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PERMITUPIRES
E PERMIT
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CITY OF EDMONDS NUMEIER",__17_e�/1/5
CONSTRUCTION PERMIT APPLICATION JAOGRESS SUITEM
ER NAME CTF BUSINESS
k"� PLIt; NAME/SUBGVISIONI No� 'LID NO,
ING ADDRESS Up E $
PUBLIC RIGHT
OF WAY PER OFFICIAL STREET M7
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al—ro.—ons.
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T EXIST No — PROPOSED
E)PH, HE
REQU�RED DEDICATION— FT
xoA� ED—), Yor.anoulner
METI�A SIZE
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LINE'SIZE
I NO. OFfqRES
Y PR�EOUIORED
ES N E3
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIORAWAGE
ZIP ITSLEPHOVE ---------- A I il S PIT;[ I tf?� � � ni PQn c, I a x � n12- - n r, w- n j K r,, a I il All T-1?
ITWNE�N_- 8err FIEVIE-12131DATE
ll�E REVIEWED BY DATE
STATE LICENSE NUMBER
EXPIRAT
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SHORELINE 08 ADB#
INSPECTION
80
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POST
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COMPLETE B11MIT
SIGN AREA
ALLOWED PROPOSED
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ALLOWED, PROPOSE
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NEW
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ALLOW 0 PRO
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REQUIRED SETBACKS (FT) PROPOSED BE HEA1
SIDE REAR FRO BETISACKS IF
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ADDITION
r COMMERCIAL
0 CHANGE OF USE"
2'�R05` 1, 5; 15
1. 6y
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REMODEL
0 APARTMENT
SIGN
PARKING
REGO P14OVIDEO
LOT AREA�
P DATE
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REPAIR
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F NOE
X Fri
REMARKS
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0 DEMOLISH
TANK
OTHER
GARAGE
9: A PORT
[3 RETAINING WALL
ROOKERY
0 RENEWAL
DESCRIBE WORK TO BE
CHECKEDBY ]TYPE OF CONSTRUCTION
I GROL
7PE"CIAL INSPECTOR
REQUIRED rl YGS JIREA
OCCO
LOAD
PER USC
I Plan Check
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PLAN CHECK NO.
STEO DATE
VESTED DATE
rBuilding
P hen" n
R6 NOTED. ITINSINERIAITCOVE.S.
71 ... AKTO
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:I ANY CONSTRUCTION )0W",TL'L'F PU'uC
MAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, FTC. REQUIRE
6EPARATEPIIIIIIIISSION.
Mechanical
Grading
Engr. Review
Recording Fee
City Surcharge
MIT
PERAUT UAR, I 'EaRN "r-P.-ATIO.: I. —
PROVIDED WORK IS STARTED WITHIN IN DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
State Surcharge
4115
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Plan Chk Deposit
/eZt./
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES To INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
IS EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
to FROM THE ISSUANCE OF THIS P ISSUANCE F THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE 08 RIERMCFT A Y REQUIREMENT OF ANY CITY ORDIMNCe
U N
Traffic Mitigation
Fire Review
Fire Inspection
Receipt #
Total Amount Due
R:7��,
NOR LIMIT IN ANY WAY THE CITY$ ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I Landscapolnsp.,
Recelpt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ TH S APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT AM THE OWNEIR, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRU
APPLICATION
APPROVAL
T IN VIOLATION OF THE LASO -Ri NO PERSON WILL BE EMPLOYED ding Official or hellner Deptay: and Fees ate paid, and
ION; AND IN DOING THE WORK AUTHORIZED THE C. CALL Bad This application is net a pernsit tdail signed by the
R CODE OF THE STATE OF SfflNrTON RELATING TO FOR INSPECTION necolpt is aeknowledard In space provided,
W051sf�EN1 COMPENSAIPNFJN�NCE AND RCW 18.27.
OFFJJIALS SIGNATU&,,
G R (OWNE AGEhTn A�Tj (425)
771-0220 DATE
ATT�WION EX`T 1333
IT =LAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 771-0221
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ORIGINAL - FILE - YELLOW - IN6ECTO�
1010, FAX PINK,OWNER - GOLD -ASSESSOR
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APPROVED AS NOTEO
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RIGHT-OF-WAY CONSTRUCTION PERMIT t
AND INSPECTION REQUIRED
Date:
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it s .73 It la = T15,�j
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-----------
Height Calculation Worksheet
Address:
Date: t to,
4
Inspector(s):
Datum Point: �7 -7,6—
Z'
0
2. Datum Point Elevation: 7'
0
3. Average Grade:
4. Maximum Elevation Allowed: :Sao, (average grade)+ 25'
a to
C a
N�
5. Reference Point Elevation Shot to House: ,
m 0
-4
C:�
(datum elevation) (grade to transit.level fine shot to house) 39 1 "�5-
m;
6. Measurements from line shot onto house to roof ridge:
c:
>
cnj
tl�'
-on
0
0 Fn
C a)
Z!
CA
z
Total 03
m
7. Actual Elevation: -3 � I I ference point elevation) +2�1 (measurements
i2 T5'(r-
from#6)= 414,bZ
Conclusion:
4 f q 7- ter Iq:e:s:s!t:h:a� 415-,v (allowed); therefore the house is/
(actual) is grea
is not over the height requirement per ECDC 16.20.30 requirements
L:\TENM\BLJlLDlNG\MISC\Height Calculation Workshect.doc
FINAL PROJECT APPROVAL FORM
TO:
DATE:-
mEmom PERmrr cooRDiNATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE. -
ENGINEERING DIVISION DATE-AlaL0.5-
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0
PLANNING DIVISION DATE -
PROJECT AA Q
0
C M
M 0
0
srrEADDREss VV
(12 0 `7/12403
MM
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PERMIT #-10-()Z ADB#_-------PATE INSPECTED
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DESCRIPTION OF WORK TO BE INSPECTFD--SfY,-
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A field inspection was conducted to determineflual compliance with approved plans. Final approval
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denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
M M
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GRANT FINAL PROJECT APPROVAL
9 cn
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
ocaprvl.doc.l:temp:bldg:fonnsio/oI
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
I Z-02
FOUNDATION:
Footing ....................
wall ..........................
'Sto, (10voer;f-�0-i"
Pier/Porch ...............
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Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
M
C:
r
Rough -in ...................
M
0
0
Commercial Final
M
ITI
HEATING:
GasTest .................
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10-4
Gas Piping .................
Equipment .................
Commercial Final
ITI M
EXTERIOR SHEATHING
C' —,T'rl 2
0
0
NAILING
C
FRAMING ......................
to —J'C� .-f-'Z
MO
FIRST FLOOR FRAMING
Z-
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INSULATION ...................
-4
Floor Insulation
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Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
it �qk
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g
SPECIAL INSPECTION
I
0
ITI
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..........