20030071.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME BUSINESS
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CITY ZIP TELEPHONE
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NAME
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PERMIT EXPIRES
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PLAT NAMEISUBDIVISI N 0
LOT NOj,&'
D NO.
L�D
FEE $
PUBLIC RIGHT 01� WAY PER OFFICIAL STREET MAP
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TESCIR Approved
RW Permit Required
Street Use Permit Roq'd
EXISTING PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION—
FT
Underground
Wiring required
METER SIZE
3
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
13 K
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YE NO
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE
FOR EROSION CONTROL/DRAINAGE
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ADDRESS
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DATE
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ITY ZIP
TELEPHONE
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6TaE LICENSE NUMBER
EXPIRATION DATE CHECKED BY
VARIANCE OR Cu SHORELINE OR ADB#
INSPE TION BOND
REO'D POSTED
11,-ILP_113716�
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HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWEID PROPOSED
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EXP
NEW VT RESIDENTIAL
PLUMBING MECH
LOT COVERAGE REQUIRED SETBACKS (IT) PROPOSED SETBACKS (Fr.)
ALLOWE� PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
ADDITION COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
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SIGN
PARKING LOT AREA PLANNING REVIEWED 13Y DATE
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REPAIR CYDS
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DEMOLISH TANK
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FIRE SPRINKLER
ALARM
CARPORT ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN/,
FIRE
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CHECKED BY TYPE OF DNS CTION
SQDE OCCUPANT
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NUMBER NUMBER OF
OF DWELLING
CIfITICAL
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SPECIAL INSPECTION JARI
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OCCUPANT I
LOAD
STORIES UNITS
NUMBER_;W
REQUIRED YES
CaII
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG'D
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VALUATION
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Description FEE
Description FEE
Plan Check
State Surcharge
Hg6T SOYFICE
GLAZING %
LOT 8 PE %
Building Permit
City Surcharge
PLAA CHECK
VESTED DATE
Plumbing
1
1.9—
Mechanical
.71A
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
33
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPUCATION: isooAys
PERMIT UMIT 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
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
F ROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
a risp.]
Total Amt. Due
ig
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
Recording Fee
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 AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
Th s 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 VIOLAT ON OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
NSATION INSURANCE AND RCW 18.27.
WORKMEN!S C9LWEI
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Sl AjfENT) —TDATE SIGNED
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771-0220
SED BY_
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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 CEFITIFI-
ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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P.O. Box 1034 VIKING PROPERTIES, INC. Phone 670-2711
Lynnwood, WA 98046. Fax 774-6315
Building in the Scandinavian State hitdOW6
. Tradition of Quality
��s#ntial/Commercial Building & Remodeling DEC 18 2002
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Height Calculation/Grading Verification Worksheet
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Date: ba
A. Datum Point*
B. Datum Point Elevatione.
C. Average Grade: 79A
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4. Reference Point Elevation Shot to Housee
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6. Measurements from line shot onto house to roof fidgeo,
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7. Actual (reference pomet elevation) measurements from
#6)=
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(actual) is greater/ ess (allowed)* therefore the house is/
is not over the height requireme r ECDC 16.20.30 requirements
LegEbOMMMINGMSOHeight CalculationGrading Verification WorksheetAoc
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROK FIRE DEPARTMENT DAT]k_
uamwd lk- ENGINEERING DIVISION DATEA&IJ-Ud
nuilm
PLANNING DIVISION DATE----.:-
PROJE
SITE ADDRESS-- qO 0
PERMIT #_q4o_�L:�462 ADB#--------PATE INSPECTED�__
DESCRIPTION OF WORK TO BE INSPECTED_f����..�.�..
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
GRAM PROJECT APPROVAL WITH CONDM- ONS NOTED
a Copy of CONDMONS given to owner/contractor by inspector
I .
FARM FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
1 .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date
ocaprddoc.1:t=V:bWg:fbrMs10/01
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
.SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pler/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground ..............
M
C= 0
M 0
Rough -In .....................
--10
0 C
11----rcial Final
0
HEATING:
Gas Test . .................... MS 4 -d I -
Gas Piping ....... ...........
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING........................
FI I RSTFLOOR I F RAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
t�kA% VyN
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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I )DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME E BUSINESS
E r I (' � (.4 ki
ING ADDFIESS
x
CITY ZIP TELEPHONE
LV,,7 t) 11t, NOW I Wr�--(7,o -� -7
NAME Ma y c c 12,o J, 1-::2
ADDRESS
CITY ZIP TELEPHONE
t-lat 7L1,',1j W_ q t
NAME L
tl Ti �
( K / A-16- 1 16 7
ADDRESS
P, 0, 90)( Wy
EITY TELEPHONE
_1h 0 V'vv/ 7e0zY'P6' 1 _-) 7//
T LICENSE NUMBER EXPIRATION DATE
v
/%1
CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
00(iModL-0001�x
[0 NEW
NUf RESIDENTIAL
Y4
PLUMBING/MECH
x
7—
0 ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
1:1 REMODEL
13 MULTIFAMILY
SIGN
1:1 REPAIR 13�y CYDS
FENCE x 6 Fn
( Ito
DEMOLISH TANK
OTHER
GARAGE RETAINING WALL
CARPORT ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUS)NESS OR ACTIVITY) EXPLAINrS-r
NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
Oki -'�fva (-/ / rit"lici/e
-/% m -,- /,/ 1- (2 ii'c �y /-I ,
H-WCAW �- cap-
HEAT S RCE GLAZING % LOT !jPE %
'7 ay -
PLAN CHECK 27— _2( VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBILIC
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
_7 —�'
PERWTAPPILICATION: 180DAYS
PERMIT ILIMM I YEAR - FROVPFD ORK 15 STARTED WITHIN 160DAYS
SEE BACK OF Pli# eERMI FOR MORE INFORMATION
'APPLICANT; ON BEHALF OF HIS 6A-9ER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFf, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY �CKNOWLEDGE THAT I HiVE READ T�HIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECE, AND THAT I AM"C- OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLYWITH-OTY AND STATE LAWS REGULATING CONSTRUC.
TION; ANDJN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMENt NSURANCE AND RCW 18.27.
SlAAW)RE [OWNER )OR AfiIENT) _YDATE SIGNED
I ATTENTION
PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB
ADDRESS 0 /0_
SUITE/APT#
LAT NAMEISUBDIVISION No,
LOT N
LID NO.
LID FEE $
PUBLIC RIGHT,7 WAY PER OFFICIAL STREET MAP
7ESCP Approved
Rw Permit Required
EXISTING — PROPOSED -
Street Use Permit Raq'd
Inspection Roquired
Sidewalk Required
REQUIRED DEDICATION— FT
Underground
Wiring required
M ER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
13
YESP� NO
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
1>fe I 1�_ i�i I o d \A aW 'F L R1 .
V—tQA
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ENGINEERING REVIEWED BY DATE
—19 1 (S r) 0 we'_L —(-, 50 '66, ,
FIRE REVIEWED BY .11ALL
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12-71h
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VARIANCE OR CU
SH&ELINE OFIADBO I
INSPECTIOW'I�*'?
BOND
(0-WREO'D
13NO
I POSTED
—
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ES
Is _
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWEP PROPOSED
,
,
a 2) 1 SLA -
EXP
.
LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOS D
'QGAP*0I
FRONT SIDE &EAR
FRONT L/R SIDE REAR
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PARKING
LOT AREA,
I PLANNING REVIEWED BY DATE
R.EOID 1,gOVIDED
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CHECKED BY ITYPE OF_QONSTQUCTION DE OCCUPANT
_)Z: Ll IT-! GROUP)<-3 /1))
SPECIAL INSPECTION AREA . OCCUPANT I
REQUIRED [I YES _1120 t4W,1�11 v, LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
0 — 11 - - I A f A J I J /.-- - - 1�2-_ Ll- -2,,-7-7 J 1:01
VALUATION
s140
Description FEE Description FEE
Plan Check
lCity
State Surcharge
Building Permit 'vj_7�3_,7/2
Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
0 '90-
Total Amt. Due
Recording �ee
Receipt#
APPLICATION APPROVAL
CALL
This application Is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION
receipt Is acknowledged In space provided.
11 G N AT DATE
O�
IA'35)
X-F&I
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771-0220
REL SED BY DATE'
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-
CATE OF OCCUPAN9Y HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
ORIGINAL - FILE YELLOW - INSPECTO
PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
W.
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