20000940.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PERMIT EXPIRES
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WNERICONTRACTOR RESPONSIBLE FOR EROSION CONTI ROU�ORAINAGE
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FIRE REVIEWED By
DATE
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NUMBER
LA
REMARKS
PROGRESS INSPECTIONS
PER UBC 11081FINAL INSPECTION REQ
A-frAr Of� b Y It 4q
-
3m
VALUATION FEE
PLA CHECKFEE
HEAYOUSCE
BUILDING
150 OW7
1, ESTEO DATE
PLAN t4LAe2_ ESTEO DATE
PLUMBING
MECHANICAL
90
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
PUBLIC
/9
BE P.R.,VAT,.E PROPERTY ONLY. AN' CONSTRUCTION ON THE
DRIVE WAYS, MARQUEES, ETC.) WILL REQUIRE
GRADINGIFILL
,ON,,ON
.UR , B EWALKS,
B.. N C
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATON: 180 DAYS
PERMIT LIMIT: AR. PROVIDEDWORK IS STARTED WITHIN ISODAYS
I YE
ENG REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
P CA F HEIRS ASSIGNS AND SUCCESORS
PLI NT, ON BEHAL OF HIS OR HER SPOUSE.
THE CITY OF
ENG, INSPECTION FEE
;A D ARMLESS
N NTEREST. AGREES TO INDEMNIFY, DEFEND AND HOL .
ITSOFFICIALS,E PLOYEES. AND AGENTS 1-0. ANY AND
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2 EDMONDS,WASHINGTO
ALL LAIMSFOR AMAGELOFWHATEV R NMTURE. ARISING DIRECTLY OR INDIRECT'
I C 0 E
RECEI T
.
x FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
LAN CHECK DEPOSIT
--17--7-7
0 DEEMED TO MODIFY, WAII E OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
ANY ORDINANCE PROVISION'
RECEIPT 60
0 NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE
X
TOTAL AMOUNT DUE
I HERE Y ACKNOWLEDGE THAT I HAVE READ X I A1PLCATI,0N. ' HATTHIINF RMATION
APP ICATION APPROVAL
GIVEN6 CORRECT. AND THAT I AM THE OWNER. R THE B Y AUTHORIZED AGENT OF -
15
Th,, ppI,,,. . -1.1 119bld by
THEOWNER I AGREE TO COMPLY Willi CITY AND STAI�ENAWS RE�GULAIlLNeGECONSTRUC
EMPLOYED
CALL
BuIld"o 0111-111 h-�' D-Jty bd F...
PER WL
TtON. ANO-ItUDOING THE WORK AUTHORIZED THERTES16F WA SHINGTON RELATING TO
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FOR INSPECTION
IN VI TION a R �N.F THE STA E
CE AND RCW 18.27
0 FI IALSSIGN.TURE DATE
WO K ENS C &kSATION "g
. DATE SIGNED
VINE RAGE I' ,
(425)
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SIGNAT
(Y11Y
771-0220
EASEDBY DATE
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ATTENTION �)
EXT 333
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IT IS UNLAWFUL TO US A OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
INSPECTOR
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE - YELLOW
- GOLD - ASSESSOR
A FINAL
BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER _p
CATE OF OCCUPANCY HAS
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STANDARD DRAINAGE DETENTION SYSTEM
WORKSHEET
14 CALC BY:
OWNER' k e �4 Cc r7o01orL
ADDRESS T,-- PHONE:,�(,o V3:�
2,0 Z_() 0 01
DATE:
... DESIGN DA TA * * -
IMPERVIOUS AREA PIPE DIA PIPE LG ORIFICE
sA
I DETENTION PIPE LENGTH LOCKI LID
FINISHCD 0 MINIMUM ITY11CALI
';EA uNRWWMfqP or
TIGHTLI C CONC BOX OR RISER
.5X TO 1% SLOPE
0 OUTLET
OUTLET CONTROL
NJ N.
UPPER CATCH BASIN ORIFICE
CONTROL CATCH BASIN
SYSTEM CROSS SECTION
2'X2'X6' DEEP, 4-6' SPALLS OR EQUAL
I
FROM CONTROL CD 2'X 2'X 3' DEEP, 3/4' CRUSHED ROCK EXISTING GRADE
FROM CONTROL OUTLET W SHED ROCK
ASHE
0 TrLW TRENCK MIN 10' L(ING.
P RF PIPE TO BE LEVEL
C F P
PERF PIPE W1 END CAPS
FIALLC
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AhOVT PLA i5ELN?6P VASHE"OKAIN ROCK
RIPRAP OUTLET
RUNOFF SPREADER -TRENCH
FOOTING DRAINS SHALL NOT BE CONNECTED TO DETENTION SYSTEM
NOTES.
1, Call Engineering Division (771-0220) for a tightline and detention system inspection
before backfilling and for final inspections. APPROVED BY
2, Responsibility for operation and maintenance of drainage systems on private property is the
responsibility of the property owner. Material accumulated in the storage pipe must be flushed
out and removed from the catch basins to allow proper operation. lie outlet control orifice DATE
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Project Review Checklist
PlanCheck#:
Project Name: -CD��
Project Address:
Receipt Date: -ig
Underground Wiring Required
Hydraulics Permit
Plat/SOdivision Requirements
S" ft
Street, Dedications
l'Ins
us -
Easements - Public/Private
V. a",
Engineering Storm Drain Review Feel
Engineering 2.2 Inspection Fee
Drainage Plan (On -site)
Setback -. Storm Drain Line
OpeiiD itch - Existing VS-4
Culvert Required V-P-5
Culvert Size
Shoulder Dramiage/Shale Open Runoff
OCT 9�� 2000
Catch Basin Required
P1 it),
icle Access
Driveway Slope & Veh:
r
�p
Sidewalk Required. Yes
,
Curb & Gutter Required
Curb Cut for Driveway Required
Street Paving Required
Right -of -Way Construction Permit Required Vdm
Bond Required for Public Improvements
FEMA Map CheckfWater Table
Side Sewer Availability
Calculate Sewer Fee ifNo LID#
Water Meter Size
Water Meter Charge Required
Hydrant Required
Street Cut
Miscellaneous
RW Permit # Date Issued Receipt #
SSPemit# Date Issued Receipt # la�a�
Meter Size Paid $ Date Receipt# 12*d
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FINAL PROJECT APPROVAL FORM
TO:-
1�
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE—
yA��ENGINEERJNG DIVISION DATE
PLANNING DIVISION DATE—
PROJEC
SITE ADDRESS
PERMIT # -� 00 OB#________PATE INSPECTED
SPECTED
DESCRIPTION OF WORK TO BE IN
s
A field inspection was conducted to determine compliance with approved plans. Final approval denote that
there are no objections from the above signed Department to the granting of:
Final approval of the described work
_V-----'GRANT FINAL PROJECT APPROVAL
"N
GRA NT PROJECT APPROVAL WITH CoNDITIONS NOTED
1. MAY 9
FAILED FINAL INSPECTION - OUTSTANDING ISSUES SUILDING
2.
3.
________p,E-INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
ocaprvl.doc.l:temp:bldg:forms6/98
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ..................
Wall .............
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Pier/Porch .................
Retaining Wall ...........
Stab Insulation ..........
PLUMBING:
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Underground ..............
I Rough -in ............... .
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Commercial Final
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HEATING:
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Gas Test ....................
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Gas Piping
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Equipment .............
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Commercial Final
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EXTERIOR SHEATHING
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NAILING .......................
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FRAMING ............... vv�s
FIRST FLOOR FRAMING...
INSULATION ...................
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Floor Insulation
Wall Insulation ...........
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Ceiling Insulation
SHEETROCK NAILING
ITI
r
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
PERMIT EXPIRES
CITY OF EDMONDS
USE
ZONE
PERMIT'
NUMRkR
CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS
SUITEIAPTN
1�(x
s-,
01117�ZAM,107US7E4,
PLAT NAMEISUBDIVISION No.
LOT NO, LIDIO-
j0ey-�
LID F ES
MAILINGADDnESS
P '86X V(0,�
P BLIC RIGHT OF WAY PER OFFICIAL STREET MAP P_',
f
ZIP ITELE1111E
3&o
E�ISTING — PROPOSED
E.UI.E.DEDCATI..—
fT
LINEjIZE
NO. OF FIXTURES
P ... 13
r unk;
YE.W'UN'o
ADDRESS
CITY ZIP
R MARKS
OWNERIC..TRACT.RRIES1.11SMIL FOR EROSION CONTROLIDRAM.—
ITELEPHONE
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(4) AbJ el
di'rt2A
RE", EDID
All
ENGINEERING
.. I I-- if
RED"
V�2
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—
FIRE REVIEWED BY
.
DATE
CI Zip TELEPHONE
3 3, 3 5
1:
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VARIANCE OR CU SHORELINE
OR ADS# INSPECTION BOND
UMBER CHECKED By
REQ;R, 1122TE.
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Lo I I s e2
13 YES 0
-TEIVI-114kI
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SEPA REVIEW
COMPLETE EXEMPT
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ALLOWED P�AOPOSSD
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ALLOWED PROPOSED
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FRONT SIDE REAR , FRONT R SIDE REAR
i
OR
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nRESIOE�TIAL
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ADDITION COMMERCIAL 0 CHANGE OF USE
LOT ARIA PL�7�ew DATE
PARKING v
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(TYPE OF US 5 ZIVITY) E - XPLAN�
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C"ECNEOBY OE.MUCTION
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ITIP
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CU
S E�IAL INMG 1A 1�,.DUPA.T
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IS MEER
RE U,.E.
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DESCRIBE WORK TO BE DON E
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REQ'D
en
A77-A a,�b 11e)L,11e cqlt qoya�g_
f
VALUATION
FEE
"U" a
PLANCHE-FEE
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�7ANG % LDT SL
BUILDING
0 q -7
UjOLIFICE
PLAW
I
45
AECHANICAL
THIS PERMIT IUTHORIIES ONLY THE WORK NOTED. THIS PERMIT COVERS WORKTO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING&ILL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS "AROUEES. ETC.) WILL FEDUIRE
SEPARATE PER�JSSIONL —
STATE SURCHARGE
PERMIT APPLICATION� III DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
—
END, INSPECTION FEE
1�0
'AP PLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEISS. ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO DEFEND AND HOLD HARMLESS HE CITY OF
IAND Clk�j
00
:NDEMNIFY,
M EDMONDS. WASHINCT N TS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
ALLCI-AINISFORDAM E OFW ATEVER,N URE. ARISING OtRECTLYOR INDIRECTLY
I H AT
I m FROM THE ISSUANCE OF THIS PERMIT SSUANCE Or THIS PERMIT SHALL NOT BE
NB�=E
—
PLAIN CHECK DEPOSIT
Al
IREC
/2-2_7
�O DOEMECT=FY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
o N RUM 'VAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
-1 TOTAL AMOLI
I HEREBY ACKNOWLEDGE TH H E READ THIS APPLICATION; THAT THE INFORMATION
AT: AV
APP ICATION APPROVAL
GIVEN IS CORRECT. AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT 01
AND LAWS REGULATING C.NSIFUC-
1.,�.db,
THEOWNER. I AGREE TO COMPLY WITH CITY STATE
TLON. A I E Wo K AUTHORIZED TIH.E.I.EBY, NO PERSON WILL BE EMPLOYED
CALL
Budd' 119 0111.1.111 h'Iffi-I DOWY; -H F ... ... P,,d.
�D
IN V ZON THE LABOR DE F THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
WO KM EN E C PENEATION INAANOCE AND RCW 10,27.
0" �IALS SIGNATURE DATE
,
SIGIR NE D ESIGNED
(425)
, -
�Tv I 11-zz�co
771-0220
RE EASED By DATE
ATTENTION
EXT333
-rt
IT IS UNLAWFUL TO USJOCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE YELLOW -INSPECTqR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
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