20020435.pdfAa�44 DATE RECEIVE
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[PERMIT
PIRES
USE
CITY OF EDMONDS ZONE
CONSTRUCTION PERMIT APPUCATION SUITEIAPT#
ADDRESS
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O`I'�,_,*M7M,10F
2� L
BUSINESS a2
Lae. t Pt —ATNAME]SUBDIVISION NO, I LOT N 0. LiD NO,
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—
MAILING ADDRESS LID FEE It
PUBLIC RIG14T OF WAY PER OFFICIAL STREET MAP aEsoP,4
_1tuan"..
ZIP EXISTING — PFIOPOSED�
ITIIEIIIO"E REQUIRED DEDICATION— FT inuale—d
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4S
WE
I NO. 01 FIXTURES
YEPIV REQUIRED
No
.... be. REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ZIP NE 0&163.
11ELEP
EL-,j,*j 4 F, MU5r III;
NAME
FIRE REVIEWED _6Y
DATE
STATE LICENSE NUMBER
CKED BY
VARIANCE OR CUI SHORELINE OR ADB#
1.10N.D.
Nyl� PffkN P er
R;E POSTS.
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YES NO
0 B N.
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PROPERTY TAX ACCO M PARCEL NO.
SEPA REVIEW SIGN AREA
COMPLETE EXEMPT ALL D
HEIGHT
ALLOWED
, 2�-
F�IOPIEII
NEW RESIDENTIAL
PLUMBING I ed ECH
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT:
ALLOWED FIGHT SIDE RW FRONT Lfil� REAR
COMPLIANCE OR
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o CHAANGE OF USE
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REMARKS
DEMOLISH TANK
OTHER
ETA114
G ARAIIE IT IN. WALL
CARPORT OCKERY
R
[j RENEWAL
(TYPE OF USE, 8 ="
CHECKED BY TYPE OF CODE OCCUPANT
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at
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47-2,
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NIGER NUMBER :w
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CRITICAL
AREAS
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TCR E UNITS
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NUMG;l0,j:j __aq
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REQUIRE
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DESCRIBE WORK TO BE DONE
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REMARKS
IOG/FINALINMON an
_Urptcl — __ I — a— (91, —
Plan Check
I
E�RCE T N
Building
"M
IE ATE
�!�
Plumbing
Plumbing
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..h naca,
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
0
t: BE DONEON PRIVATE P OPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2
ra I g
Grading
4
Record ing Fee
a To t WILL. our..
:1 OMAIN (CUMS, SIDEWALKS. DRAIMAYS, MARQUEES, ETC.t WILL REQUIRE
L SEPARATE PERMISSION.
—
Engr. Review
City Surcharge
PFRmrfAPPUCATiON: INDAYS
PERMIT LIMIT I vm. PROVIDED WORK IS STARTED WITHIN 160DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engc Inspection
state Surcharge
—LICA ON BE-11 01 HIS on .1. EP * HEIRS, ASSIGNS AND SUCCESORS
Nr OUSE
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFN, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT
Fire Inspection
Total Amount Due
OF MY CITY ORDINANCE
0 NOR LIMIT IN AM WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscapalnsp.
Receipt #
I HEREBY ACKNOWLEDGE THAT [ HAVE READ THIS APPLICATIM THAT THE INFORMATION
GIVEN is CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION A VAL
THE OWNER. I AGREE TO Cc FLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE ORK AUT"OFUZ EIE-bNO IE SON WILL 13E EMPLOYED
W
CALL
D',,Thisappi, Via Is not a peanyt,tall signed by Me
d1c, Cadet . huilhin Deputy: and Fees we paid, and
IN VIOLATION OF THE LABOR CODE OF TATE , WASHINGTON RELATING TO
FOR INSPECTION
oscolpt Is ack-1,diged In space prmided,
WORKMENS51WPENSATION 11PLAANCE YIN 18.27.
0 'A'S SIGNATU DAT�
7IGN
)/Ar
(425)
A M/o
771-0220
FIFILEA1 6AT(
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE - YELLOW ;?SPECfOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK . OWNER - GOLD - ASSESSOR
total
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M 0
0
80
�K -, .
1111 IT
to
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0
0
0
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IT 0
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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.
APpRo= AS Nf*�'*
sEram. ell i
FmR It
DE -
Dale: REJ
MAX. COVE�E - OTHER Mall",
ACTUAL CO�E 2q2D 51'. (34.45%) HEIGHT
MAX KEI—T FE�
COVM4AN�— Iso.00
A' MAL HE*�= 12q5l.
A 6
=?A— u
IST
4-
nu—
o
TEMPORARY CONSTRUCT
MAIN FLOof� 114-15,
FO. BOX 526.2 L.� FLOM ENTRANCE REQUIRED
all;
�AL PeU-R[�ON 4 a
LOT S. ELM Vl� AVO nON VIVISJO� 1. VOL- 55 P9 TIN t' i D(2A(
PA6E 2 OF �ORD5, S�OHO-*H CO.. AA.
lu
EUJLDI� AREA
OVEFZRA--S)z 5 F- IL
JU <
TOTAL IMP. 4,550 SP�
D-
0 F
NOM4 ALL �KEPJrS FZrAlNl� K44-L5 V (14
WATER & SEWER APZ BELCH EX15r6 6f�r DL
INSPECTIONS REQl)
CALL 42rr77i-o= EXT.101 A NNING
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Fm
OMERICMRk(;
EROSION CoMOL �ND DR"GE RE� �El ED, m
JUN 1 1 21302
t
BUILDING DEPT.
-ld
fiLL id, 940cr
iN
it
M.
Eg
:t Ck
AN F'-OCR, 114,55' 1
FLO--�� 1045
m M
0
C:
VY
ELM PL. re5T I
NC>I-=: ALL- RO��KE�IE5 4 iZ=-T.AINNC- PNALL5
ARE BELOIN EX15-cs sRApEE
Im
PLAN
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4
Height Calculation Worksheet
Address: to
Date:
Inspector(s):
1. Datum Point:
2. Datum Point Elevation: -0
0
3. Average Grade: -3 At' I
C)
M�
4. Maximum Elevation Allowed: LL3 -5j (average grade) + 25'
5, lReference Point Elevation Shot to House:
m 0
0
�qo.v (datumelevati on)+411", (grade to transit,level line shot to house)= 104-
4 M
m
6. Measurements from line shot onto house to roof ridge:
10
C-1
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t:
(a
K,
o -n
n
m M
0 a
K
Fn'
m O'�
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Total
zo�
_J,
0
7. Actual Elevation: t64 l D (reference Point elevation) +�54S (measurements
from #6)
Conclusion -
d`� 9 k (actual) is grea *a (,58,o (allowed); therefore the house Is/
ter (]Ces��i
is not over the height requirement per ECDC 16.20.30 requirements
LATENOWILDINGUISOHeight Cakulation Worksheet.doc
LSIADAPT DAILY FIELD REPORT wo, 3
ProjectName: KoeZ-A !�FR Permit No: Job No:
Location: -IL9 Time: ................... ... — Date:, A41�L� WTFSS
Weather. sanyr'!V !F /
Client/Owner: PLklY_ Obe�,h6l�Lt_r Client/owner Rep/Phone: (104, 17 47 - o7o 121
-T—t '10 --rk, <_ Contractor Rep/Phone:
Contractor:
Subcontractor: Subcontractor Rep/Phone:
ADAPT Field Rep: V 10 e<e ADAPT Office Contact:
TypeofWork: Equipment Used:
Comments:
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This report presents opinions formed as a result ofour observations ofthe Contractoes activities relating to geotechnical engineering. We rely on the Contractor to
comply with the plans and specifications throughout the duration of the project, irrespective of the presence ofthe 1.51 ADAPT representative. The presence of our field
representative is strictly for the purpose of providing observation and field testing. Our work does not Include supervision or direction ofthe actual work performed by
the Contractor's employees or agents. Neither the presence ofour representative nor the observation and testing by our firm shall excuse the contractor In anyway for
defects discovered in the work performed by the Contractor, Our firm will not be responsible forjob or site safety on this project.
Page
Field Rep: Reviewed By: —of—.
Distribution: White -Owner/Client Yellow -Contractor Pink-FieldFile
f
,'.0/18/02 FRI 17:46 FAX 2065467606 KINKOS SHORELINE fin 00 2
L S1 ADAPT DAILY FIELD REPORT NO:
F ProjectName: �Sf�g Permit No: WO Of'Z 6 — Job No:
Location: Ple, -, _Time: — Date: 10110/177- M T W TO 5
Edll—,.11 5, 1 14) A Weather:
vbl� ke, h,,— Client/Owner Rep/Phone: IL2�E6-� ,7 Oa
Contraclor: contractor Rep/Phone:
Subcontractor Rep/Phone: ---------------
Subcontractor:
ADAPT Field Rep: �v e-- ADAPT Office Contact:
Type of Work: Equipment Used:
Comments:
Aig aLe-
As a conrs:sb:�hk I.
I " j I," J bztlatj cl—eli. . .. ...
j e-,
-4, > Ok cue t4-e
e. P-,c POSI-:d . . . . . .
It-c be
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Fi4
�17, '(4, J, 1—
t— 5 T—
A b A P*r 7F,-
6w MaqAsad Ali&
-
5e,11 Ix , wA 7013
to
-7.9 f b
mw�
This report OP'm;ors formed as a result of air olpseNalion, ofthC
the contract., to
Contractors activitie"el-tIng to qe.—hnk:�] ong1,1c1i,,9. Werelyo. -teofo.,fi,ld
af1h, LSI ADAPT The P",
Presents ,,fom,edby
complyw6thef,IaMa d specillcationstbro,19bOuttflo afths, p,ojccL irrespective Ifth, presence
I , d fold testing. our work does hot —jtrde supervision., dl,e,tion of 'he actual work P
"hy way for
representative 15 Strictly or %he purpose of proidlng 01—wrt.- a.,
nor the observation and testing by our firm shall excuse
the c0oll"c'O"m
theCon Neither the presence of our representative
in the work performed by tile C--act0l. Our firm
will not be responsible forjob of site safety on this projeM
def"ts discovered
/, , ,/
Page
Field R p: 'r "`� A-)
Reviewed By:
—Lof-j— I
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O�pt 24,02 09:22a 1_51 HUHVI
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cum .01 1.".
LSIADAPT DAILY FIELD REPORT FN-0 -: �6 7
Project Name: t—p_ y5d!d Permit No: 1611% — 0'�15' — Job No:
Location: -7�15 Elo, Time: 4:4 Date: 10113 LV L M T@T F S 5
gdk?V,dS, Weather: ,w""
Client/Owner 7Fi�o Client(Owner Rep/Phone:
Mike- 4921w"APY-
Contractor. Contractor Rep/Phone: -0706
Subcontractor Subcontractor Rep/Phone:
ADAPT Field ReV. (,PrVC5e_f1 ADAPT office Contact: g�v&exa 4 Q
_51 ,,, ZVAJUgkWn Equipment Used
Type of'Work:
Comments:
4mre,4 otP riti- ip doet,wien't- vpsfg�hom &-I
& 64 eLffl,"er 4. - �,o �a!r
Siva .16, An"perarm S%612�1 _. 4�4_ 1�-_A;ed_ krexa- (r-ke4,-)
iW se-gueed 16:1 Awljig_ ty -C�ezl sAgr-,!�j
go 6 s-4f-eiF OJ 41A �Vp 8J
lh5&4aj;% 4a-A _-Wmi; 19.� ree
Aok,d lit ckx, s lope We Wes, or,
irceo�kwotd awtdAhysied i#11 A i I "
be owzzd 'Llciap" �6,0 6J, Aez.fg ip flmH. eWl 3L44!
/ 4 . lda+ "�,+ 1 /1* --
km!!een" Spill �V *-,kt* &-' k4s-. _40"If
U",.s V F rout-.-M
tvwq_
7k*-K- Rol+a I new (QuA" :�e_aAc
a
Ik 1;&,C; M194 h, VX&I
his report presents opinions formed as a resultofour obsemdons ofthe contnictoes activities relating to geotechnical engineering, werelyontheC.Mmaort
omplywith the plans and specifications throughout the duration of the projea Irrespective ofthe presence of the LSI AcIAPTrepesenutive. Thepresence of —field
,preserimthre is strictly forthe purpose of providing observation and field testlrg� Our Work does not include supervision at direction of the actual work performed by
wContractor'somployessioragenu, Neftherthe presence ofour representative nor the observation and testing by our firm shall e=use the contractor in any wayfor
elects discovered In the work performed by the Contractor. Ourfirm will not be responsible forJob or site safety on this PrOleM
ield Reo: elf C-11, Reviewed BY: — Page —of—
n6bution; Whim- 0-4111t Ygim—Cmmaor Pink-Fieldi'lm
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE�_
D (Le, 6v-�r -ENGINEERING DIVISION DATE. 31
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PLANNING DIVISION DAT9_
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0
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PROJECT
SITE ADDRESS
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PERMIT # 61 Q+�5ADB#______DATE INSPECTED__42�J3
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--10
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DESCRIPTION OF WORK TO BE INSPECTED_jElj�.�..
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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
�--�GRANT
M m m
CO
0 r-
FINAL PROJECT APPROVAL.
M
A 0
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
3:
>
u Copy of CONDITIONS given to owner/contractor by inspector
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FAILED IZINAL INSPECTION - OUTSTANDING ISSUES
M
E3 Copy of CORRECTION NOTICE given to owner/contractorby inspector
2.
3.
RE-INSpEcTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_
ocaprvl.doc.l:ten4):bldg:fomisIO101
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
C3 4f IT'
SETBACKS .....................
FOUNDATION:
Footing ...........
5—ciz
wall
Pier/Porch
Retaining Wall ..........
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Stab Insulation 10
0
PLUMBING:
Underground
Rough -in ...................
Commercial Final
M 0
-40
HEATING: 0 C
jZ. I �nt IT
GasTest .................... IT[
J 12L 10
Gas Piping .................
Equipment .................
Commercial Final
0 -n�
n
EXTERIOR SHEATHING
NAILING ............. M M
0
FRAMING ........................
0
FIRST FLOOR FRAMING
IR
0
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Gelling Insulation
-o3
S
SHEETROCK NAILING
SPECIAL INSPECTION
0
ITI
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY
SideSewer#
-71 #
AM6UtFafd$
6 4-e
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