20020573.pdfK�% DATE RECEIVED
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PERMIT EXPIRES
CITY OF EDMOND S
US'
I.NE PERMIT
NUMBER,;;�4* -(5757_5
CONSTRUCTION PERMIT APPLICATION
JOB -7
SUIT
ADDRESS
L
OV;NER NAMENAME OF BUSINESS
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PLAT NAMEISUBDIVISION NO
LOT NO,
L�D NO.
L D FEE S
MAILING ADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EX STING
is PROPOSED
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CITY III 'ILEP'111
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RECLIM1. DEDICATION— F-r
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13
METER SIZE
LINE S!IE
I NO. OF 11-UREI
PRV REQUIRED
03
4 A
YES NO 13
ADDRESS
REMARKS 'A
OWNEFYCONTRACTOR RESPONSIBLE FOR EROSION CONTROLIORAINAGE
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FIRE REVIEWED BY DATE
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VARIANCE OR CU
SHORELINE OR ADS#
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ALLOWED PROPOSED ALLOWED
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FONT SIDE, HEAR FRONT
UR SID
REMODEL
APARTMENT
CHANGE OF USE
El SIGN
ENCE
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IS REW D BY Dlfl�y
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L_j REPAIR W ' CYOS E] i — - — '
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IWARAGE o RETAINING WALL
ARPORT MOCKERY 0 SEN.
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is NUMBER OF CRITICAL "'V
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DWELLING AREAS
UNITS NUMBS
CHECKED BY
TYPE OF CONSTRUCTION
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EPECIAL INSPECTOR
R ON 0
EDUIRED 0 YES
AREA I_ I
DESCRIBE WORK TO BE DONE
R MARKS
GRESS INSPECTIONS PER USC
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VALUATION $
Description
Plan Check
0 GLAZIN�,�
LO:�Or
7
C CNM4
PLAN CHECK NO: r
—D DATE
Plumbing
THIS PERMIT AUTHORUES ONLY INC WORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
It IME DONE ON P111 PROPERTY ONLY. ANY CONSTRUCTION on THE pUBUC
.MAJN
Grading
:, JCURBS, SIDEWALKS. DRIVEWAYS, MARQUESS, ETO.) WILL REQUIRE
ic SEPARATE PERMISSION.
PE MITAPPLICATIONl
Engr. Review
ISOIDAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 1. DAYS
SIZE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
ON BEHALF OF HIS OR HER SPOUSE, HIEIRS�ASSIGNS AND SUCCESORS
IN INTEREST, AGREES To INDEMNIFY. DEFEND AND NO D HARMLESS THE CITY OF
IDMONDI WASHINGTON III OF1IC1111* EMPLOYEES, AND AGENTS FROM ANY AN.
Fire Review
ALL CLAUNIS FOR DAMAGEii OF WHATEVER NATURE , AS SING DIRECTLY OR INDIRECTLY
E
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT Be
DEEMED TO
Fire Inspection
MODIZ WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
RCALL
Land" P. IWS7P
I HEREBY ACKNOWLEDGE THAT I HAVE MEAD n1le APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT� AND THAT I AM INC OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH C17Y AND STATE LAWS REGULATING CONSTRUC.
TION; AND IN DOING THE
IN ZED THEREBY No PERSON WILL BE EMPLOYED
ON OF TMe_
IN VIOLATI OF E OF WASHINGTON RELATING TO
=D=RNS.0D`NCE AC
FOR INSPECTI1
WORKMENS COMF;� RS(INATIB27.
a
(425)
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
771-0221
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
FAX
WIN
FEE
Recording Fee
City Surcharge
State Surcharge
Plan Chk Deposit
Receipt #
Total Amount Due
_F-_---Pt#
APPLICATION APPROVAL
fiding Official,, his/har Depnay� andlFsaarapald, and
r—fird is ack—finiged in spa,, pnwid-
CIALS SIGNATL�J, DATE
ORIGINAL - FILE YELLOW - INSPECi
PINK - OWNER GOLD � ASSESSOR
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MAY-14-2002 13:51 CITY OF EDMO.NDS�
WORKSHEET
42577,10221 P.06/06
OWNEa, CALIC AY:
ADDREESS 2?-t PHONE-
DATEt
"DCSIGN DA TA
PIPE DiA PIPE LG ORIFICE
FIMPERVIOUS AREA
i5� I / 7/,041
? 32
OUING LID
XTUTION PIPE: LENGTH
ATYPICAL)
MICK!) a MINIMUM
TIC TL "EAL"Ralft"Fop Or
CDC Sax OR RIM
10 1% 3LOPE
UZiL>
OU
tg;l ?LET C04TAM
MIN,
UPPER CATCH BASIN
CONTROL CATCH BASIN
OSS SECTIO�
SYSTEM C.R
1!'X2'X6',DZtP, 4-61 3PALLS OR CGUAL
rqDm CONTROL C9 a'X 2X 3' DEEP, 3/4' CRUSPC�;OCK EXISTING GRADE
CL
���raw CWRQL TLC
LOW
MI. III
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A1,41, Vip WOV4�- QOcx
RIPAAP WWI'
RUNOFF SPREADER -TRENCH
Foo7m, DmNs sHAu Nor BE coNN.EcTED To D.E TENTION SYMM
NOTES.
1. cau Engineering Divislop (771-0220) for a tightline, and ddoctiou System luvection
befort, backfilliag and for ficiad inspoctlou. APPROVED BY
2, Responsibility for operalloil and maLutwance ofdrainago Synems ED Ixiv&tc WOPetty is the
mspo�ilbility of the property Owuw. M0,10rial Swumulated ia the StOrU* PIPS must be flushed
out =4 raInoved J)rom Lbe wtc*a basics, to alloW proper Op*VJ404- no outlet coarot orifice DATE
TOTAL P.06
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Height Calculation Worksheet
Address:
Date: ',r-�— I I -- 0 Z
Inspe to,($):
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1. Datum Point:
2. Datum Point Elevation: t Q 3
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0'
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3. Average Grade: 100.tOO
oa:
4. Maximum Elevation Allowed: WO (average grade) 25' As
M",
5. Reference Point Elevation Shot to House:
0
0�
(datum elevation) + 45 (grade to transitlevel line shot to house)
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6. Measurements from line shot onto house to roof ridge:
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Total
0
0
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7. Actual Elevation -A (reference point elevation) + (measurements
from #6)
conclusi
(actual) is greater lt�� (allowed); therefore the house Is/
is not over the height requirement per ECDC 16.20.30 requirements
L\TEMBUILDINGWISOHeight Calculation Worksheet.doc
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE—
D
ENGINEERING DIVISION ATE
PLANNING DIVISION DATE—
PROJFCT_���.���� —
SITEADDRESS Pak q4 Ave'.
PERMIT �05 �AD13#___�DATE INSPECTED___j
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:
-GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
I
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date— Sign
ocapn,l.doc.l:tenip:bldg:fonnsIO/OI
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
07-
SETBACKS ....................
FOUNDATION:
2
Footing ......................
Wall .........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground ............. .
Rough -In ..............
Commercial Final
HEATING:
Gas Test
Gas Piping
Equipment ..: ..............
Commercial Final
EXTERIOR SHEATHING
NAILING .......................
FRAMING ............ I ...........
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
to -WO
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .............. .
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