20020797.pdf-7N
GARY HAAKENSON
CITY OF EDMONDS MAYOR
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121 5TH AVENUE NORTH EDMONDS, WA 98020 (425) 77 1 -0220 FAX (425) 771 -0221
Website: mAv.d.edmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
September 21, 2005
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Khuong H. Nguyen
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PO Box 33214
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Seattle, WA 98,133
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Re: Building Permit # 2002-0797
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Issue Date 10/11/02
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According to City of Edmonds Building Divis ion records the subject building pei will
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expire Oil 10/11/05 without obtaining the req u i rec I final inspections. Fii ial inspections are
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required pursuant to Edmonds Community Development Code, S ection 19.00.005 and
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include both' Engineering and Building Division inspections. If the permit, expires you
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must obtain a new permit with full fees. in order to complete the w ork and call for your
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final inspection(s).
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als lease
I f City records are incorrect and the job card indicates final inspection approv p
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provide a copy for City records. If your records concur that no final i s ),ectio s ave bee
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lie 2003 1 n
y U I using t ternational
granted o -nust remit fees with a new permit application
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Building Code within� 10 days of 10/11/05. Failure to respond shall result in this matter
being turned over to Code Enforcement for resolution and possible legal action
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If you have any questions please feel free to call our offices at 425-77 1-0220.
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Thank you,
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JoAnne Zulauf
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Permit Coordinator
i,:rren1li/DS1"s/Exl)ired I)ernlit 10/00
Incorporated August 11, 1890
Sister City - Flekinan, Japan
CITY OF EDMONDS
DEVELOPMENT SERVICES DEPARTMENT
121 5th Avenue North, Edmonds, WA 98020
(425) 771-0220
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Location of Violation (Address and Tax Account Parcel No): 7213 Lake Ballinger Way, Edmonds,
WA 98026 Tax Account Parcel No. 48880800200
Issued To: KHuong H. Nguyen, Proverty Owner
Address Of Person This Order Is Issued To: 7213 Lake Ballinger Way, Edmonds, WA 98026
Code Section Violated:. Uniforrn Building Code Sections 106, 108 & 109 and Edmonds Communit
Development Code Chapter 19.00.005 (A) (6) (b).
Description of Violation: Failure to obtain all required inspection approvals including, final approval of
construction permit by JanuaKy 14, 2006.
Background Information: On 10/11/02 Mr. Nguyen obtained a building permit (reference #2002-
0797) to add a two stoEy addition/g-arage to his existing home. Mr. Nguyen renewed his pen -nit (as
permitted by the code) in 2003 and 2004 and was given a final building pen -nit expiration date of
October 11, 2005. Mr. Nguyen failed to obtain reqjftred inspection apnrovals by this date but did obtain
a limited building pennit that granted him until Janua!y 14, 2006 to finish the remaining work and obtain
all required inspection approvals.
Corrective Action Required: Complete work under authorized permit and obtain all required
inspection approvals by Janua!y 17, 2006. Failure to adhere to this Order shall result in the following
action: Issuance of a Notice of Civil Violation and imposed fines of $100.00 per day until all inspection
=rovals are granted.
Correction is Required no later than: 5:00pm (time) January 17, 2006 _ (date)
If correction is not made by the date and time specified in the Order, a Notice of
Civil Violation shall be issued. The Notice of Civil Violation shall assess fines of
$100.00 per day, or portion of a day, during which the violation continues.
Date Posted:
Issuing Party--j
Signature
Date Mailed: January 5, 2000 Date Served
Grat' Title Building Official
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CITY OF EDMONDS
DEVELOPMEN'r SERVICES DEPARTMENT
121 5th Avenue North, Edmonds, WA 98020
(425) 771-0220
ORDER TO CORRECT VIOLATION
Location of Violation (Address and Tax Account Parcel No): 7213 Lake Ballinger Way, Edmonds,
WA 98026 Tax Account Parcel No. 48880800200 .
Issued To: KHuong H. Ngmyen, Property Owner
Address Of Person This Order Is Issued To: 7213 Lake Ballin er Way, Edmonds, WA 98026
Code Section Violated:. Unifon-n Building Code Sections 106, 108 & 109 and Edmonds CommunLty
Development Code Chapter 19.00.005 (A) (6) (b).
Description of Violation: Failure to obtain all required inspection approvals including final approval of
construction permit by jang= 14, 2006.
Background Information: On 10/11/02 Mr. Nguyen obtained a building pennit (reference #2002-
0797) to add a two stom additionlgarage to his existing home. Mr. Nguyen renewed his Pennit (as
pen-nitted by the code) in 2003 and 2004 and was given a final building Pennit expiration date o
October 11, 2005. Mr. Nggyen failed to obtain required inspection approvals by this date but did obtain
a limited building pennit that granted hiln until janua!y 14, 2006 to finish the remaining work and obtain
all required inspection approvals.
Corrective Action Required: Complete work under authorized Pem-1 t and obtain all required
inspection approvals by JanuaKy 17, 2006. Failure to adhere to this Order shall result in the followin
action: Issuance of a Notice of Civil Violation and imposed fines of $100-00 per day until all inspection
approvals are granted.
Correction is Required no later than: 5:001)111 (time) January.,0,'-2006 ���ate)
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If col-l-ection is not made by the (late and time specified in the Order, a Notice of
Civil Violation shall be issued. The Notice of Civil Violation shall assess fines Of
$100.00 Per day, or portion ofa day, during which the Violation continues -
Date 13osted:
Issiihig I)arty---jeantli
Sigilature
Date Mailed: January 5, 2006 Date Serve(l
Title Buildhig Official
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9
SINGLE-FAMILY RESIDENTIAL
SHORELINE SUBSTANTIAL DEVELOPMENT PERMIT
EXEMPTION
project Location: 7213 Lake Ballinger Way, Edmonds
Applicants: Khuong H. Nguyen
Project Description: Remove existing shed and construct a 3'300 square foot addition to an
existing house, including a 600 square foot garage. Project also involves
total grading of approximately 210 cubic yards of material, removal of an
underground oil tank, and placement of an above ground oil tank.
Applicant will also be doing work under an approved Mitigation Plan to
remove an invasive species (yellow iris) by hand from the lake shore along
this site and replant with native species.
See Attached: 0 Site Plan 0 Elevation
Plan Check Number: PC-02-262 and CA-2000-196
Date Issued: September 12,2002
SEPA Determination: Determination of Nonsignificance, appeal period expires September 27,
2002
Issued by: Meg Gruwell, Senior Planner
The above project has been determined to be exempt from the requirement to obtain a Shoreline
Substantial Development Permit under WAC 173-27-040(2)(g), which states:
Construction on shorelands by an owner, lessee or contract purchaser of a single-family
residence for their own use or for the use of their family, which residence does not exceed
a height of thirty-five feet above average grade level and which meets all requirements of
the state agency or local government having jurisdiction thereof. "Single-family
residence" means a detached dwelling designed for and occupied by one family including
those structures and developments within a contiguous ownership which are a normal
appurtenance. An "appurtenance" is necessarily connected to the use and enjoyment of a
single-family residence and is located landward of the ordinary high water mark and the
perimeter of a wetland. On a state-wide basis, normal appurtenances include a garage;
deck; driveway; utilities; fences; installation of a septic tank and drainfield and grading
which does not exceed two hundred fifty cubic yards and which does not involve
placement of fill in any weetland or waterward of the ordinary high water mark. Local
circumstances may dictate additional interpretations of normal appurtenances which shall
be set forth and regulated within the applicable master program. Construction authorized
under this exemption shall be located landward of the ordinary high water mark;
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Robert Fritzen, Shoreline Planner with the bepartment of Ecology, has stated that this has been
interpreted to include additions and remodels to existing single-family houses, provided that they
are normal appurtenances to single-family dwellings.
This exemption is not being sent to the Department of Ecology because it appears to City staff
that it is not subject to U.S. Army Corps of Engineers section 10 permit under the Rivers and
Harbors Act of 1899 (the provisions of section 10 of the Rivers and Harbors Act generally apply
to any project occurring on or over navigable waters. Specific applicability information should
be obtained from the Corps of Engineers.) Nor does the project appear to City staff to require a
section 404 permit under the Federal Water Pollution Control Act of 1972. (The provisions of
section 404 of the Federal Water Pollution Control Act generally apply to any project which may
involve discharge,of dredge or fill material to any water or wetland area. Specific applicability
information should be obtained from the Corps of Engineers.) Robert Fritzen has advised us that
per W . AC 173-27-050, no letter is required to be sent to Department of Ecology.
While this letter provides an exemption from the need to obtain a Shoreline Substantial
Development Permit from the City of Edmonds, it does not evaluate whether other State and
Federal approvals are required and leaves that responsibility to the applicants.
cc: Street file for 7213 Lake Ballinger Way
Shoreline Permit Exemption File
Page2 of2
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SPZCL4J, INSPXCnON5 HAVE BEEN CALLED FOR -ON TMS rpoj= AND
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rr PERMIT IT. IT IS THE OWNER ANDIOR CONTRAI&MRS RMONSIBELITY
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FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002
MICROFILM ELEVATION CERTIFICATE
Important: Read the instructions on_Rages I - 7.
SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use:
BUILDING OWNER'S NAME, Policy Number
'< " el c4,N(n 14(l Ll Vf 44
BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number
`7 2-1 3 L-A iC- C Z,14 L LrAb', t=_ 2 C.41A V
CITY STATE ZIP CODE
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PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
-",X / 4.-) n 6 18 RA n r, 5;� nn -1_,-)n
BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use Comments section if necessary.)
LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: 1_1 GPS (Type):
##'-##'-##.##" or ##.#####*) Z� NAD 1927 1_1 NAD 1983 1_1 USGS Quad Map -I;I< Other: i��kW
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SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3.STATE
1t;M046Kt'.� i-( (�!ccz-iJIY 5 qe� R.
4-JA5 4 ii,16—ibiq
B4. MAP AND PANEL
B5. SUFFIX
B6. FIRM INDEX
B7. FIRM PANEL
FLOOD
B9. BASE FLOOD ELEVATION(S)
N 5 M B E R
DATE
EFFECTIVE/REVISED DATE
�
ZONE(S)
(Zone AO, use depth of flooding)
:530(o&p i315-
A/
o0.8 11179
A
B10. Indiclte the source ot the Base Flood Elevation (BFE) data or base flood depth entered in B9.
1_1 FIS Profile 1_1 FIRM 1_1 Community Determined 1_1 Other (Describe):
B1 1. Indicate the elevation datum used for the BFE in 139: JX� NGVD 1929 1_1 NAVD 1988 1_1 Other (Describe):
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 1_1 Yes bL--,l No
Designation Date:
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: 1_1Construction Drawings* )ICIBuilding Under Construction* I
_lFinished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Building Diagram Number _:� (Select the building diagram most similar to the building for which this certificate is being completed - see
pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.)
C3. Elevations - Zones Al-A30, AE, AH, A (with BFE), VE, V1430, V (with BFE), AR, AR/A, AR/AE, AR/Al-A30, AR/AH, AR/AO
Complete Items C3a-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from
the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion
calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion.
Datum Conversion/Comments ,12=222= � ' q S N z.��t
Elevation reference mark used d iTY-e, Qoes the elevation reference mark used ap ar on the t!,R�Yes K1 0
0 a) Top of bottom floor (including basement or enclbs-uFd�� 'Z cd'7 La— (9 - (m)
El b) Top of next higher floor ft. (m) 10 WA
0 c) Bottom of lowest horizontal structural member (V zones only) ft.(m)
0
C] d) Attached garage (top of slab) ft-(M) _E0
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0 e) Lowest elevation of machinery and/or equipment
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servicing the building fl.(m) -OE
C) 0 Lowest adjacent grade (LAG) ft. (m) Z I S J!�
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• g) Highest adjacent grade (HAG) 06 ft.(m) L k. Mk\�
• h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade
El i) Total area of all permanent openings (flood vents) in C3h sq. in. (sq. cm) �i EXP!R',:S 11124163
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
/ certify that the information in Sections A, 8, and C on this certificate represents my best efforts to interpret the data available.
/ understand that any false statement may be punishable by fine orimprisonment under 18 U.S. Code, Section 1001.
CERTIFIER'S NAMEe -3
LICENSE NUMBER
4,5
TITLE COMPANYNAME 4,19A)JI -51:-1 -Z G16 IJ6
ADDRESS CITY STATE ZIPCODE C.;J'ndu
7- AZ- A)ds c-J4 0:7,
SIGNATURE DATE TELEPHONE 41:Z -
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FEMA Form 81-31, AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
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IMPORTANT: In these spaces, copy the corresponding information from Section A. For Fnsurance Company Use:
BUILDING STREET ADDRESS (including Apt., Unit, Suite -,and/or Bldg. No.) OR P.O. ROUTE AND BOX NO, I Policy Number
CITY
STATE
ZIP CODE I Company NAIC Nu
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent1company, and (3) building owner.
COMMEN
dc 5 riec-1 7
,L/,6,1J L Y
LA16f & LL YA)KCZ
Check here if aftachments
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO and ZONE A (WITHOUT BFE)
For Zone AO and Zone A (without BFE), complete Items El through E3. If the Elevation Certificate is intended for use as supporting
information for a LOMA or LOMR-F, Section C must be completed.
El. Building Diagram Number _ (Select the building diagram most similar to the building for which this certificate is being completed —
see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.)
E2. The top of the bottom floor (including basement or enclosure) of the building is 1_1_1 ft.(m) 1_1_lin.(cm) 1_1 above or 1_1 below
(check one) the highest adjacent grade. IN
E3. For Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's
floodplain management ordinance? 1_1 Yes 1_1 No 1_1 Unknown. The local official must certify this information in Section G.
SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owners authorized representative who completes Sections A, B, and E for Zone A (without a FEMA-issued or
community -issued BFE) or Zone AO must sign here.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS
CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
1_1 Check here if attachments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete
Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below.
G1. 1_1 The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor,
engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the
elevation data in the Comments area below.)
G2. 1_1 A community official completed Section E for a building located in Zone A (without a FEMA-issued or community -issued BFE) or
Zone AO.
G3. 1_1 The following information (Items G4-G9) is provided for community floodplain management purposes.
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-2-00 Z-70 7
ISSUED
G7. This permit has been issued for: 1_1 New Construction 1_1 Substantial Improvement
G8. Elevation of as -built lowest floor (including basement) of the building is: ft.(m) Datum:
G9. BFE or (in Zone AO) depth of flooding at the building site is: ft.(m) Datum:
LOCAL OFFICIAL'S NAME TITLE
J,CAW,v,A,V,-- 4 61Z
GuivimuNiiY NAMt TELEPHONE
SiGN ATU RE DATE /2- -,40 2-
Check here if attachments
FEMA Form 81-31, AUG 99 REPLACES ALL PREVIOUS EDITIONS
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CONFORMED COPY
CITY CLERK 200210281593
CITY OF EDMONDS 10/28/2002 04:51 PM Snohomish
121 5TH AVENUE NO. P.0001 RECORDED County
EDMONDS, WA 98020
STATEMENT ON ACCESSORY DWELLING UNITS
GRANTOR:
Property Address: 7 -?- rS L 14 --4
Edmonds, Washington
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GRANTEE: 0-F "�
QF��( nicc'ld 1',-)
Assessor's Parcel Number: qff? 09, oo-loa
I have read the requirements for accessory dwelling units contained in Chapter 20.21'of
the Edmonds Community Development Code (ECDC) and understand that an accessory
dwelling unit, including a second kitchen, as defined in ECDC Section 21.05.015 is
prohibited until an Accessory Dwelling Unit Permit is approved.
I also understand that an Accessory Dwelling Unit Permit cannot be approved unless all
the criteria in Chapter 20.21 are met, and all the necessary items are submitted,
including an affidavit of occupancy and a covenant to be filed with the Snohomish
County regarding the regulations imposed on Accessory I)welling U
___gits.
Property Owner gignature: 1.1/1111 W-11YI
Property Owner Name (printed): KguoA)A�-A
Date: le-VII /0 Z-
STATE OF WASHINGTON)
COUNTY OF SNOHOMISH)
I certify that I know or have satisfactory evidence thatk/1 4t &A. /t,�
signed this instrument and acknowledge it to be his/lier free and voluntary act f&r the uses and
purposes mentioned in this instrument..
Notary's pressure seals must be smudged. Dated: .1)&6046- 20d
Signature of
Notary Public:
rcE�CARL-A RAYMOND
N NOTARY PUBLIC Residing at:
TATE Or- WASI-IINMN My Appointment
,OMMIS8jC)t,4 EXPIRES Expires: 22/—d 3
APRIL-1.3, 2003
THIS DOCUMENT MUST BE RECORDED WITH THE SNOHOMISH COUNTY AUDITOR.
MICR, (')FILIM"
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CONFORMED COPY
C',,'TY CLERK
01 f" OF EDMONDS 200210281592
1 .21 0 H AVENUE NO. 10/28/2002 04:51 PM Snohomish
EDMONDS, WA 98020 P.0002 RECORDED County
STATEMENT ON NUMBER OF DWELLING UNITS
Property Address: -'7,? 13 �Akg_ aA*1hA)r,-r__r Lk)py
Edmonds, Washington
Assessor's Parcel Number: 4Z 9,'0 R o v 0 o.;z c o
Legal Description: I-OTa . Q�E(x4-,,?, p)AI G, n(!�F
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8uLA j o;SkaQ tJ 0, 1 Ac:�o P, b 1 �3& 7 0 D 46, P)_�VT 7 h-g_r�O�F lzacn r-ac-cl 1 t�
VaW/LiF_Q 01: OLKIN, I PA&F-S _57 Atob,2e-� \kA1-4,'ta(,,-tvrJ'
I, the undersigned, have attained approval for a building pennit at the property address above,
to construct a substantial addition to an existing home.
I certify that the use of this addition and the existing home are for the use of my family as a
single-family residence.
I know that only one residential unit is currently allowed in the Single -Family Residential
(RSW-12) zone in which this property.is located. No duplexes or triplexes are allowed in this
zone under current code.
Further, I have read the requirements for accessory dwelling units contained in Chapter 20.21
of the Edmonds Community Development Code (ECDC) and understand that:
no residence. can have more than one accessory dwelling unit;
an accessory dwelling unit cannot be more than 800 square feet;
ail accessory dwelling unit must maintain the single-family residential character;
in no event shall the total number of occupants of the primary unit and the accessory
dwelling unit together exceed one "family" as defi.ned in ECDC 21.30-010;
ECDC 21.30.010 defines "family" as two or more persons related by genetics, adoption, or
marriage, or a group of five or fewer persons who are not related ...
A permit is required to allow an Accessory Dwelling Unit.
This statement is an acknowledgement of the current limitations of city code. Nothing herein
shall be interpreted to create a contractual obligation or private enforcement rights or
obligations. A 10 F-_ /
Property Owner Signatu
Print Nam
Property Owner Signature:.
Print Name:
Date: 11,z) 1/0/
STATE OF WASHINGTON
COUNTY OF SNOHOMISH)
I certify that I know or have satisfactory evidence that k k4 g 0 eJ c, tQ 6 0 Y o- fJ
signed this instrument and acknowledge it to�be his/her free and voluntary act for the uses and
purposes mentioned in this instrument.
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Notary��,Rjj�jkuih W�smust be smudged. Dated: 7 —43
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I Signature of
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01 t4OT Notary Public:
Apy
PLIBLIC 01 Residing at:.
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My Appointment
c1r.. Expires:
WAS
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THIS DOCUME NT MUST BE RECORDEDWITH THE SNOHOMISH COUNTY AUDITOR.
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINKroR, BUILDING DIVISION
FROM: FIRE DEPARTMEN'r DATE
PLEASC SIGN
ENGINEERING DIVISION DATE
�111A H S 11
PLANNING DIVISION DATE
PROYECT /V/,/
SIT.EADDRESS /5-4Z*
PERMIT 4,20CZ.— (07�9]Z ADBY DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED ev-2q
A field inspection was conducted to determine compliance with -approved plans. Final apprioval
denotes that there are no objections from the -above signed Department to the release of
PERF ORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by inspector
FAfLED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy ofCORRECTION NOTICE given to owncr/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
bate Signature
I:teiiii):I)Idg:foritis:ocal)rvI 3/25/04
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PIXASII SIGN
ENGINEERING DIVISION DATE
I'LEASESIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT
SITE ADDRESS
PERMIT# 0 --717 ADB# DATEINSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine 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
11 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
El Copy of CORRECTION NOTICE given to owner/contractor by inpector
I
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:ten1p:b1dg:ronns:oca1)rv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
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 ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
17-
OCCUPANCY ..................
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DATE RECEIVED
PERMIT EXPIRES
C I --- . I I -_ -
USE PERMIT
ZONE
CITY OF EDMONDS � � )-" kx-' NUMBER
'JOB 11 . I SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS -7 1 -A
OWNER NAME/NAME OF BUSINESS
PLAT NAME/SU BDIVI SION NO. LOT NO. LID NO.
LID FEE $
cc MAILING ADDRESS 4 1
111 TESCP Approved 0
z PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW Permit Required 13
R. 71 f
0 1 -)e I ---), , - , -- �._ _1/ Street Use Permit Roq'd 0
CITY ZIP TELEPHONE EXISTING - PROPOSED inspection Required 0
Sidewalk Required E3
Underground
REQUIRED DEDICATION- FT Wiring required
'mall
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV,REQUIRED
YES)!� NO 13
W
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t: ADDRESS REMARKS z
x OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROIJDRAINAGE a
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CITY ZIP TELEPHONE
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NAME
/Aj(,`).;Q ENGINEERING REVIEWED BY D
Ir AODRESS 1_�
FIRE REVIEWED BY DATE LU
CITY ZIP TELEPHONE
0 2_2,6-1-,
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VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY flEO'D POSTED
I QyE S
- SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
, L_>, IV N
oo 41-0 0 E it7
XP 1)/Z714A
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS IF
NEW RESIDENTIAL PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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COMMERCIAL COMPLIANCE OR y)34 -2
ADDITION F-1 CHANGE OF USE 35-7o 1;� -791 15' 10 35) -q 2- -4 1 z
L9 PARKING LOT AREA I PLANNING REVIEWED BY DATE n
REMODEL MULTIFAMILY ED SIGN REO'D I PROVIDED CL
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GR� FENCE 1 4 1
REPAIR CYDS ( X Fr) REMARKS o.
T7 - (,, ,>� 41 to"i-e-11 oli.A I
El DEMOLISH TANK I b7 F] 0 HER
GARAGE E] RETAINING WALL FIRE SPRINKLER
z 154 CARPORT ROCKERY El FIRE ALARM
(TYPE OF USE, BUSINESS OR A IVITY) WLAIN:
TYPE OF CONSTRUCTION _T9pE OCCUPANT
GROUP
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NUMBER MBER OF CRITICAL OCCUPANT
ELLING AREAS SPECIAL INSPECTION
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M OF ilh LOAD
ES ' I c 11�� I/
0 STORIES U N1 S NUMBER REQUIRED _0 2
YES
DESCRIBE WORK TO BE DONE 9
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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VALUATION umc ft
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$ C1
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;e7k7A-P -T-E -,L 4� eaD T6 Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE ING % LOT SLOP
City Surcharge
< Building Permit 7?
Txt- it 1?I/r,
HECK NO- VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK To
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS Engr. Review
W
IL PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit t_�� --71—
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Z7.
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIREC I LY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapeinsp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMEN I OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY THE CITY'S ABILITY 10 ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee 2 Receipt #
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 AUNIORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITI I CITY AND STATE LAWS REGULATING CONSTRUC. CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged fit space provided.
WORKMEV.S-e,0iitNSATION INSURANCE AND RCW 18.27.
OFF IALS SIGNATURE DATE
SIGNATU E (425)
� L(N E R 0 R/A DATE SIGNED
R E L'IE Aj�t
771-0220 DXT E I
ATTENTION/ E)ff 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSO11
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall.......................... _MS LC
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Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
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Underground ............. ITI 0
Rough -In ................... 0 C
Commercial Final ...... M
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HEATING:
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Gas Test ....................
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Commercial Final .......
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NAILING .......................... co
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FRAMING ........................ Z
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Ceiling Insulation ....... 0
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SHEETROCK NAILING ... M
? SPECIAL INSPECTION ...
MISCELLANEOUS .........
FINAL APPROVAL FOR
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