20030689.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF USINESS
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MAILING ADDRESS I
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CITY ZIP TELEPHONE
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ADDRESS
CITY
NAME it
ADDRESS
CITY
STATE LICENSE NUMBER
PERMIT EXPIRES
USE PERMIT
ZONE R5_(Z�,NUMBER 1,00 3- 0& 99
JOB SUITEIP
ADDRESS IK 9 1 J_ � S,I)L'�nt-Alic ' ssrossls."
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW Perrrdt AsquIred
Stt et Use Poffnft Ftoq'd
EXISTING — PROPOSED .:=. FI1.sd
Sidewark Required
UrAerground
'41 REQUIRED DEDICATION— FT WWgrequked
. I . . I ki^ PAV REQUIRED
MCI —
NO 13
REMARKS
WNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ZIP TELEPHONE owaia::=� "rza4z
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ZIP TELEPHONE %.#1 __j FIRE REVIEWED BY
PROPERTY TAX ACCOUNT PARCEL NO.
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300 of 0—
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULnFAMILY
REPAIR
CYDS
DEMOLISH
0
oGARAGE
CARPORT
[3 RETAINING WALL
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVTM EXPLAIN:
-45�
NUMBER
—
NUMBER OF
OF
DWELLING
I
STORIES
UNITS
DESCRIBE WORK TO BE DONE
CHECKED BY
PLUMBING/MECH
COMPLIANCE OR
0 CHANGE OF USE
SIGN
FENCE
( _ X _ FT)
OTHER
By DATE
DATE Lu
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VARIANCE OR CU SHORELINE OR ADBM I INSPECTION BOND
POSTED
0 $
REQ
13YES a,
SEPA REVIEW SIGN AREA - JM HEIGHT
COMPLETE PT ALLOWED PROPOSED ALLOWED PROPOSED
_XP
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FROffr SIDE REAR FRONT L/R SI E REAR
.57 q
74,
PARKING LOT AREA [PLANNING REVIEWED By DATE
REO'D I PROVIDED
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FIRE SPRINKLER
FIREALARM
CHECKED BY TYPE F.&IONSTRUCTION
P,
CRITICAL CHEl
AREAS SPECIAL INSPECTION JAREA
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NUMBER ItREQUIRED 0 YES
REMARKS
PROGRESS INSPECTIONS PER UBC
So. FT. t1g:
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OCCUPANTf.,,
GROUP EV
OCCUPANT
LOAD
INSPECTION REG'D
HEAT SOURCE
6AS RatJ .
GLAZING %
I
LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO:
VESTED DATE
Plumbing
-
Mechanical
THIS PERMIT AUTHORMES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I-- BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
:21 DO&WN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
t: SEPARATE PERMISSION.
Engr. Review
PERMIT APPUCATIO14: 160DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS
Engr. Inspection
Uri
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Depp
IN INTEREST, AGREES TO INDEMNIFY; DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt III
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMrT. ISSUANCE OF THIS PERMIT SHALL NOT BE
91 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp.
Total Arn�t. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
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
This application Is not a pennit until signed by the
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
FOR INSPECTION
Building 01ficial or his/her Deputy: and Fees are paid, and
receipt is acknowledged In space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
P/ATq
SIGNATUR� OR AGENT)
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
- I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
IGINAL - FILE YELLOW - INSPECTOR
GOLD
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
GREEN - ACCOUNTING
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AUG -14 26103
Height Calculation/Grading Verification Worksheet
Address: Vi 01-i Permit #:
Date:
A. Datum Point:
B. Datum Point Elevation:
C. Average Grade: ..9-4,4S
3.Maximum. Ele0ation Allowed: 5(average grade) + 25? 6311S
4. Referenge Point Elevation Shot to Hou*
(datum elevatIon).+e"*(O' ' (grade to transit level Hue shot to ho us�) .7
6. Measurements from line shot onto house to.roofridge:
Total.-.
7. Actual Elevation*.9S� (referenc point elevation) +I) easurements from
e
Conclusion:
U S.S.-T (actual) is gita less th;' (allqwed); therefore the-hotise W
Is not over the height requirein per ECDC 16.20.30 requirements
L-%TE&IFYV=M%N9,9Mi& CskubdOnM� Verification Wbdmhe6tAob
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