20020399.pdfDATE RECEIV��J,,,
PERMIT EXPIRES,
CITY OF EDMONDS
USE
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PERM T
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS
SUITE/APT#
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PLAT NAMEtSUBDIVISION NO.
LOT NO, Ul 11
LID FEE
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EXISTING — PROPOSED
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NAME
En SIZE I LINE SIZE
I NO, OF MIXTURES PRV AEOUIR
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ADDRESS
REMARKS
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OWNERICONTRACTOR RESPONSIBLE F R EROSION
CITY
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CHECKED
PROPERTY TAX ACCOUNT PAR EL NO.
Z52_70a - I - W-5 - 005
171 NEW
R-WENTIAL
PLUMBING I MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
0 APARTMENT
0 SIGN
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0 REPAIR
0 FENCE
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DEMOLISH TANK
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RENEWAL
ITYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER
OF
STORIES
NUMBER 01
DWELLING
UNITS
CREITICAL
A. A.
NUMBER
DESCRIBE WORK TO BE
DONE
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FIRE REVIEWED BY DATE
VARIANCE OR CU
SHORELINE OR ADS#
DYES EVIO
ED
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
A�
_XP ,
PROPOSE"
LOT COVERAGE
REQUIRED SMACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FROW SIDE REAR
FRONT URSIDE RW B,
35-T. '4,1%1
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PLANNING REVIEWED BY DATE
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CHECKEDDY ITYPEOr271.0,N 1 0 CUPANT
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PROGRESS INSPECTIONS PER URC 108/FINAL INSPECTIC
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Plumbing
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK
L. BE DONE ON PaJVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
Recording Fee
32 DOMAIN (CURBS, SIDIEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REOU18E
SEPARATE PeRwissioN.
Engr. Review
City Surcharge
PERIMITAPPUCATJ N: 160DAYS
_73 T_
PERMUTUM I YEAft - PROVIDED WORK IS STARTED WITHIN INDAYS
SEE BACK OF PINK PERMIT Fort MORE INFORMATION
Engr. Inspection
State Surcharge
'APPLICA ON BEHALFOF HIS OR HER SPOUSE, HERS, AIIIINI AND rUCr1E.RS
HOLD
Traffic Mitigation
Plan Chk Deposit
ffI.NT..E'S'T. AGREES TO DEFEND AND HARMLESS THE CITY OF
frS OFFICIALS, FROM ANY AND
Review
Receipt #
EDMONDS, WASHINGTON. EMPLOYEES, AN AGENTS
ALL CLAIMS FOR DAMAGES OF WHATEVE NATURE, AMStNG DIRECTIYOR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT" ISSUANCE OF THIS PERMIT SHALL NOT BE
Fire
Inspection
T.t.IA..untDu.
DEEMED TO MODIFY, WAIVE OR REDU EANYREQUIREMENROFANYCITYOHDINANCE
Fire
ORDINANCE PROVISION'
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORD114ANCE PROVISION.-
Landscapoinsp-I
P,
ZmL
I 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
THE OWNER. I AGREE TO COMPLYWITH CITY AND STATE LAWS REOULATING CONISTRUC-
CALL
rhis application is not a p-1-111 signed by ins
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
Buliding OMOW., hisine, Dopedy: and FOOO are paid, and
FOR INSPECTION 'COapt IS Oak ... ledged 11 $PICO P—IdId.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27,
kLS SIGNATURE
DATE
al
�i-AIG;Ejy ATE HE.
IG
(425)
"RB(.W
771-0220
IsI Rell—
RELEASED BY
DATIJ
ATTENTION
EXT 1333
7,
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221 -ORIGINAL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
- FJLE'_-)YE1UOW -
IN4ECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD � ASSESSOR
10/01
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Height Calculation Worksheet
17'
Address: 99 o!
Date: I--
Inspector(s): �M-),
N
N,
1. Datum Point: �4
2. Datum Point Elevation: 40
z
01,
3. Average Grade:014-
(av
4. Maximum Elevation Allowed: c4 S erage grade) + 25'
Vi
m
5. Reference Point Elevation Shot to House:
m 0
Lt!��datum elevation) +4-5� (grade to transit.level line shot to house)
�Oc
mm
6. Measurements from line shot onto house to roof ridge:
cz�
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MM
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Total
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m
7. Actual Elevation: 64 35 (reference point elevation) + (measurements
from #6)
CORCIUSLOR:
(actual) is greater /(je::s:sj�Jmtd 'Z (allowed); therefore the house is/
is not over the height requirement per ECDC 16.20.30 requirements
LATEMPSUILDINGWISOIleight Calculation Worksheet.doc
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APPROVED BY PLANNING s
LEGAL DE WITION
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EINAL PROJECT APPROVAL FORM
TO: -
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE -
ENGINEERING DIVISION DATF__5�03
Pl, G DIVISION DATE-
PROJEC
SITEADDRESSk . ........ .
PERMIT#_202af 03019 ADB#_____-PATEINSPE
PATE INSPE
INSPE
PATE INSPE
INSPE
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
PE RFORMANCE B_ONDS and the granting of
�GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
E3 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractorby 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:
rvvAr-> n,:3 —
Footing....................
wall
Pier/Porch .................
z
Retaining Wall
0
Slab Insulation ..........
PLUMBING:
Underground .............
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Rough -in .................
M 0
Commercial Final
0
0 C::
HEATING:
z
Gas Test ...............
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Gas Piping ............
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Equipment ............
O"n
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Commercial Final
:�
EXTERIOR SHEATHING
NAILING ......................
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0
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FRAMING
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.. .....................
FIRST FLOOR FRAMING
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INSULATION ..............
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Floor Insulation
Wall Insulation ...........
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Ceiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
VV'\-S
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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