20020951.pdfDATE RECEIVED
PERMIT E PIRES
L x
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
'VSE PE M T
ZONE UR
N M BE R -
B SUIT
JAC RESS
Do
ER NAMEINAX al N17
C ,
C' 17 CL 411564
PILAT NAMEISUBDIVISION No,
I LOT NO
LID NO.
Lt. FEE I
—
ING A Do HESS
r 12�r5 _�_f
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
—
EXISTING PROPOSED
alw.Z111.111
almor —
m._omAm
ale —
A ZIP I TELEPHONE
L-41'V'11L
)L
ADDRESS
I -'-_C4 X_
-ITY, ZIP ITILEPHONE
ADDRESS
:Z�
CITY '/ X/ ZIP TELEPHONE
REQUIRED DEDICATION----- FT
METER SIZE
'3 h
LINE S
IlIZE
I
NO. OF FIJURES
P
Y�S'VIWIEI
Me C3
REMARKS
OWNERICONTRACTOR
RESPONSIBLE FOR EROSION CONTROUDRAINAGE
PROPERTY TAX ACCOUNT
�_- —10 T -_
PARCEL NO.
0? --' /
'76 Pe
XNEW
% RESIDENTIAL
;gPLU..I..I.ECII
rl ADDITION
rl COMMERCIAL
0
INFLAME OR
rl CCH)ANGE
OF USE
REMODEL
f-I MULTIFAMILY
0
SIGN
A PAIR
EPAIR
2L
C. Fn
DEMOLISH
rl TANK
El OTHER
GAR E
RETAININGWALL
0 F RE SP13INKLER
g CAPPO
ROOKERY
FIRE ALARM
(i OF USE. ;��IVITY) EXPLAIN:
NUMBER
IIIIIR IF
-`UTCA;�O� I
104
OF
LIWELUNG
AR15AS.
STORIES
UNITS
UMBE '4
N W'17
M
DESCRIBE WORK TO BE DONE
ENGINEERING REVIEWED BY
k
102—
�1
_
FIRE REVIEWED BY
DATE
SHORELINEORADBN
INSPECTION
SON
=U I
Fv ;$
POSTED
E3YES
NO:
SEPA REVIEW
SIG AREA
HEIGHT
EIIMP
COMPLETE T
A
1�7;�
A�o P.
Ij
:XP X
ITK 1
1
T C
0 T COV BE
REQUIRED SETBACKS (FT)
PROPOS D SETBACKS (Fr.)
ALLOWED POSED
.;55,
I SIDE REAR
;D I
FRONT V�J;oEt RJE;�
L
P#KING I
LOT AREA I PLtAIIIAG REVJtWE0
Iffl/ &TE
CHECKEDBY ITYPEO!jr I -C U" ��
__VN I C 7 11 �Z:'
GROUP
SPECIAL INSPECTION JAREA f4 P OCCUPANT
FEOUIR51) 0 Yes LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
--jr—n
A 0 jilt [?
1 1*�1611160
I
Descriptlon
FEE
DesubriptIon
FEE
Plan Check
State Surcharge
HEAT SO GLAZING % LOT
��PV
L D
Building Permit
r
city Surcharge
PLAN CM VESTED DATE
Plumbing
!b2
:k
mechanical
ql -
THIS PERMIT AUTHORIZ 'MMCOVERSWORKTO
I: B DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
/7,()
ETC) W
DOMAIN (CURBS, SIOEWAUIXS, DRIVEWAYS, MARQUEES, ILLREG IRE
u
SEPARATEPERMISSION. - __jEngr.
Review
PIE MITAPPLICATION: INDAYS
PERMIT LIMM I YEAR- PROW ED WORK IS STARTED WITHIN 1 80 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS 08 HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
7pcbl,..p..n
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
—
-
EDMONDS , WASHM.N. HIS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Receipt If
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SPA E
CITY LL NOT BE
I C
DIEMIDJO M0DI1Y,'WAVV.E OR REDUCE ANY REQUIREMENT OF ANY ORDINANCE
Landscap a Insp.
Total Arm Due
at NOR 'M IN ANY W T CON's AGILITY TO ENFORCE ANY ORDINANCE PROVISION..
Recording Fee
R ... ipt III,
I HERE ACKNOWLEDGE THAT I HAVE RE D THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED
APPLICATION APPROVAL
JAGENTOF
THE OWNER. I AGREE TO COMPLy WITH CITY AMD STATE LAWS REGULATING CONSTRUC.
CALL
This application Is not , permit until signed by me
Lo
ION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
Building Olficlat a, hialhor Deputy: old Fees Ire paid, and
FOR INSPECTION I ... lot I—Inmeltutgrel In are. P1.1dd.
ORK IN SURANCE AND RCW 18.27�
— v
W29 0 A DATE SIGNED
(425)
OF AL IGNATURE DATE
�EN
Ll
k771-0220
�11
R "OAT
ATTENTION
Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC, SECTION 109
PINK -OWNER - GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN -ACCOUNTING
z
0
ITI
1171 1 1 1
0
0
C:
M IT
co
0
ITI M
0'-
0
C
M CO)
IT 0
z
Cl)
z
0
=j
0
TI
Height Calculation Worksheet
Address:
Date: I t 4-
invec'to s):
1. Datum Point:
2. Datum Point Elevation: 00 -3
0
O�
M.
ge Grade: C,-� -
3. Averag
4. Maximum Elevation Allowed: ?-�averag. grade) 2 5
Ma
5. Reference Point Elevation Shot to House:
-10,
0�
0
(datum elevatign) + 4,o 3 (grade to transit level line shot to house) =1
PH
M
iK,
0,
6. measurements from line shot onto house to roofridge:'
C-
Z
M M
.0
0
10
Totd:.
Z;
0
-4.
5
M
7. Actual Elevation: i (reference point elevation) 4� 6 �-I-(measurements
from #6)=
ass than (allowed); therefore the house Is/
(actual) Is greater /(-::a 7thi
is not over the height requirement per ECDC 16.20.30 requirements
FINAL PROJECT APPROVAL FORM
TO:
DATE:
mEmo To: PERmrr COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTNIENT DATA—
�(L9,Ga DIVISION DATE-��A P
_—ENGINEERING
�OM
z
0
PLANNING DIVISION DATE—
0
PROM CT.--tA I Ai o r�
V5
0 M
a
srrEADDREss
rn 0
0
PERmrr# iq Ail)B# INSPECTED 1(0 103
0
8C
-4 r.
---DATE
MM
DESCRIPTION OF WORK TO BE INSPECTED
Mz
10
C
A fleld inspection was conducted to determine imal compliance with approved plans.' Final approval
9;
denotes that there are no objections from the above signed Department to the release of
BONDS the
0 -r!
n �
PERFORMANCE and granting of:
M M
GRANT FINAL PROJECT APPROVAL
U5
0 r-
0 M
C
ca
9 Zn
M 0
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
z
u Copy of CONDITIONS given to owner/contractor by inspector
co
z
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
M
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign,
ocaprvl.doc.l:temp.bldg:fom)slO/01