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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PUBLIC RIGHTi OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street Use Permit n6q'd
EXISTING — PROPOSED Inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT UndorWound
wiring required
METER SIZE LINE SIZETNO. OF FIXTURES YE PRV REQUIRED
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ARKS
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AREAS SPECIAL INSPECTION JAREA OCCUPANT
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REMARKS
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Building Permit
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VESTEP DATE
PLAN CHECK NO: F, Plumbing
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED- THIS PEERMIT"COVERS, WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMITAPPUCATION: 180DAYS En9r. Review
PERMIT UMM 1 YEAR -PROVIDED WORK IS STARMD WITHIN ISODAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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AP P L 'C 0 N a E HALF OF H
'APPLICAK ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
PIanChk.Deposft
I N I N T E RE S T A R IN
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IN INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
S
ED M 0 N S W A S H IN G T N
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
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Fire Inspection
Receipt #
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L L L M F 0 R D MA
C A GES OF
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM S S A
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FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
EM To M o Y
DE ED 0 IF WAIVE O�
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp.
Total Amt. Due
NOR U IT IN ANY W Y THE Cl
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
Recel
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E A KNO DGE
BY
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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APPLICATION APPROVAL
GIVEN IS FIRE .
Co a AND
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
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THE OWNER. I AGREE To COMPL,
THE OWNER. I AGREE TO COMPLY WITH C17Y AND STATE LAWS REGULATING CONSTRUC'
CALL
This application Is not a permit until signed by the
TIO N . DOING THE % ORK
ION;AND DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid, and
WAND
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IN VIO N OF THE L-WOR CODE OF THE STATE OF WASHINGTON RELATING TO
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FOR INSPECTION
receipt Is acknowledged In space provided.
WOR, E 8 COMPENW N I NCE AND RCW 10.27.
IA IGNA DATE
si R E DATE SIGNED
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IT IS UN(AWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW -IN1PEcj6F1
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/Grading Verification Worksheet
Address: C> ->c') Oc Permit #:
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A. Datum POWU
B. Datum Point Elevation:
C. Average Grade:
3. Maximum Ele4ation AUowedP' I TO grade) + 25?'= 0
4.'. ReferenPe PointElevation Shot to Housi:'
Td4datum elevation)..,+
L'qQ'rade to tra sit level line shot to housb) a—.(
6. Measurements from line shot -onto house to.roof ridge:
Total poll �-9 0
'99 eference point elevation) 4p,9 8
7. Actual ElevatiOn.4 'LS (r _`:_(measurements from
conclislon:
,c;Ze7,.B (,actual) 4 gioniter Mee-ss*`ih;Z?8." � sia—vowed); th4refore the.hodise. lid
is not over the height requirement per ECDC 16.20.30 requirements
LATEb9O8=JNGNh99CM;O& CalcubdonMading Muffimdon Worksheddob
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CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAk (425) 771-0221
Website: wmdedrnondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building *Engineering
September 25, 2003
GARY HAAKENSON
MAYOR
The purpose of this letter is to inform you that the last remaining inspection on your
project is a final inspection(s). The final inspection(s) determines that there are no
outstanding life -safety issues and approval allows the City to close your permit file.
The City considers the final inspection to be one of the most important inspections
conducted on a project. In order to grant final approval the following must be complete:
smoke detectors, house numbers, guardrails, handrails, self -close doors between garage
and residence, egress from sleeping rooms, safety glazing, weather-stripping, any
Engineering department requirements etc. Of course not all of these things may
specifically apply to your project but it does give you an idea about the kinds of things
that must be complete as well as some items that do not need.to be installed such as:
paint, carpet, moldings, wallpaper, etc. Please be advised permits expire one year from
the date of issuance. If you will need more time to complete the work, permits can be
renewed,prior to expiration for one half fees. If the permit expires without a final
I approval granted by the Building Inspector, full fees are required in order to renew the
permit. This can be very costly to you and we strongly encourage you to check your
permit expiration date and call for the required final inspection(s). Note: If more than
one department is required to final your project, this is noted on your Job Card.
Please feel free to contact me at 425-771-0220 if you have any questions.
Sincerely,
Permit Coordinator
Incorporated August 11, 1890
Sister City - Hekinan, Japan
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PERMIT EXPIRES
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CITY OF EDMONDS I q\,s NUMBE��—
CONSTRUCTION PERMIT APPLICATION JOB surrE/Apfo
__ NAMEIN ME OF.VUSINESS ADDRESSL2
PLAT NAME/SUBDIVISION NO. LOT No. LID NO.
I LID FEE S
MAILINCII ADDRESS TESCIR Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP MY PennIt R@wWW
Street Use Permh RW
21P T'LEPHVE EXISTING PROPOSED InspectIon RoqLArod
Sidewalic ReqAked
Underground
x REQUIRED DEDICATION— FT 13
NW;r" METER SIZE LINE SIZE NO. OF FIXTU;7E7�EQUIRED
NO 0
0
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APDRE REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ZIP TFLEPHOUE
CITY 7_7 1 WaMo0c, RAI Z aq OZOMU jO
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NAME CBLN
GINEERING REVIEWED BY- DATE
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FIRE REVIEWED By DA4
VARIANCE OR Cu SHORELINE OR ADS# INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY REQ'D POSTED
10YEq,�<o
SEPA REVIEW SIGN AREA HEIGHT
CE PROPOS
PROPERTY TAX ACCOUNT PAR COMPLETE EXEMP ALLOWED PROPOSED ALLOWED ED
OW NO. 00 1
EXP 75 .1
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%L NEW a RESIDENTIAL PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSE FRONT SIDE REAR FRONT LIRSID, REAR
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ADDITION I COMMER M1% ;;174 :7-s" le"?5I
0 A., G
PARKING LOT AREA �LANI�G REVIEWED BY DATE
REMODEL 11 MULTIFAMI RE(YD PROVIDED
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14 G1"I FE
REPAIR CYDS Mlo?_ 03
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DEMOLISH 11 TANK OTHER 5t��V,
S&P6AS
WAGE RETAININGWALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(qPE OF OR.ACTIVITIQ EXPLAIN:
E., qUSINr
fS 'OCCUPANT
CHECKED BY TYPE OF CONSTRUCTION
N 1BER I NUMBEU OF CRrnCAL ,I 3r59 GROUPJ��
0 DWELLING AREAS _40k y SPECIAL INSPECTION JAREA OCCUPANT
W LOAD
UNITS NUMBER REQUIRED
[]YES
DESCRIBEAORK TO BE
JDONE
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD
Waa 0 7 t dL I
MaW'VL 146- 5F
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
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HPAI SOURCE % LOT PE %
Building Permit 6W City Surcharge 6
110 �s
PLAN CHECK NO: VESTE DATE P44z Plumbing
jj^ I.A>T Age
4z Mechanical
ED. THI 6Q54
THIS PER Arr AUTHORIZES ONLY THE WORK NOT
t: BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIV`EWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMI[TAPPLICATION: 100
PERMfT LIMIT: I YEAR - PROVIQED WORK IS = WITHIN 180 DAYS Engr. Inspection
SFE 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, WASHINGrON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection celp
Re i#
S FO"AMAGES'OF WHATEVER -NATURE,'ARISING DIRECTLY OR INDIRECTLY
F E ANCE IF 11R1 ERUI AN E THIS PERMIT SHALL NOT BE Landscape,16sp.' Total Amt. Due �z
IT SU C OF
22' U AIVE RED Ci AY RE UIRE ENT OF, ANY CITY ORDINANCE
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BE MED D FY Q M
LIM F
IT W , THE C'. ,. To ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION 1
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. CALL This application Is not a permit until signed by the
TION; AN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building OlkW or hbftr Deputy: and Fees are paid, and
IN VIC N OF THE.-L"OR CODE OF THE STATE OF WASHINGTON RELATING TO receipt Is acknowledged In opera provided.
WO . E B.COMPEN )6N>jW1ANCE AND RCW 16.27. FOR INSPECTION
�.� SAI IA GN07, DA . TE
8 A (0 E DATIE SIGNED (425)
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771-0220 RtE�!D BY, T —,./DATE
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ATTENtION1C_-V' EXT 1333 / j J
IT IS UN(AWFUL. 10 USE OR 0CCUrT'XVUdDING OR STRUCTURE UNTIL LLL V91 Ll W / JAZZ
A FINAL INSPECTION HAS BEEN MADE'AND APPROVAL OR A CERTIFI- 'ORIGINAL - FILE — - YELLOW - INAPEC7/OR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER - GOLD -ASUCOGOR
04/02, PRESS HARD -YOU ARE MAKING 5 COPIES GREEN-ACCOUNTIN G
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