20020260.pdf0
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF RUSIN;;'!
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NAME
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CITY 'ZIP
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STATE LICENSE NUMBER EXPIRATION CAT
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PROPERTY X ACCOUNT PARCEL NO.
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M-IIE-W E I 'NT'A LU MB'NG 'M2(
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ADDITION ON ERC AL COMPLIANCE OR
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A __�.CAIEFING WALL E3 RENEWAL
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r ITYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
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]�UMBER
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NUMILlt"�l OF
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C IT CAL
AREAS
NUMBER
DESCRIBE WORK TO BE DONE
C P
HEAT SOU G
LOT SLOPE %
PLAN CHECK NO:n g O'�
IIESTED DATE
THIS START AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS .BK TO
GE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
OMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: IIQ DAYS
PERMIT LIMIT. I YEAR _PROV'O D WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
;APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
N NTEREST. AGREES To �ADEMNBFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, TSOFFiCIALS, EMPLOYEES, AND AGENTS FROM ANY AND
C ALL CLAIMS FOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
I
FROM THE ISSUANCE Or THIS PERMIT SS ANCE OR THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANYCITY ORDINANC E
Ol NOR LIMITINANYWAYTHE CITY'S ABILITY TO 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
THEOWNEM, 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 A� BE OF THE STATE OF WASHINGTON RELATING TO
WORKM EN S CONFERS S CE AND RCW I&2T
S(GNATYRE �R AGENTI
DATE SIGNED
////" A,
PERMIT EXPIRES
USE
ZONE PERMIT
NUMBER
ADDRESS 'tLaj
LTSMPTI
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LID NO. Fw-i
PLAT NAMEISUBDIVISION N UD FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP A 0
-.11 A-l- 0
F11 U.. P1 R.4 d 0
EXISTING (yk PROPOSED '� '___ R. 0
0
REQUIRED DEDICATION- FT
�K_
.ET%�;4 I LINESIZE NO. OF FIXTURES PAN REQUIRED
YE NO 0 K
R MARKS I,
NERICONTRACTOR RESPONSIBLE FOR EROSION CONTR
-_ i �'
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FIRE REVIEWED BY
DATE
-VARIANCE
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SHORELINE Oft%_ 20
2
INSPECTION
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SERA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED DIED
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LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS J�.)
kLLOWED PROPOSED
J
3 '31
FRONT SIDE REAR
1 h5, /0 15
FRONT US SIDE REAR
W-5 /0 14,5
lEQ'G I PROVIDED I
LOT ARIA
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HEOXEDBY JTYPEOFCON� N 0 CUPANT
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aft LOAD
EMARKS 5bll
INALINSPECTU
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VALUATION I FES
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADINGIFILL
7 V
STATE SURCHARGE
277 LIA�
ENG REVIEW FEES
ENG INSPECTION FEE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
RECEIPT
TOTAL AMOUNT DUE
APPLICATION APPROVAL
CALL
�� - . P.' '. �'g i,'
B., A-19 Off-l" 11 hlV Dopuly 4�d F001 11 pAd
FOR INSPECTION
0 1
IA I NATURE
1 1� L SIGN
(425)
771-0220
FEL
FEL
_A
E Y DATE
EENTION EXT 1333
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IT IS UN AWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 15 A/1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 771-0221
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 RI NAL FILE IELLO - INSPECTOR
FAX '�INK OWNER' GOLOWASISSI..
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Height Calculation Worksheet
Address:
Date:
Inspector(s):
1. DatumPoint:
2. Datum Point Elevation: C)
4
MI,
3. Average Grade:
.4. Maximum Elevation Allowed: 9 S-6, (average grade) f�2� 1,�q: Ib
FRK
m 0
5. Reference Point Elevation Shot to House:
0
0
b9 (datum elevation) + (grade to transit level line shot to house) (21 Q if�
m T,
6. Measurements from line shot onto house to roof ridge:
0 "n'
.73
m M
0 a
'Or
C
?K
A
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Total
7. Actual Elevation: (reference point elevation) + 7 (measurements
from#6)= 12'L-22
COAClusion:
"a, '7 7 (actual) is greater l@'sstIa)t I d!�' (allowed); therefore the house is/
is not over the height requiremen per ECDC 16.20.30 requirements
FINAju PROJECT APPROVAL IPRM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: DEPARnIENT DATM�_
E DIVISIONDATE V97L-13
DIVISIONDATE
PROJECT &9-PE.A) Cqr(Arg
SITBADDRESS
PERMIT # J�004- �__ADB# DATEINSPECTED
DESCRIPTION OF WORK TOBE INSPECTED� -tFWAL-
A field inspection was conducted to determine final compliance with approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
E BONDS and the granting of
-GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL wrm CONDITIONS NOTED
a Copy of CONDMONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTTCE given to owner/contractor by inspector
2.
3.
RE-iNsPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date_ Sign
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing
z
......................
wait ................
Pier/Porch .............
Retaining Wall ...........
Stab Insulation
-4
M
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PLUMBING:
0
Underground .............
Rough -In .................
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Commercial Final
HEATING:
Gas Test ....................
0
0
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Gas Piping ..........
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Equipment .................
0
0
Commercial Final
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EXTERIOR SHEATHING
NAILING
vyls
M 0
........................
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FRAMING
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FIRST FL06R FRAMING
INSULATION .................
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Floor Insulation
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Wall Insulation ...........
Ceiling Insulation
R1
SHEETROCK NAILING
SPECIAL INSPECTION