20020535.pdfDATE RECEIVEF
PERMITFXPIRES
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CITY OF EDMONDS
USE
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URMIT
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CONSTRUCTION PERMIT APPLICATION
JOB
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SUITEIAPT#
NNER
ADDRESS'2,;_,,�/
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NAMEINAME OF BUSINESS
P 'T
LAT NAME/SUBDIVISION N
LID NO.
AILING ADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
LID FEE S
T"C'
100'6CK
ITY ZIP 11ELEPHON1
EXISTING- PROPOSED -
REQUIRED DEDICATION— I
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AME
MI, I - .11, 1 LINE SIZE
r. OF FIXTURES
AEOU'IIK
PR E
Es 13 No
Does S
:3.30 P,+Y7z IJ S7—
REMARKS
NERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLJORAINAGE
ry ZIP ITELEPHONE
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_A�'DAfOAIJOS
AME
FIRE REVIEWED BY
DATE
CRY
TELEPHONE
VARIANCE OR CU
SHORELINE OR ADS#
INSPECTION D
STAr
T LICENSE NUMBER
EXPIRATI ED BY
t..MPIETe
REIV PC
'TjrN
1300
13Y ES '0
$EPA REVIEW
SIGN AREA
HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
EXEMPT
ALLOWED PROPOSED
ALLOWED FROM
EXP
f
0 NEW
IDENTIAL
0 LUMBING I MECH
REQUIRED SETBACKS IFT) PROPOSED SETBACta
D'O"PERROG
ADDITION
COMMERCIAL
ri COMPLIANCE OR
CHANGE OF USE
ALL029TE DES E D FRONT SIDE REAR
FRONT
91791,
0 REMODEL
0 APARTMENT
[:1 SIGN
PAR KING L�T AREA. PLANNING REVIEWED
RECIND PROVIDED
':�- :�
BY DATE
REPAIR
GRADING Y.,
[3 PENCE
( - X FT)
-
REMARKS
DEMOLISH
TANK
0 OTHER
M16.A.E
WALL
0 RENEWAL
RIETAINING
OCKERY
UWE OF USE, BUSINESS OR ACTIVITn EXPLAIN:
CHECXEDBY ITYPEOF!WION
NUMBER
NU
D
SPECIAL INSPECTOR
OCCUPANT
:T,0RIES
JAREA
REQUIRED rl YES 1 -111 -
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRII
VALUATION
Deacriptio
Plan Check
0-44 _�( 111) 1
Mechanical
THIS PERMIT AUTHORIZES ONLY THE ORKNOTIED. THIS PERMIT COVERS WORK TO
....... P"'T"O"Go"", ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PtRIAiTAPPUCATION: ISODAYS
PERMITUM .1YEAR-PROWDEDWORKISSTARTEDWITHIN 180DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
— _11
'APPLICANT. ON RENAL OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Traffic Mitigation
IN INTEREST. AGREES To INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OF1111M.1, EMPLOYEES, AND AGENT' FROM ANY AND
Fire Review
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMFr. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE 08 REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
NOR LIMIT IN ANY WAY THE DRYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscapainsp.
IIHERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT TH INFORMATION
GIVEN IS CORRECt. AND THAT I AM THE OWNER OR THE DULY AUTHORIZED AGENT OF
THE OWNER IAGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC"
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON HEWING TO
FOR INSPECTI(
WORKMEWS COMPENS*ATI Q�4SURANCE A 0 HOW 18,27. 1
el
(425)
,
4r:10
771 -0220
ATTENTION
EXT 1333
IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL 08 A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
FAX
REO'D
Recording Fee
City Surcharge
State Surcharge
Plan Chk Deposit
Receipt #
Total Amount Due 16,7h.6
APPLICATION APPROVAL
Thi-ppli..11- b r.l.p—h �MdMgr.dby ft
"dI.q Oftlat., hHjh.r D.pwy:.�dF pld,.,
1.��ip�l...knowledgedinspaceprmided.
ALS SIGNATUR�q DAT I E
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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.
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PERMIT COUNT ER
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BY PLANNINIG
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CONSTRUCTION PI
1441
MIT
RIGHT-6
At
F.WAY
D INSSPECTION REQUIRE
4-
0
CITY COPY
ACCEPTABLE TIGHTLINE
1+4
ex —
APPROVED AS NOTED
BY ENGINEERING
MATERIAL
176&il- 0
SDR 35
�CH 40
pte: 0
F810 R olro
I'M'S
t; �Lp
OWNER/CONTRACTOR IS RESPONSIBLE
FOR EROSTTROL AND DAMAGE
EA,
-F, WAY
cu,"r L�ir 1".6�
NOKTH
it,
14ri Fl*
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eX . A� Avr.�
R[VEWAY SLOFI!
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14% -PpEL .1.75 . H
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01.75 1
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Zle_J F IN DRAINS NOT"
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pem"
tO B TIED INTO
DETENTION SYSTEM
Height Calculation Worksheet
Address: li-A t,-
Date:
Inspector(s):
1. Datum Point:
Z'
0.
2, Datum Point Elevation:
M
3. Average Grade: 06
ra
4. Maximum Elevation Allowed: LOLS �L(average grade) +* G
m
M 00
5. Reference Point Elevation Shot to House:
M
(datum elevation) +9t -5 (grade to transit.level Hue shot to house)= log -
a
6. Measurements from line shot onto house to roof ridge:
m
0 n
m
05,
0
z
Total
M
7. Actual Elevation* (reference point elevation) + (measurements
from #6)
Conclusion:
Fiesifigz—n) 1 �31 �5b (allowed); therefore the house U/,
U�Y,561 (actual) Is greater)\,
is not over the height requiremefit-per ECDC 16.20.30 requirements
LATEWBUILDINGWISORei& Calculation Workshoet.doc
FINAL PROJECT APPROVAL FORM
TO-_
DATE:
MEMOTO: PERWT COORDINATOP4 BUILDING DIVISION
FROM: ME DEPARTMENT DATE-
-ENGINEERING DIVISION DATE-144f&3
P DIVISIONDATE___�
PROJECT
SITE ADDRESS
p, 4
an D
______pATE,,zSPEcTF
DEscRLmoNoFwoRKToBEiNsPEcrED
A field Inspection was conducted to determine .1 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:
__4GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WrM CONDITIONS NOTED
o Copy of CONDITIONS given to owner/conbactor by inspector
FARED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractorby inspector
2.
3.
RE-INSpECTE.D OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date- SIP-
ocaprvAdocA:WW:b1dg:fhnns10/01
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ............
0
FOUNDATION:
Footing ....................
wall ..............
Pier/Porch ...........
0
—4
Retaining Wall ...........
Stab Insulation ..........
PLUMBING:
Underground ............
IT!
C:
M
Rough -in ..................
0
0
Commercial Final
ITI
�EATING:
M z
GasTest ....................
C
>
Gas Piping .................
Equipment ............
Commercial Final
M M
EXTERIOR SHEATHING
NAILING ..........................
if
o Fn
to
FRAMING ........................
w
M 0
FIRST FLOOR FRAMING...
r—
INSULATION ...................
Floor Insulation
z
Wall Insulation ..........
Ceiling Insulation
z
SHEETROCK NAILING
SPECIAL INSPECTION
ITI
MISCELLANEOUS ..........
FINAL APPROVAL FOR N\S
OCCUPANCY ...............