20010820.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEiNAME OF BUSINESS
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MAILING ADDRESS
CITY ZIP TELEPHONE
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NAME
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CITY
NAME
ADORE
CITY
STATE LICENSE NUMBER
ZIP I TELEPHONE
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ZIP I TELEPHONE
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EXPIRATION DATE I CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
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[D NEW
0;1*"RESIDENTIAL
jP3"ADDITION
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REMODEL
APARTMENT
REPAIR
GRADING CYDS
DEMOLISH
TANK
o GARAGE
RETAINING WALL
CARPORT
'ERY
ROCK
(TYPE OF USE. BUSINESS OR ACTIVIT EXP A N:
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I\IUMBER OF
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DWELLING
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UNITS
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DESCRIBE W RK TO BE DONE
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HEAT SOURCE GLAZING %
Pgi� n I AW/1 -52,
PLAN CHECK NO: I
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11-�
ID PLUMBING / MECH
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OR
CHANGE OF USE
SIGN
FENCE
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OTHER
RENEWAL
PERMIT EXPIRES
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USE PERMIT
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12,f -�w NUMBER
JOB suiTE,,APTa
ADDRESS \ \o I\\
FLAT NAME/SUBDIVISI NO.
NO�
LID NO.
rT
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 0
RW Permit Required 0
Street use Permit Req of 0
EXISTING - PROPOSED
Inspection Requ red 0
Sidewalk Required
REQUIRED DEDICATION— FT
Underground
Wiring required 0
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
0
YES 0 NO 0
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING REVIEWED/DATE
FIRE REVIEWED BY DATE W
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VARIANCE OR CU SHORELINE OR ADBrf INSPECTION BOND
REO'D POSTED
(:]YES C3 NO
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE I EXEMPT ALL ED I PROPOSE ALLOWED PROPOSED
X, A
EXP 4
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED RPIOPOSED FRONT SIDE REAR FROJ)T UR SIDE REAR
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PAR14NG LOT AREA P L N G;;R E E Y DATE
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REO'D I PROVIDED
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REMARKS Ldl- 4rbL%e,, N6 RLIE44Z�
CHECKEDBY
JIYPE OF CONSTRUCTION
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OCCUPANT
GROUP
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CRITICAL
AREAS
NUMBER
SPECIAL INSPECTOR
REQUIRED C] YES
JAREA OCCUPANT
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REMARKS
PROGRESS INSPECTIONS PER LIBC 108/FINAL INSPECTION REQ'D
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VALUATION
FEE
PLAN CHECK FEE
LOT SLOPE %
BUILDING
157
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/1079(3.
PLUMBING
VESTED DATE
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MECHANICAL t,9L/
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADING/FILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE&
PERMIT APPLICATION: 180 DAYS
W
CL PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEE;
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Ln 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS ENG. INSPECTION FEE
U) E CITY OF
Uj IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS TH LANDSCAPING
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M EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND INSPECTION FEE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERmir SHALL NOT BE PLAN CHECK DEPOSIT
a DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE /f 'lei
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION RECE7,
TOTAL AMOUNT DUE
I I -A, 3,50
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
TATE LAWS REGULATING CONSTRUC- This applic.flion is not a pornrill Unhl signed by Ino
1HEOWNER I AGREE TOCOMPLYWITH CITY AND S CALL B idding Official or ki,slhor DePLAY and Fousato paid. and
TION. AND IN DOING THE WORK AUTHORIZED THEREBY NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION rompt is acknowlecigod in space provided
WORKMEN S ��Et�SATION IN URANCE AND RCW 18.27 0 FICIAL GNATURE DATE
SlGNATUHEgWNFR 11111 ACENT1 DArE SIGNED (425)
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C. 771-0220 (DATE I
RLLI;,A�LIJ by
-XFTE TION
A I 100%)
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE
YELLOW - INSPE(�TOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER
GOLD - ASSESSOR
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NOTICE: IF THE DOCUMENT IN THIS FRAME IS LESS CLEAR THAN THIS NOTICE
IT IS DUE TO THE QUALITY OF THE DOCUMENT.
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GARY HAAKENSON
CITY OF EDMONDS MAYOR
Q15THAVENUE NORTH EDMONDS.WA98020 (425) 771-0220 FAX (425) 771-0221
Website: wwwb edmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
November 2, 2004
John Plancich
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3830 NE 195
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Seattle, WA 98155
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Re: Building Permit: 2001-0820
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Site Address: I 10 8"' Avenue N, Edmonds, WA
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Expiration Date: October 30, 2004
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Dear Mr. Plancich:
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According to City of Edmonds Building Division records, the above referenced building
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r inspections.
permit expired on October 30, 2004 without obtaining the required inal
Edmonds Community Development Code Section 105.3.2 e. states "The maximum
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amount of time any buildino permit may be extended shall, be a total of three (3) years.
At the end of any three (3) year period starting rrom the original date of permit issuance,
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the permit shall become mill. and void and a new building pern-iit shall be required, with
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full permit rces, in order for the applicant to complete work." In order for you to
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complete work on your project, You must submit a new permit applicatio n along with
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permit rees or s 1,288.00.
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If City records are incorrect and the job card indicates final inspection approval, please
provide a copy of the job card for City Records. If your records concur that no final
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inspections have been granted, you niust remit fees with a new p ermit application
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within 10 days from the date of this letter. Failure to respond shall result in this matter
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being turned over to C ode Enforcement for resolution and possible legal action.
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If you have any questions please feel rree to call our offices at 425-771-0220.
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Sincerely,
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Senior Permit Coordinator
1,V1'enil)s\DS'I"s\N,1aster LettersVixpired Prniit.doc 7/01
Incorporated August 11, 1890
Sister Citv - Hekinan. Janan
Height Calculation Worksheet
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Address: 1/ 3 .D
Date:
Inspector(s�*___ �VN�)
1. Datum Point:
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2. Datum Point Elevation:
3. Average Grade:
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4.. Max.imum Elevation Allowed: (faveriag6 giade): 25
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5. Reference Point Elevation Shot to House:
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6�- (datum elevation)+ (grade to transit level Une'shot to house) 0�'6
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6. Measurements from line shot onto house to roof ridge'
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7. Actual ElevationA C�A U (reference point elevation) + (measurements
from #6) 13
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(actual) is greater/ (A- (allowed); therefore the house is/
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is not over the height requirement per ECDC 16.20.30 requirements
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ......................
FOUNDATION:
Footing ." ....................... UA;0
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
1> F49".
V PLUMBING:
Underground ............. w—
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Rough -In ................... 14t
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Commercial Final ...... , A&
HEATING:
"4+L—
Gas Test ....................
Gas Piping .................
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Equipment .................
444-17?--cf.
Commercial Final .......
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EXTERIOR SHEATHING
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A`/D 2—
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
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Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
�P,ECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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