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22511 96TH AVE W
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. 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.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PCIRMIT FOR MORE INFORMATION
"APPLICANT. ON BEHALF OF HIS OR HER �POUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMEDTOMODIFY, WAIVE OR REDUCEANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT INANY WAYTHE CITY'S ABILITYTO ENFORCE ANYORDINANCE PROVISION."
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 THE STATE OF WASHINGTON RE LATING TO
WORKMEN'S C
'9%�NSATION INSURANCE AND RCW 18.27.
SIGN�U :5�(gw_
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Wff ENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CEFITIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
5/98
PERMIT EXPIRES
PERMIT
NUMBER
SUITEIAPT-
LOT NO. L�D NO.
L D FEE $
TESCP Approved 0
E OFFICIAL STREET MAP RW Permit Required 0
Street Use Permit Req d 0
PROPOSED Inspection Required 0
Sidewalk Required 0
DEDICATION- FT Underground
Wiring required 0
SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I YES 0 NO 0
=%!ARKS
O�WNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING
FIRE REVIEWED BY
REVIEWED/DATE
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VALUATION I FEE
PLAN CHECK FEE
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ENG. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
RECEIPT
PLAN CHECK DEPOSIT j
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TOTAL AMOUNT DUE RECEIPT
CALL
FOR INSPECTION
(425)
771-0220
EXT1333
771-0221
FAX
APPLICATION APPROVAL
This application is not a cermi!,jr:,� signez Dy ine
Building Official or his1her Decuy ar.c Fees a-w caid, and
receipt is ackr_--.-.,ez:gec n soace rrovicea.
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,,EVELOPMENT SERVICES CTR.
CITY OF EDMONDS
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Any request for modification, variance or other
administrative deviation (hereinafter "variance9l)
must be specifically called out and identified.
Approval of any plat or plan containing
provisions which do not comply with city code
and for which a variance has not been
specifically identified, requested and considered
by the appropriate city ofricial in a'ccordance.
with the appropriate provision of city code or
state law does not approve any items not to code
specification.
UBC-310.4
Provide one openable escape window in
basement and in each sleeping room
meeting all of the following requirements:
1. An openable area of not less than
5.7 sq.ft.
2. A minimum clear height of 24"
3. A minimum clear width of 20"
4. Finished sill height of not more
than 44" above the finished floor.
0
CITY OF EDMONDS
SINGLE FAMILY ADDITION /REMODEL COVER SHEET
Directions: Applicants are to complete the information In the WHITE BOXES ONLY (Shaded boxes are for City use only).
This cover sheet must accompany each building permit application for a single-family residential addition/remodel project.
PLAN CHECK#
APPLICANT
'svit-t p)
DATE RECEIVED
v
PROJECT ADDRESS
PROPERTY TAX ACCOUNT PARCEL #
DESCRIPTION OF WORK
0 W N E Rj
PHONE
CONTACi PERSONY PHONE 51"&—
E-MAILSCAj&,At,' Op, ka t I" i C0,4,., FAX
MAILING ADDRESS 27Z-r0 94rl,& f AV. 4--do-duPS, um, ffo
1:1 FAX CORRECTIONS El MAIL CORRECTIONS El E-MAIL CORRECTIONS
BY SIGNING THIS STATEMENT I UNDERSTAND THAT I AM THE CONTACT PERSON FOR THIS PROJECT. IT IS MY RESPONSIBILITY TO
COORDINATE ALL SUBMITTALS WITH THE CITY AND ONLY I CAN MAKE INQUIRIES ON THE STATUS OF THE APPLICATION. I
UNDERSTAND IT IS MY RESPONSIBILITY TO DETERMINE IN ADVANCE OF PERMIT SUBMITTAL ANY DISCRETIONARY PERMITS THAT
MAY BE APPLICABLE TO THIS PROJECT. I ACKNOWLEDGE THAT TO THE BEST OF MY ABILITY I HAVE SUBMITTED ALL NECESSARY
DOCUMENTATION IN ORDER TO, L, ION AND NO DISCRETIONARY APPROVALS ARE REQUIRED.
,.*A�fi� COMPLETE APPLI
SIGNATUR%E�� DATE /-OzztZL200
ZONING INFORMATION
ZONE Rs — LOT AREA
NUMBER OF DWELLING UNITS EXISTING DEMOLISHED PROPOSED
DISCRETIONARY APPROVALS CA Determination — SUBDIVISION — CU
VARIANCE SHORELINE SEPA Expires OTHER
LOT COVERAGE INFORMATION
EXISTING SF PROPOSED SF TOTAL SF %
HEIGHT CALCULATION INFORMATION
DATUM A 8 C D
'AVE MAX ACTUAL
SETBACK INFORMATION
RE UIRED FRONT%' SI . DE -SIDE REAR
FRONT 11.91 SIDE .431 SIDE 7 REAR 61
CNR. LOT' YES NO FLA' G LOT YES NO ST. DEDIC, YES NO 4FT.
El
ADU STATEMENT REQUIRE D YES N 0 RECORDING # 000
ef
STAFF COMMENTS:..,'.
N*GINEERING I NFORMATION
DRIVEWAY SLOPE % GRADING CYDS EASEMENTS
EXISTING IMPERVIOUS AREA CONSTRUCTED BEFORE 11977 SQ.FT
EXISTING IMPERVIOUS AREA INSTALLED 1977 OR LATEA.�"�� SO.FT.
PROPOSED NEW NET IMPERVIOUS SURFACE SO.FT.
(City Use"Cinw
SIDEWALK REO'D YES[] NO DRAINAGE PLAN REO'D []YES []NO
LID#
UNDERGROUND WIRING REO'D YES NO 'STREET DEDICATION FT.
.STAFF COMMENTS:
BUILDING CONSTRUCTION INFORMATION
CODE EDITIONS. 1997 UBC, UMC, UPC, WSEC, VIAO WITH AMENDMENTS
DESIGN CRITERIA
Floor Live Load
Floor Dead Load
NUMBER OF STORIES
WIND EXPOSURE B WIND SPEED_
Roof Snow/Live Load
Roof Dead Load
80 MPH
SEISMIC ZONE 3
Balcony Live Load
Balcony Dead Load
FLOOD ZONE
LOT SLOPE % SOILS REPORT PROVIDED Lj YES
BASEMENTS
FLOOR AREA (Measured to face of exterior wall)
Existing Proposed Total
Living Space
Garage
Carport
Deck/Cov. Porch
Other
1:1 NO
(City Use OnW
Ceiling Insulation Window U-Value
-Value
Wall Insulation Skylight U
Floor Insulation Glazing %
Door U-Value Slab Insulation
EnergYe 0 Prescriptive 0 Target t] Systems.
who ie ouse Van . tilation System Riq'd 0 Y ei's 0 No.
Any request for modification, variance or other administrative deviation (herinafter "variance") must be specifically called out
and identified. Approval of any plot or plan containing provisions which do not comply with the city code and for which a
variance has not been specifically Identified, requested and considered by the appropriate city offical In accordance with the
appropriate provision of city code or state law does not approve any Items not to code specification.
PERMIT ISSUANCE APPROVALS (City On F)
PLANNIN.0, REVIEW & APPROVAL
-DATE
CONDITIONS OF APPROVAL: 0'�j Irs.
ENGINEERING REVIEW & APPROVAL DATE
CONDITIONS OF APPROVAL:
BUILDING REVIEW & APPROVAL .4 A DATE
15 4A2 D
CONDITIONS OF -APPROVAL:
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