20030603.pdf4
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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CITY I — I zip ITELEPHONE
NAME
ADDRESS
CITY ZIP ITELEPHONE
NAME
ADDRESS
CIV zip I I TELEPHONE
STATE LICEWSE NUMBER
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%0' -No
=NO.
I L., 111c"
PROPERTY TAX ACCOUNIF;IZE—L
-
VD-74 1 1500
f
NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
0 SIGN
REPAIR
GR4�*G CyDS
X—F
(FENCE
X FT)
DEMOLISH
TANK
OTHER
GARAGE
RETAINING WALL
0 F RE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
CRITICAL P.— #M
OF
DWELLING
AREAS
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
HEAT SOURCE GLAZING % LOT SLOPE %
4-6vT I �- 15. 1 1- 10
PLM CHECK NO: VESTED DATE
- c9 7 (je
'MIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
L "E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: ISODAYS
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
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I HEREBY 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 COMPENSATIO��URANCE AND RCW 18.27.
SIGNATLIRRE��(OR OrGENn) DATE SIGNED
I A— 07 or—, - 0*?
PERMIT EXPIRES
USE PERMIT
ZONE N U M B E R
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ADDRESS ,�gg j
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PLAT NAME/SUBDIVISION N
OT NO.
LID NO.
LID FEE $
&3LIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
Rw Permit Required
Street Use Permit RKd
EXISTING PROPOSED
Inspectio" Roquired
Sidewalk Required
REQUIRED DEDICATION—-==: FT
Underground
Wiringrequired
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRE
1
",-7
1 -,--
3—
YESD NO 10
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE
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VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
BOND
1----1[3YEs_Wb
REQ'D
POSTED
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s —
$EPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED
PROPOSED
,
:XP
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SET13ACKS (FT)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE REAR
-7,5 10 21
:51 "le?
KING
LOT AREA
PLANNING REVIEWED BY E
REQ`D
PROVIDED
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= M�
CHECKED BY ITYPeTQNS) VUION GUW15-2-1— uLiuu
GROU
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED LOAD
DtYES
REMARKS
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REO'D
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VALUATION
V1 II&
Desc4flon
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
PlanChk.Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
1425)
1,12
771-0220
EXT 1333
APPLICATION APPROVAL
Th13 application Is not a permit until signed by the
Building Official or hIsiher Deputy: and Fees are paid, and
receipt Is acknowledged In space provided.
OFFICIII. DATE
IG T RE
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In r-- - A Y� DATE
�A A I Ir
IT IS UNLAWFUL JO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL f 044, 4— Wff.1.&d6(Zf t_1
0 NAL - FILE YELLOW - IN
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI Rij, �
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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RECEIVEd
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JUL - 2 2003
�44
PERMIT COUNTER
waW.
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IS R E E N E ill
Sin6le Famil-y Remodel -0-N
I; Rg Edmonds, Washin6ton
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jl�-KraZan & Associates tnc
GEOTECHNICAL ENGINEERING 9 ENVIRONMENTAL ENGINEERING
CONSTRUCTION TESTING AND INSPECTION
DATE:
PROJECT #: OCL4
PROJECT: 6- �- d;1,
LOCATION: Ja 41r-- Z-z -
KRAZAN PROJECT MANAGER:
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FIELD REPORT NO:
CONTRACTOR:
JURISDICTION: ii;i�
PERMIT #: ic, Y
INSPECTOR: TF-MP:
WEATHER:
NOT performed In accordance with the approved P_Ions, specifications, and regulatory requirements
To the best of my knowledge, the aboAffWAS NAS
Technicl
Supedntendent/Representative'
burn, 9800
1 0 (253) 939-2500
W Suite 106. Auburn, 98
— 7 uit 5 PoulsM - (360) 598-2126
(559) 348-2200 1501-1 on - e3 98370
215 West Dakota Ave., Clovis, CA 93612 20714 VStHvwy 305 NE Suite 3C, Poulsbo'
w 1. 11
(661) 633-2200 -in c;r Invi (425) 485-5519
4231 Foster Ave., Bakersfield, CA 93308 (209) 572-2200 19501-144th Ave, NE #F-300, Woodinville, 98072 (360) 254-3200
1025 Lone Polm Ave. #8G, Modesto, CA 95351 (408) 271-2200 12816 NE 95th St. Suite B- 100, Vancouver, WA 98682
545 Parrott St- Son Jose, CA 95112
mento, CA 95815 (916) 564-2200 Rel-akin 0
123 commerce Circle, SOM (909) 974-4400 liffectiletliale 9-I&OZ
4221 Brickell St., On torlo, CA 91761 1 timy not Ile I epioduced tit an) 110MMI %lIh,luj Ile *I llicn 1),mussKin of the client and Kjv.,*ui At Asswialo
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CITY OF EDMONDS
1215TH AVENUE NORTH* EDMONDS. WA98= e (425) 771-= 9 FAX (425) 771-ml
Website: wwdedmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning, Building* Engineering
September 29, 2003
Attn: Perry and Tracy Greene
6921 163rd P1 SW
Edmonds, WA 98026
Building Permit: 2003-0603
Site Address: 6921 163rd PI SW
Expiration Date: 8/12/04
Dear Perry and Tracy Greene:
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
renewedpdor to expiration for one half fees. If the permit expires without a final
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 0
Sister City - Hekinan, Japan
FINAL PROJECT APPROVAL FORM
TO:
DATE:
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy. of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
GRANT FINAL PROJECT APPROVAL
RE-INSpECTED OUTSTANDING ISSUES
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ocaprvl.doc.l:temp:bldg:fonnsIO/OI