20030550.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
Ajolund t
MAILING ADDRESS
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CITY ZIP
NAME
--.-.D. �56
ADDRESS
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NAME
ZIP ITELEPHONE
CBL #
LPERMITEXPIRES
USE PERMIT
ZONE NUMBER
7 13
SUITEIAPT#
ADDRESS 8-o#1 At)t W.
PLAT NAME/SUBDIVISION NO,
LOT NO.
L�D NO.
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L D FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STR T MAP
7ESCP Approved 'ad .13
R"' Permit R u:1
S" M U.. P:.q 11'd
Inspection Required
1
EXISTINal!�� PROP SEDIF
Sidewalk Required
11*Q
REQUIRED 70EDIC�ATION
Undarground
Wiring required
METER SIZE
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LIN S ZE
NO. OF FIXTURES
EQUIRED
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YRV
YES NO 13
25
REMARKS
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OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED BY VT
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STATE LICENSE NUMBER
REO'D POSTED
izis ONO IS 2.1 NO R,
8
HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
SEPA REVIEW SIGN AREA
CgMPL§TIE EXEMPT ALLOWED PROPOSED ALLOWED
2-3 o!j an
(5rall Q122 99)
E .el-71
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13 RESIDENTIAL
PLUMBING I MECH
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LOT COVERAGE_
S* - REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
E LIR SIDE REAR
ALLOWED PROPO FRONT SIDE REAR FRONT
ADDITION
COMMERCIA L
COMPLIANCE OR
CHANGE OF USE
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GRADING CYDS
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CARPORT
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FIRE ALARM
OWE OF USE, BUSINESS OR ACTINTM qPLAIN:
cogg OCCUPANT
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CqNSTRUCTION
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NUMBER
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CRITICAL Wf7f
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NUMBEPf!00—/Z/
REQUIRED
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DESCRIBE WORK TO BE DONE
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EMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RE
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Description
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FEE
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-July
Description
Mwe-M&LAIM9
FEE
Plan Check
State Surcharge
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HEATdQURCE GLAZING% LOT SLOPE %
Building Permit
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City Surcharg
PLAN CHECK N 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
3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
3
SEPARATE PERMISSION.
t:
2
Engr. Review
5 PERMITAPPLICATION: 1110DAYS
CL PERMIT ILIMM 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.
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
3 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FR M THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
MDeposd—
ODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp. -,-d e,4
Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee 1.:26 6 0-
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-
This application Is not a permit until signed by the
CALL
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
Building
FOR INSPECTION
Official of his/her Deputy: d Foos are paid, and
receipt is acknowledged In space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
SIGNATURE (OWNER AGEAb- DATE SIGNED
Cr
gFfffici
(425)
G1 DA E
IGt E
C-
771-0220 -
RE
LIJ
ti DATE
Y
ED613Y
ATTENTION L
EXT 1333
IT IS UNLAWFUL TO U SE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE. YELLOW- I INSPECTIR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER - GOLD-ASSESSOFV
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
GREEN - ACCOUNTING
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Height Calculation Worksheet
Address: �j
Date: I a
Invemr(s):
1. Datum Point:
2. Datum Point Elevation:
3. Average Grade: ro
4. Maximum Elevation Allowed: (Avergg6 giade)
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51. Reference Point Elevation Shot to House:
(datum elevadpn) +3,Sb (grade to transit level line *shot to house) 1.0 I-S8
.......
6. Measurements from line shot onto house to rdofri-'---*
u9c.
-L
5F
MN
Total CP
7. ActualElevation: (reference elevation) +01,3( -(measurements..
point
fronA,,e%
Conclusion:
(actual) Is greater ess n
(allowed); theref
ore the house is/
gn
Is not over hel'-t requiremeniPper ECDC 16.20.30 requirements
FIN-.L PROJECT APPROVAL.&-ORM
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
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FIN, aj PROJECT APPROVAL i
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TO: 8EAVICES cl
COMONDS
DATE:
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
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FINAL -'ROJECT APPROVAL FOr-M,
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DATE:
. MEMO TO: PERMIT COORDINATOR, BUILDING DIMION
2.
3.
RE.INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL.
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