20020388.pdff
RECEIVED
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PERMIT EXPIRES
CITY OF EDMONDS
USE
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PERM T -0
"MI'ER1002
CONSTRUCTION PERMIT APPLICATION
FNG
JOB
ADDRESS
OWNER NAARiRiAME
OF BUSINESS
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FLAT NAMEISUSC
MAILI ADDRESS
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If
u-1 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
CITY ZIP ITE"PHONE
c 66YI0IkQ5 r7go"At, 41�15' 77q_cc7j,,5
EXIS 11-1— PROPOSED�
REQUIRED DEDICATION— FT
R. l=d" 13
13
NAME
METER SIZE LINE SIZE
NO. OF FIXTURES
PRV REQUIR
�j ( CJ YES 13 NO
ADDRESS REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/TIRAINAGE
CITY ZIP [TELEPHONE oc� R�[ 9:60 , n, qw_-10 tJ —
fi��3
IN SRIN.
REVIEWEDIDATE,.,7.
ADDRESS
4
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'7 0 cr 9- 175
FIRE REVIEWED BY
DATE'
CITY zip
TELEPHON
41 -) 5'
71,) - 0 1619
r
STATE LICENSE NUMBER EXPIRATION DATE
ED BY
VARIANCE OR CU
SHORELINE OR ADO#
IN SPECTION
0Y E.E��.
Pilot"'
POSTED
�ROPERTY TAX ACCOUNT PARCE-0.
$EPA REVIEW
COMPLETE EXEMPT
S ON AREA
ALLOWS P .. *SID
HELISHT
.,2
EXP 7
,
NEW
RESIDENTIAL
PLUMBIN MECH
LOT COVERAGE
REQUIRED SETBACKS (FT.)
REAR
ALLOWED PROPOSED
FRONT SIDE
ADIRTION
COMMERCIAL
o
C MPLIANCE OR
CHANCE OF USE
I �_;,O` 51
PARIQ��
LOT AREA
I FLANNING REVIEIA
QU REMODEL Li APARTMENT El SIGN Rao VID
REPAIR ' NCE
0 !M ONDS 13 ( X FT) R
DEMOLISH [3 TANK 0 OTHER
o GARAGE o RETAINING WALL
CARPORT ROCKERY [3 RENEWAL
OWE OF USE, BUSINESS OR ACTIVITY) CHECKED BY TYPE OF
N CRITICAL
U
NUMBER MBER OF
WELLING SPECI L INSPECTOR A
OF D AREAS
M REQUIRED
STORIES UNITS NUMBS
E3 YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPEC
- 11� _.s
IS PER USC 1OS/FINAL INSPECTION RECrD
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Description
FEE
Description
FEE
Plan Check
10
LOTSUOPE%
Building
/My 6.115, e
aoliat,
Plumbing
THIS ONLY THE WORK ilOTED. THIS PERMIT COVERS WORK TO
Mechanical
1: 0 DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
Recording Fee
:21 DOMAIN (CURBS, SIDEWALKS, DnIVEW4YS, IMAQUEES, ETC.)VIRILLREQUIRE
SEPARATE PERMISSION.
Emir. Review
City Surcharge
PER RIAPPLICATION: ISO DAYS
PERMIT LIMM I YEAR - PROVI ED WORK IS STARTED WITHIN 180 DAYS
SEE. BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
State Surcharge
-APPLICANT. ON BEHAL OF HIS OR HER SPOUSE� HEIRS, ASSIGNS AND SUCCISORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
Receipt #
CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTIN OR INDIRECTLY
IALL
FROM THE ISSUA CE OF TH S PFRMIT ISSUANCE OF THIS P EAMIT SHALL NOT a
CITY
9 DEEMED TO MODIF`r� WAIVE OR RLLUCE ANY REQUIREMENT 0 ANY C ORDINANC
Fire Inspection
Total Amount Due
(ell
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,'
Landscapainsp.1
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Receipt III
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CO RECT. AND THAT I AM THE OWNER. OR THE OULY THORIZED AGENT OF
THE OWNE . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
not a goumit until alrintolby
out
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE Or WASHINGTON RELATING TO
EIRThil.proictolonla
ding Offiri.1cohlAbolOrroly: and Front— P-id,..d
FOR INSPECTION owip, I—kn-hudg.or I..p.. pl.,Idudr
A
WowMEN's Cow%�SATION INSURANCE AND RCW 18,27.
G I.S. SIGNATURE
DATE
D TE
(owjE R AD A, NED
(425)
(VI
Z
77 11-02.2.0
R-El?!AS
ATTENTION
EXr 1333
IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
IT
CERTIFI-
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A
�FRGINAL �Ft YELLOW -
INSACTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER GOLD -ASSESSOR
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Height Calculation Worksheet
Address:
Date: a- 14--6S
Inspector(s)
1. Datum PointWl
0�
2. Datum Point Elevation:
0�
M�
3. Averag e Grade:
[;'A
4. Maximum Elevation Allowed: 10-3-�t
1.�(average grade)+ 25'=
C m
5. Reference Point Elevation Shot to House:
In
01
c:
(�-o " (datum elevation) + (grade to transit,level line shot to house)
m
M Z�,
6. Measurements from line shot onto house to roof ridgc
0 -Mn:
-n
bm
M��
0
m 01,
z
Z
0
Total: A. io
:d
O�
7. Actual Elevation: LA - (reference point elevation) _O (measurements
from #6)
Conclusion:
I�L� -U (actual) is greater /,(fe—ss than IA,72 (allowed); therefore the house is/
is not over the height requiremed-t�r ECDC 16.20.30 requirements
LATENOWILDINGWIS011eight Cakulation Worksheet.doc
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93.61'
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---------- -----
FINAL PROJECT A�iRQVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE,�(4- �Ot,
—PLANNING DIVISION DATE
PROJECT —F S!
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SITEADDRESS AACI(�-k;n
PERMIT# a000—o3gj�-.. ADB# DATE (w C)
INSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED LJ&,,4rL t Y'101
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A field inspection was conducted to determine final compliance with approved plans. Final approval
(D
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denotes that there are no objections from the above signed Department to the release of
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PERFORMANCE BONDS and the granting of:
FINAL PROJECT
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C CD
--ZGRANT APPROVAL
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GRANT PROJECT APPROVAL WITH C0NDrrloNS NOTED
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u Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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u Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_
ocaprvl.doc.l:tenip�bldg:fonnsIO/OI
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO- PERMIT COORDINATOR, BUILDING DIVISION
FROM: ------YIRE DEPARTMENT DATE._
ATE 11[03
----ENGlNEE DIVISIOND
DIVISION DATE�..
PROJECT
SITE ADDRESS
PERM[rr#�QQ,�t—QS2,? ----ADB#--DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
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
PERFORMANCE BONDS and the granting of:
--L��GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WTIH CONDITIONS NOTED
a Copy ofCONDITIONS given to owner/contractorby inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
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
ON,
.............
Wall ..........................
Pler/Potch
.................
z
Retaining Wall ...........
0
Slab Insulation ..........
0
PLUMBING:
Underground ............
Rough
om
C:
-in
0
ITI 0
Commercial Final
0
HEATING:
:C rn
IT z
Gas Test
z
Gas Piping .................
Equipment
w
Commercial Final
-4
EXTERIOR SHEATHING
IT1 IT
C7 V;
NAILING ..........................
0
FRAMING ..................
CJ)
FIRST FLOOR FRAMING
Q 0
F
INSULATION ...................
V1 S, 3-31-oS
Floor Insulation
Wall Insulation ...........
z
Coiling Insulation
Z
SHEETROCK NAILING
SPECIAL INSPECTION
0
M
vA S 14- 03
MISCELLANEOUS
FINAL APPROVAL FOR
vM
L
OCCUPANCY ............