20000812.pdf�DATE RECEIVED I
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNlRNAMl�AMlOF,8qSINESS
ad MAILING
CITY ZIP
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ADDRESS
DAY ZIP
TELEP.,
NAME
ADDRESS
PERMIT EXPIRES
PERMIT
ZONE NUMBER 9,0911
IDS HESS _Lo � 0 SUITIIAPTI
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PLAT NAMEISUBDIVISION NO. CYNO. LID NO.
I LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
P-72"d
EXIS ING — PROPOSED—
SW% 81, kId
REQUIRED DEDICATION— FT —
PAV RIOU'll D
YES 0 NO 0
F REVIEWED BY
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DATE
CITY
TELEPHONE
VARIANCE OR CU
SHORELINE OR ADS#
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ST
STATE LICENSE NUMBER
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0 YES
SERA REVIEW
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SIGN AREA
ALLOWED P10111SEll
HEMST
ALLOWED PROPOSED
PROPERTY T" UN PARCELNO.
EXP
LOT COVERAGE
REQUIRED SETBACKS "T�
PROPOSED SETBACKS (FT.)
RESIDENTIAL
0
PLUMBIMGIMECH
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT US SIDE REAR
TN
COMPLIANCE OR
ADDITION
COMMERCIAL
CHANGE OF USE
[3 REMODEL
0 APARTMENT 0 SIGN
RKING OT FA
REOQ PROVIDED
0 REPAIR
0 GRADING FENCE
CYOS 0 ( _ X
FT) RE s
0 DEMOLISH
0 TANK o OTHER
0 A CIE
G=�F.RT
0 WALL
BRMIFIN�G 0 .13ENEWAL
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPILAIN:
CHECKEDBY
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NUMBER
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DESCRIBE WORK TO B E DONE
REMARKS
onn('AF!qq INSPECTIONS PER UBC 108/FINAL INSPECTION RED
cowtA 0 AlAn 1
VALUATION
PLAN CHECK FEE
WADE GLAZING %
LOT SLOPE I
BUILDING
VESTED DATE
P UMBING
PLAN CHECK NO:
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
L BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURB% SIDEWALKS. DRIVEWAY" . MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION,
G�ADINGIF
SIIIIIIIC SURCHARGE
PEAMITAPPLICATIO : 160DAYS
PERMIT LIMIT.� I YEAR . PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Es
;A F HIS OR HER SPOUSE. HEIRS, A SIGNS AND SUCCESORS
PPLICANT, ON BEHALF C
In N INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALLCLAIMS FOR DAMAGES OFWHATEVER NATUSE,ARISING 11—L' -111--
FROM THE ISSUANCE OF THIS PERMIT. ISSuA CE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIRCM51,IT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE
ENE, INSPECTION FEE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSil
TOTAL AMOUNT DUE
RECEIPT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION
GIVEN S CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
I H CITY AND STATE LAWS TING CONSTFUC,
THE OWNER. I AGREE TO COMPLY WIT , OF WILL BE EMPLOYED
TION; AND IN DOING THE WORK AUTHORIZED THEREBY 11 F=LA
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
woRKMEWS COMPENSATION INSURANCE AND RCW 18,27.
�E SIGNED
APPLICATION APPIRUVAL
Tall 11 I'll, ia "t p,, jill,gaedbyth,
CALL ojjp�',' n.an , Gdp,d`y; and ra.a — a"d And
1.1.1Z dood in
FOR INSPECTION a—Pli—k"wil a.... p—Id-
OF IALS SIGNATURE DATE
(425)
771-0220 BE ASEDBY
EXT 333
XIT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX
A A I Alf),
ORIGINAL�FILE YEUG'
PIN�-OWNES GOLD-AS$ESSOR
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SINGLE FAMILY/DUPLEX COVER SHEET
N,— Or. 1. IR. WADEJUIXES-II111 Im City
-1 -he-' ---I --erplAy —H blilding permit APPI1.1fle, Ir' A
Thr. —
SPECIAL INSPECTIONS REQUIRED FOR THIS PROJECT (City US. 0.1y)
lolls, STRUCTURAL,
[:]START OF WORK OPLACEMENT OF REINFORCEMENT
E] EXCAVATION A GRADING
[3PLACEMENT OF CONCRETE
05"ORING INSTALLATION & MONITORING
[]BOLTS INSTALLED IN CONCRETE
[3PROOF ROLLING
OSTRUCTURAL MASONRY
C]PLACEMENT OF FILL & GO I MPACTiON
OSTRUCTURAL STEEL ERECTION
[:]SUBSURFACE DRAINAGE
I
[]HIGH STRENGTH BOLTING
nVERtFY SOIL GEARING
[]WELDING (WASO CERTIFIED ONLY)
OPILE PLACEMENT
E]OTHER�
[3EROSION CONTROL
[]GENERAL SITE MONITORING BY THE
GE TECHNICAL ENGINEER OF RECORD
NERAL SITE MONITORING T 9
PLAN CHECK
DATE RECEII
BUILDING CONSTRUCTION INFORMATION
..BE EDITION. I— UKH,� ONG, UPC, WSEC. VIAB, WIT. AMENDMENTS
VSENU, RITE`N. "No "I"HUHHE . WIND SPEEk -0 _NPH SEISMIC ZOHE__3
Lt.' Get ... I LIV. Wed
F:::: 131. DWKI L... 0.1 .... Beer! —d
N...E. or STORIES BASE ... IS — fi. ... Z..E
LOT SLOPE %� SOILS EP..' IN -It ... NO
FL07OR AREA (MEASURE. 10 EXTERIOR FACE Or EX�TERIOR WALL)
T.L.1
LHIr' S,...
DIV.,_
ENERGY CODE COMPLIANCE INFORMATION
EJELUE,E []GAS, OIL [:]ELECTRIC 0 OTHER
OFORCEDAIR []HEATPUMP OHYDROHIC [30THER
ENERGY CODE NETHQQ -1 COMPLIANCE — — — — — — — — — — --
[3 PRESCRIPTIVE: Litt o'H.. Eok��
0 TARGET UA APPROACH: P Id. uA c.1 ... C.."",
0 SIVEWS ANALYSIS: 1—Lt. —1-1 F-11...
D ... u-1mm. —
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I rl SHINCYIVENTILATION WORKSHEETS PROVIDED up;h, u.�v...=1
HWINDOW SCHEDULE PRDVIPED
VENTILATION CODE COMPLIANCE INFORMATION
KITCHEN FAN CFN_ BATHROOM PARIS) Cllk_ LAUNDRY FAR OFM_
WHOLE HOUSE VENTILATION SYSTEM
[3EXHAU 7 OPTION
FRESH AIR TO BE PROVIDED TO 0 WINDOW VENTS []WALL PORTS
EACH HABITABLE ROOM WITH;
EXHAUST FAN TO BE CONTROLLED :ITH 24 HDUA TI ER AND SIZED AS FOLLO—
[31 - 2 BEDROOMS! 50 - IS C' E]4 ofitflooms: 100 - 150 cfm
n-BOROOMS: 40 -120 CFM [:]S DEDROG— 120-180 GPM
0HVAc INTEGRATED OPTIDN
f—I.E.ICAIE. HEAT RECOVERY VENTILA110. OPTION
SEPARATE PERMITS (City Us, Only)
[3RIGHT OF WAY CONSTRUCTON =PERM1,11? []MECHANICAL PERMIT
0 '
OENCROACHMENT PER-11 OPLUMBING PERMIT
F
0
OSTATE ELECTRICAL PERMIT []WATER METER
. C E SEW IT P.
OFENCE PERMIT []SISE SEWER PERMIT
[0 EG PERM 0
3ESECENTIAL FIRE SPINNKL R PERMIT [3111RIGATION (SPRINKLER SYSTEM)
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PERMIT ISSUANCE APPROVALS (City Use Only)
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C.—yr.RS`N`-P—V—
!EH,UN ... IN. APPROVAL —
CONDITIONS OF APPIE—L:
BUILDING REVIEW & AP-D r. Sy.
C—.11. -1 AM 1:.
LizioTECHNICAL ENGINEER OF it CORD
DURING WET WEATHER CONSTRUCTION
OFINAL GRADING A FIELD REPORT
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
Fouimox!`ION:
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Wall. .........................
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P e
Retainlrig Wall ...........
Slab Insulation ..........
PLUMBING:
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Rough -in ............
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-40
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Commercial Final
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HEATING:
Test
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Gas ....................
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Gas Piping .............
Equipment
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Commercial Final
M M
EXTERIOR SHEATHING
0
NAILING ..........................
FRAMING ........................
M 0
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FIRST FLOOR FRAMING
INSULATION
Floor insulation
Z,
Wall Insulation
Ceiling Insulation
Z
SHEETROCK NAILING
M
SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL F on
OCCUPANCY ..................
AT' 'CEIVED
ATE RECEIVED
IT
PERMIT EXPIRES
P ER M
OFEDMONDS
CITY OF EDMONDS
USE
Zo N E
ZONE —5,
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NUMBER
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ION PERMIT APPLICATION
CONSTRUCTION PERMIT APPLICATION
JAC
JOB
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NET NAMEINAME OF BUSINESS
FLAT NAMEISUBDIWSION NO
L. NO
LOT NO,
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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CITY ZIP
'NAME
TELEPHONE
R FE.0 RON _
EQUIRED DEDICATION
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FT
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LINE I'll
NO. OF FIXTURES
No OF
PRV REQUIRED
METER SIZE I
YES 0 NO 0 9
NGIl
E 6NGINEERING
EVIEWED By DATE
FIRE REVIEWED BY
FIRE R
(TITY
4
9 VARIANCE OR CU SHORELINE OR AD84 INSPEC,TION BOND
VARIANCE OR 1U
T D POSTED
STATE UCENS� NUMBER EXPIRATION DATE CHECKEDBY
OYRE
ES 0
E SIGN AREA
Ep REVIEW HE HIT
Co SEPAREVIEW
o OMPUETE EXEMPT ALLOWED PROPOSED ALLOW 11 PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO,
c ca
a EXP
7 LOT COVERAGE REQUIRED SETBACKS I') PROPOSED SETBACKS (FT.)
"S' FRONT SIDE REAR FRONT UPSIDE REAR
kNE- RESIDENTIAL [3 PLUMBINGIM 11 ALLOWED
PROPOSED
M P., :COMPLIANCE OR
[ON COMMERCIAL
z
0 AD CHANGE OF USE
0 ASKING AREA I PL�NNING EVIEV EDEN D E
'o RMENT PROVIDED
RE DEL APARTMENT SIGN REG'
REPAIR GRADING CYDS 0 FENCE X E S
0 DEMOLISH TANK m OTHER
W
GARAGE RETAINING WALL C] RENEWAL
CARPORT ROCKER
�p
r (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
0 oU CTWITV , UPANT
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--o up I
NUMBER NumBE8OF ITICAL OCCUPANT
A.
o AREAS PECIALINSPECTOR AREA LOAD
OF "RmBER
Un��UNG cf 'a, F EQUIRED 0 YES
STORIES N,
DESCRIBE WORK TO BE DONE
REMARKS
..nrngqq INSPECTIONS PER UBC 1081FINAL INIE�EITION REO'D
a
VALUATION
FEE
PLAN CHECK FEE
REA GLAZING % LOT SLOPE %
BUILDING
,gOUSCE
PLAN CHECK NO: ;TED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTEM THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
G�ADINGIPILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Sliall El GE
P RMTAPPLICATIONl ISO DAYS
E
PERMIT LIMIT. I YEAR, PROVIDED WORK IS STARTED WITHIN ISO DAYS
ES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS 08 HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
ENG. INS ECTION FEE
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
2 EDMONDS, WASHINGTON. ITSOFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
INSPECTION FEE
x E OFWHATEVER NATURE. ARISING DiRECTLYOR INDIRECTLY
,, ALL CLAIMS FOR DAMAGE
PERMIT SHAUL NOT BE
RECEIPT
X FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS
t DEEMED TOMODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
N013 LIMIT IN ANY WAYTHE CITY�S A61LITY TO ENFORCE ANY ORDINANCE PROVISION �
RECEIPT
TOTAL AM NTDUE
I HERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
APPLICATION APPROVAL
GIVENB CORRECT AND THAT I AM THE OWNEl OR THE DULY AUTHORIZED AGENT OF
11 LA NO RUC;_
CITY AND STATE LAWS EGUWTL.2C�CN�ST
C ALL
Th—ppIl.lit ]%net . pallailt pill aigirld b'Y line
T14E OWISEFL I AGREE TO COMP LY WITH
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERS' , N , M OYE
TO
FOR INSPECTION
a jda, Official oral, OnCepuly; and Fee, ,a p,ld.,,d
ipt I, acknowledged in apace provided..
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING
WORKMEN'S COMPENSATION INSURANCE AND ACW 18,27.
SIGNATURE DATE
_�JGRATURE JOWNER OR ADEN T DATE SIGNED
(425)
771-0220
mil—
3FIlAL!
T5)
P Y DATE
)EASED
7f FE N`T_I ON
EXT 2333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-Mil
HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORCIPAL,- FILE YIELLOW - INSPECTO4
A FINAL INSPECTION
CATE OF OCCUPANCY HAS BEEN GRANTM UBC SECTION 109
FAX
PINK�OWNEl GOLD -ASSESSOR
5198
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