVE ADB-4778 SUBJECT TO SUBMITTAL OF COLOR SAMPLES. MOTION CARRIED. ADB-109-78 PAUL LUND - Review of elevations and landscape plan for doctor's office .at 110 4th Avenue North. (BC) Dr. Lund was present to submit his requests for some general ex- terior changes in the window sizes and in the landscaping. Mrs. Luster stated that the members had received a letter from Dr. Lund outlining the changes which he would like to make. Dr. Lund stated that in order to update the rooms for patient care, he would like to change the size of the windows to 2 x 4 in order to have more wall space for privacy. In addition, Dr. Lund requested the removal Of some window space on the south side of the building in order to install a 6' sliding glass door which would lead out to a private court and garden area. This revision would -lighten up the consul- tation room considerably without changing the overall lines of the building. He further stated that he is attempting.to improve the parking area which is now existent in order to accommodate his wheelchair patients as well as the appearance of the parking area. Mrs. Luster informed t e Board tha + rev7p�, +--ti ��-� he Enginee rinn rK�n area. MR. .SPANFELNER MOVED, SECONDED BY.MR. MATTSON, T APPROVE D - -78 AS SUBMITTED. MOTION CARRIED. ADB-95-78 DAVID KINDERFATHER - Design'review of 14 unit planned residential development at Lot 8, Block 5, of Alderwood Manor #9, except the northerly 501' thereof. (East of Yost Park, north side of Shell Valley Road) (RS-8) Mr. David Kinderfather asked to be excused inasmuch as he is the applicant in this hearing. � P r The Board reviewed the plans for development of this site. Mr. Greg Selvidge expressed concern about overcrowding and traffic congestion in this area. Mrs. Luster stated that this development should be ' o CITY OF E D M RECEIVED 0 NOD $8 1978 Dir, .Of Public .Works TO: �IVC�I N£E = 0 a z Uj U a o SUSPENSE DATE: MAYOR As We Discussed Investigate and report Take Appropriate Action Prepare Letter/Memo for My Signature Mayor's Signature Previously Ref'd Status of Action? For your Information Note & File Return to: MAYOR'S ADMIN. ASS'T. CHIEF of POLICE CITY ATTORNEY CITY CLERK COMMUN. DEVELOP. DIR. FINANCE DIRECTOR FIRE CHIEF PUBLIC WORKS DIRECTOR COMMENTS: Tc +iras BEEN IssUIUD aO i -lOv'LQ P2o►3AE,C wA 0 T TO NA 1-,E R 4::-1Wkl\ L INSprECTIO0- FROM: — STRE FILE DATE: 10 } 17 78 (3/77) F LDING DEPAR wIENT Applicant Fill RMIT APPLICATION " e Heavy Lines R NAME O� BUSIN ESSI iJ C _ — yl ING ADDRE Z 3 0 CITY NA F U W ADDRESS F t7 I u C CITY a C 0 F U a E F Z 0 U EPHONE NUMBER ELEPHONE NUMBER LEPHONNE NUMBER 7,c7L // y/ T �// rY LICENSE NUMBER ption of Property ( how Below or Attach Four USE 11W PERMIT I ZONE SC, NUMBER 780585 I JOB ADDRESS // e) LEGAL LOT PLAT NAME ❑YES ONO PUBLIC RIGHT OF WAY PER ORDINANCE NO. EXISTING RIGHT OF WAY PROPOSED RIGHT OF WAY DEFICIENCY OF RIGHT OF WAY 9 SUBDIVISION NO. STREET/UTILITY WORK REQUIRED ❑YES ❑NO PERMIT FOR WORK IN PUBLIC R/W El YES ❑NO UNDERGROUND WIRING REQUIRED ❑YES ONO CONNECTION TO SANITARY SEWER ❑YES ❑NO SEPTIC TANK PERMIT REQUIRED OYES ONO SEPTIC TANK PERMIT NO. SEE MEMO DATED IJ REMARKS CHECKED BY Y SIZE N l C— SIGN AREA ENV. REVIEW ADB NO. ALLOWED PROPOSED COMPLETE EXEMPT C — 9< XSHORELINE REMARKS _ VARIANCE OR CU PLANNING REVIEW BY DATE 10-/0 YARDS v , N LOT COVERAGE ❑ NEW RESIDENTIAL GAS FRONT SIDE REAR FIRE ZONE 2 TYPE OF CONSTRUCTION T CODE 197/ j� HEIGHT N K LINE SIGN NON-RESIDENTIAL IE] ADD DEMOLISH ❑RETAINING WALL �•,� SPECIAL INSPECTOR REQUIRED AREA OCCUPANCY GROUP OCCUPANT �� JJ�� IYI ALTER EXCAVATE FENCE ❑ YES O R LOAD 5— 2 1101CLI OR FILL ( X - PLAN CHECK D BY THIS SITE IS LOCATED IN THE CITY OF EDMONDS. LOCAL SALES TAX SHOULD BE CODED 31.04. REPAIR PRE -MOVE SWIM E1 INSP, POOL � Z NUM BE F STORIES NUMBER OF REMARKS 0 DWELLING R�r1D. F• UNITS h N URE OF WORK TO E DpNE !Y U �G!iZGG(/JLIr W W e: ` ` ' PLAN CHECK FEE VALUATION FEE 0 ---- --- _ �• ,• ABUTTING STRE'ETS)�•�� BUILDING lU 00 1(0 U In W 0 PLUMBING m 0 MECHANICAL FENCE -- SIGN m "Applicant, on behalf of his or her spouse, heirs, assigns and Uj successors in interest, agrees to indemnify, defend and hold harmless i the City of Edmonds, Washington, Its Officials, employees, and RETAINING WALL < a agents from any and all claims for damages of whatever nature, x _ arising directly or indirectly from the issuance of this permit. Issu- SWIMMING POOL o ance of this permit shall not be deemed to modify, waive or reduce J 0 any requirement of any city ordinance nor limit in any way the I City's ability to enforce any ordinance provision." I hereby acknowledge that I have read this application; that the in- TOTAL AMOUNT DUE 10 formation given is correct; and that I am the owner, or the duly author- ized agent of the owner. I agree to comply with city and state laws regu- ATTENTION APPLICATION APPROVAL lating construction; and in doing the work authorized thereby, no person will be employed in violation of the Labor Code of the State of Washington THIS PERMIT This application is not a permit relating to Workmen's Compensation Insurance. AUTHORIZES until signed by the Building Official or NOTE: Permit Limit One Year(Except DEMOLITIONS and FILL ONLY THE his Deputy; and fees are paid, and PERMITS without conditional use permit, which shall be completed in 90 WORK NOTED receipt is acknowledged in .space pro - days; MOVED -IN BUILDINGS shall completed in six months.) vided: IGN URE (OWNER OR AGENT) DATE SIGNED INSPECTION DEPARTMENT DIRECTOR'S Sbr.NATU E CITY OF EDMONDS 775 DATE ^� o This Permit covers work be done on private prop ty ONLY. Any construction on the public -2525 ic domain (curbs, sidewalks, driveways, marquees, etc.) will require separate permission. STREET FIL — l (J ATTENTION RIGINAL —Fite YELLOW —Inspector IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE PINK — Owner GOLD — Assessor UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCV HAS RFFN r.PAA1TFn, LIRC ine 3nr; C,v� �Aa�DATE RECEI A, PERMIT EXPIRES I CITY OF EDMONDS ZUSE ONES PERMIT CONSTRUCTION PERMIT APPLICATION Lam./ NUMBER - 0 JOB OWNER NAME/NAME OF BUSINESS ADDRESS % SUITE/APTY J� In 4/ lot 7UCAV- L PLAT NAME/SUBDIVISION LOT NO. NO. �i MAILING ADDRESS j LID NO. OU LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approve7tReWq'dj CITY ZIP TELEPHONE HW Permit Requ EXISTING PROPOSED street Uee Pem, uupeedoo aequo-ed c REQUIRED DEDICATION Sidewalk aequBed Q NAME FT Vrtderaround Wiling required1. 11 Iu METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED = ADDRESS YESI� i NO V REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE zZ CITY 1 ZIP TELEPHONE 'fhJIIJ`�"�� Ur� , NAME CBL ADDRESS' Q , ENGINEERING REVIEWED BY i ` D E CITY ZIP TELEPHONE FIRE REVIEWED BY � DATE W I %-S C a f STATE LICENSE NUMBER 77 — EXPIRATION DATE CHECKED BY VARIANCE OR CV SHORELINE OR A I 17" DB# INSPECTION I 1 SECTION BONE REp'p POSTED PROPERTY TAX ACCOUNT PARCEL NO. ••/ " - ❑YES p Is r••� ^ •^^' SEPA REVIEW SIGN AREA ��`�y<x�� Ur COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED HEIGHTPROPOSED' ❑ NEW EXP '• ...�...er .,�, � RESIDENTIAL ❑ ❑ PLUMBING / MECH LOT PROPOSED REQUIRED SETBACKS ALLOWED P(Fr..) PROPOSED SETBACKS (FT.) ❑ ADDITION COMMERCIAL COMPLIANCE OR . ROPOSED FRONT SIDE REAR FRONT UR SIDE REAR � ddd 111 ❑ CHANGE OF US i�. I 1 , , ^ O Z REMODEL ❑ i MULTIFAMILY ❑ SIGN PARKING LOT AREA P NNING REVIEWED BY �. a = REQ'D PROVIDED DATE' g REPAIR GRADING FENCE d ❑ NCE ❑_ � - _ CYDS n 1 ❑DEMOLISH �� ( X REMARKS �� (' ISH T OTHER ❑ ANK N. /-� GARAGE i D A i RE TAINING WAL L ❑ FI RE .IRE SPRINKLER ROC KERY ERY ❑ FIRE ALARM (TYPE OF USE, BUSINE S OR CTNIT1�-EXPLAIN: YUMBER i?. CHECKED BY TYPE OF CONST UCTION ! NUMBER QF OCCUPANT )F DWELLING CRrrI L GROUP I 2TORIES UNITS AREAS / SPECIAL INSPECTION AREA )ESCRIBE WORK TO BE, DONE NUMBER REQUIRED 0 YES OCCUPANT � LOAD REMARKS j .PROGRESS INSPECTIONS. P ,- ER UB � C 108 FI / NAL INSPECTION REID'D 9 VALUATION $..J�! f I Description FEE Description P on FEE HE Plan Check AT SOURCE eck GL AZING % LOT SLOPE % State Surcharge 5`L i Building Permit AN CHECK N City SurchargeVESTED DATE. 1 V Plumbing Its PERMIT AUTHORDES 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 SEPARATEPERMISSION. Grading' , I ' PERMITAPPUCATION: ISO DAYSEngr. ReView PERMIT UMM 1 YEAR - PROVIDED WORK IS STARTED WITHIN ISO DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION .. Engr. InSpeCtlOn ' 'PLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, AS31GN �W INTEREST, AGREES TO INDEMNIFY DE § P 4UCCESORS Fire Review FEND. AND HOLD NOND HARM S, WASHINGTON, ITS OFFICIALS EMPLOYEES,LESS' THE CITY OF Plan Chk.1Deposit I CLAIMS FOR p AND AGENTS FROM DAMAGES OF WANY AND WHATEVER NAT URE, LIRE, ARISIH Fire Inspection ) G D ecti M I O THE REC n E IS TLY P ISSUANCE O NCE R IN OF THIS INDIRECTLY B S Y PER MIT. R :MED TO MODIFY, WAIVE OR REDUCE ANY REQU REMENT OF ANY CI ORDINANCE Landscape Insp. Receipt # C' i LIMIT IN ANY THE C17Y'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION., Total Amt. Due )IS Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION Recording Fee Receipt k IN R�R ECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CAGE IN CF ND IN DOING THE WORK AUTHORIZED THEREBY NO PERSON WILL BE EMP � UC- CALL ALIAToONpermit APPROVAL�e ATION OF THE LABOR CODE OF THE STATE OF WASHINN WILL RELATING ED This application is EN'S COMPENSATI' URANCE AND RCW 18.27. FOR INSPECTION Building Official or his/her Deputy: entl Fees are paltl, and receipt Is acknowledged in space provided. IRE (6WNER 0 AGENTS OFFICIAL s DATE SIGNED,., ATU (42J) E / j D E 55 ' (�l( 771-0220 ON ��/ya RE A By GA � 1333 D TE LAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- i /1�f OCCUPANCY HAS B r EEN GRANTED..: UBC SECTION 109 ORIG� INAL - FILE YELLOW -'INSPECTOR PRESS HARD -YOU AR PINK - OWNER GOLD -ASSESSOR E MAKING 5 COPIES GREEN -ACCOUNTING CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME NAME OF BUSINESS Ob y /T(-4-S7 Pr- Lu MAILING ADDRESS 0 Ll "I Ili C), ZIP TELEPHONE NUMBER NAM /11 C` IvA r W ADDRESS �} CR ZIP TELEPHONE NUMBER , / NAM6 ADDRESS CITY ZIP TELEPHONE NUMBER STATE LICENSE NUMBER EXPIRATION DATE Description of Property - include all easements 2 O a , Cc U N O J a u uj Property Tax Account 7 ( y _ /•• �• G -� �' Parcel No. v ( NEW RESIDENTIAL IJWLUM13ING ADDITION COMMERCIAL MECHANICAL El APT. BLDG. SIGN REMODEL GRADING FENCE REPAIR CYDS. t_%_FT) WOODSTOVE SWIM POOL DEMOLISH INSERT HOT TUB/SPA GARAGE RETAINING WALL/ CARPORT ROCKERY RENEWAL, Of z (TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN; USE PERMIT ZONE- �3 •' / NUMBER •'C•••�•�' JOB SUITE!APT a ADDRESS . t- �l /J LEGAL DESCRIPTION CHECK ! IUQDIVISION N� LID NO RI` ; PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP Approved ❑ RW Permit Required ❑ EXISTING REQUIRED DEDICATION Street Use Permit Req'd ❑ Inspection Required ❑ PROPOSED Sidewalk Required ❑ w METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED a YES ❑ NO ❑ O REMARKS Z w w z 0 W DATED REVIEWED BY =IRE MEMO DAI ED ,.-� ncv,cvvcuo SIGN AREA SEPA REVIEW ADB ALLOWED PROPOSED COMPLETE LI ]EXEMPT Y $NZIA EXP VARIANCE QRyCU I !'PLA p SETBACKS FEET HEIG LOT C A E i z FRONT SIDE REAR 1 J REMARKS a 1 ✓// >i.. �,.�n. _ 11,1 _A.1i v CHECKED BY TYPE OF_J,pplsTHucnvn wu�� uwu Y`NN GROL le SPECIAL INSPECTOR AREA OCCU REQUIRED ❑ '� LOAD YES REMARKS PROGRESS INSPECTIONS PER UBC 305 re C.-- CRITICAL3 u NUMBER OF o STORIES NUMBER OF j� UNITS DWELLING n AREAS NUM ER d1A L1hhr1wi "" t`- -d p Amov[,DESCRIBE WORK TO BE DONE (ATTACHPLOT PLAN)/dt0 FINAL INSPECTION REOUIRED VALUATION FEE PLAN CHECK FEE - BUILDING _ HEAT SOURCE: GLAZING PLUMBING t . Plan Check No. MECHANICAL GRIenoar M -S/6A/ -V*4 p j4 M)r This Permit covers work to be done on private property ONLY. 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 ENG. INSPECTION FEE "Applicant, on behalf of his or her spouse, heirs, assigns and /, In successors in interest, agrees to indemnify, defend and hold W City of Edmonds, Washington, its officials, harmless the for damages of l0� t�r u �—' s employees, and agents from any and all claims cr whatever nature, arising directly or Indirectly from the Issuance of this permit. Issuance of this permit shall not be deemed to PLAN CHECK DEPOSIT 0 d irement Of any city ordinance modify, waive or re uce any qu = to enforce any ordinance nor limit in any way the City's ability provision." TOTAL AMOUNT DUE �Cr, I hereby acknowledge that I have read this application; that the ATTENTION APPLICATION APPROVAL 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 THIS PERMIT This application is not a permit until state laws regulating construction; and in doing the work authoriz- AUTHORIZES signed by the BuildingOfficial or his/her /ed\thereby, no person will be employed in violation of the Labor THE WORKNOTEDDeputy; and fees are paid, and receipt Is `Code of ;he State of Washington relating to Workmen's Compensa• acknowledged in space provided. tlon?ns rance and RCW +8 27 INSPECTION SIgNAT IQE.I WNE ENTI D jTE SIGNED DEPARTMENT CITY OFN ATURE DATE EDMONDS ATTENTION CALL FOR INSPECTION ELEAS r' DATE ��, u.J IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE HAS BEEN MADE AND APPROVAL OR ��� oAwo lL ORIGINAL — File YELLOW — Inspector UNTIL A FINAL INSPECTION A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC r.HAPTFR 1. PINK—.0-A-r;er GOLD — Assessor