20030202.pdfDATE RECEIVED
[PERMIT r:xPIRESE51 i 4k�4
CITY OF EDM;NDS
USE PERMIT
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CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS
DIENER
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PUBLIC RIGH-400-WAY PER OFFICIAl STREET MAP
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RW Permit Required
EXISTING — PROPOSED
street Use Permit Roq'd
Inspection Required E3
Sidewalk Required Ell
CITY ZIP
TELEPHONE
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REQUIRED DEDICATION- FT
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NAME
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NO. OF FIXTURES
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REMARKS
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STATE LICENSE NUMBER EXPIRATION DATE
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PROPOSED SETBACKS (Fr.)
FRONT UR SIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL
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PARKING
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LOT AREA
PLANNING REVIEWED BY DATE
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CYDS ( _ X _FT)
REMARKS
DEMOLISH �ANK OTHER
RETAININGWALL FIRE SPRINKLER
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CHECKED BY I
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Description
FEE
Descrip)(on
FEE
Plan Check
State Surcharge
,-KEAT SOURCE G LO T St.
�3PNG % 'il OPE % Building Permit ;7b City Surcharge
PLAN CHECK NO: VESTED Plumbing
60 77La-
- Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I-. BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
Grading
I lu
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. - Engr. Review .0
L2
PERMIT APPUCATION: ISO DAYS
PERMIT UMIT 1 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 # 44 1A (9
ALL CLAJMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION." --[�BCeipt
Recording Fee #
1 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 This application is not a permit until signed by Lho
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 LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided.
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WORKMEN S COMPENSAT19 E
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SIGNAT�U�RNIE 0 '�.�S 23 NCE AND RCW 18.27. DATE SIGNED (425) 0 CIA 5 IJAT
106
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771-0220 REQ
AT TEf 9 Off 1333
IT 191 LX%WAFUL 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 -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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Height Calculation WorlArwheet
Address: n-If LP
Date:
hWector(s):
1. Datum PointJOL, C\ pi
2. Datum Point Elevation:
3. AverageGrade: P
A. Maximum Elevation Allowed:T.2� �-averagb giade)-* 259"'—'- '36 (,0, -3(0
5. Reference Point Elevation Shot to House:
7450-7(datum elevation) +5,.4-' :� (grade to transit level Kne'shot to house)
6. Measurements from line shot onto house to roof ridge:'
Tot1d . —7
-7
n) + (measurements
7. Actual EIPUROOT (reference point elevatio
from #6) V5, 9 -7
Conclusion:
(actual) is greater Cless-�&An (allowed); therefore the house isl
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is not over the height requiremen�CDC 16.20.30 requirements
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FINAL PROJECT APPROVAL
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BURLDING DIVISION
FROM: —FIRE DEPARTMENT DATE
PLZAWSW
rnkLAet—_.r ENGINEERING DIVISION DAT
—PLANNING DIVISION DATE'
nZANSM
PROJECT
SrIE ADDRESS— (,0
PERMIT # 2- c- ADB# --_DATE INSPECTED_q
DESCRIPTION OF WORK TO BE INSPECTED (::7�n_aA
A fleld inspection was conducted to determine flnal 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 YaM CONDITIONS NOTED SEP 2
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
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2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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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:
GasTest .................... . .
Gas Piping .............
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING L3
NAILING..........................
FRAMING ........................
F . IRST FLOOR FRAMING... JV Its
o14-o3
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
-7 -T'Q,t.)3
SHEETROCK, NAILING ...
SPECIAL INSPECTION
A
MISCELLANEOUS ..........
FINAL APPROVAL FOR C�
OCCUPANCY ..................
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ERMIT EXPIRES ILI 11-A
E PERMIT
CITY OF EDMONDS ZOSNE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS J�� i
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ER NAMEINAME OF BUSINESS 10L Sto I
or. I -- A- -A- PLAT NAME/SUBDIVISION NO. OTNO LID NO. I
.6r%f_" ft
MAILING ADDRESS
CITY ZIP ITELEPHONE
F,Jr_t�L-4 Wa IUN I 10�<- 14'ZI -oa-15-
NAME 16 rr-r
KCUL'
ADDRESS (I
N 10 1k)4, P1. SE
CITY ZIP TELEPHONE
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NAME NA CBLN
TV
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ADDRESS GAM-C AS Ajaoye,
CITY ZIP I TELEPHONE
1
LID FEE $
PUBLIC RIGH-eOFVWAY PER OFFIC-AAl STREET MAP
' Zed
r1=1IPR ".
tAoet Use Permit RWd
EXISTING - PROPOSED
Inspection Required
Siclowalk Required
REQUIRED DEDICATION- Fr
underground
Wiring required 13
METER SIZE
LINE SIZ7E
NO. OTURES
PRV 5EQUIRED
YESK NO 13
REMARKS
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
1I1q0a;"00c;,
0AM-n, (LT OF Eywo 00?D-C�'Ozm
Lov
6MVINCI (rn)f*A1,
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
Z197
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STATE LICENSE NUMBER
'A,e+ C. 0L. "�,
_9
'?�5TAXkACC.5p
42
L NO.
EXPIRATION DATE CHE KED B
NA I h) 14
05 EXP
VARIANCE OR CU
V-?'al - / 76
SHORELINE OR ADB#
INSPECTION
RE'D D
[3YES Oro
BOND
POSTED
1 $
SEPA REVIEW
COMPLETE , EXEMPT
V-111,
SIGN AREA
ALLOWED , PROPOSED
(0
HEIGHT
ALLOWED I PROPOSED
2.7-13 Z'7- 1.3
Jk0'
NEW
0 ADDITION
WRESIDENTIAL
COMMERCIAL
A�PLUMBING / MECH
COMPLIANCE OR
El CHANGE OF USE
LOT COVERAGE
ALLOWED PROPOSED
35% 3517.
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
1 U G' /5
PROPOSED SETBACKS (FT)
FRONT - LIRSIDE REAR
12�i 5 25 z
PARKING
REO'D I PROVIDED
Z_ z
LOT AREA
PLANNING REVIEWED BY DATE
rl REMODEL
REPAIR
MULTIFAMILY
CYDS'
[3 SIGN
FENCE
El ( - X -FT)
REMARKS
DEMOLISH
TANK
[:] OTHER
Alk Alk
M M N MM
Minn
Ul
1! 1 11
)qZL,dRAGE
LakCARPORT
RETAINING WALL [3 F:RE SPRINKLER
ROCKERY F RE ALARM
-(TYPE OF USE, BUSINESS ORACTIVITY) PVLAIN:
M NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS I I NUMBERI6&Zb'��
DESCRIBE WORK TO BE DONE X1 le, - - t"%
0 W-A-111111i a n W*-. -1 iv"Ff_� IIIII MOM z W, fe 19
M W_ 001. 1.11 -4 — i
,.HEAT SOURCE GIWING %
(7�* 1 �S�m r fLt.± I
PLAN CHECK NO: - _y r% , � I VESTED
I K ) _: � I — &)& —/_ I
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBILIC
2
:I DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPAhATE,PERMISSION.
15 PFRMITAPPILICATION: 180DAYS
CL PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, 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
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
I HERgI3Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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-
TION; 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
WORKMEN'S COMPENSATISWN'S03 NCE AND RCW 18.27.
SfbNATURP011_NyVr- DATESIGNED
CHECKED BY
I TYPE OF j=UCTION
C
GROUP
SPECIAL IN�P�CTION
JAREA
-71
OCCUPANTWI
LOAD
REQUIRED
19
YES
1,/,,S
REMARKS
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PROGRESS
INSPECTIONS PER UBC I 08/FINAL INSPECTION REG-0
__ . I j1__ 0-- 10M
VALUATION osix Lvri6L
/'Ov - I — i A e5i.
Description
FEE
Descripdon
FEE
Plan Check
jqTj
State Surcharge,
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
I TU
Engr. Review
50
Engr. Inspection
300—
Fire Review
PlanChk.Deposit
Fire Inspection
Receipt #
A i
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
1A0
x,25)� J
7710220
APPLICATION APPROVAL
This application Is not a permit until signed by the
Building Official or his/her Deputy; and Fees are paid, and
recelpt Is acknowledged In space provided.
0 F;F j MIN IJATE
I I , GIN
VIL 4 Ul 0
-R'ELdASFQM ATE
Y—)
EXT 1333
0 USE OR OC UPY A BUIVDING 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 - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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