20030970.pdfI
DATE RECEIVED I V
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP ITELEPHONE
ADDRESS
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CITY
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ZIP 7ZO
NAME CBLN
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ADDRESS #/
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CITY ZIP TELEPHONE
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PERMIT EXPIRES --- -
E PERMIT -70
ZONE NUMBER (�06,5— 6 q
JOB SUITE/APT#
ADDRESS ) -A D �
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PLAT NAMEISUBDIVISION 0. LOT NO. LID NO.
LID FEE $
I ESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street Use Permit Rsq'd
EXISTING — PROPOSED Inspection Required
Sidewalk Required
REQUIRED DEDICATION FT Underground
I WinnUF uLred
METER SIZE LINE SIZE NO. OF FIXTURE PRV REQUIRED
4 1, YES 0 NO 13
S
REMAR98
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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DATE
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FIRE REV_1EWED BY DATE W
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STATE LICENSE NUMBER EXPIRATION DATE I C
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PROPERTY TAX ACCOUNT PARCEL NO. N��
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VARIANCE OR CU SHORELINE OR ADBO I INSPECTION I BOND
REO'D POSTED
S PA REVIEW SIGN AREA [3YEs )gNo s HEIGHT - .
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
016 1 1 24. 1111
EXP x I ��
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
NEW RESIDENTIAL PLUMBING / MECH ALLOWED PROPOSEAD FRONT SIDE REAR FRONT L/R SIDE REAR
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ADDITION
COMMERCIAL
COMPLIANCE OR
E] CHANGE OF USE
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. -7 Gt`6 -7. E5 IX.,xc, 1.5' 1440.
-
REMODEL
MULTIFAMILY
El SIGN
PARKING I LOT AREA I PLANNING REVIEWED BY DATE
REO'D PROVIDED
06
REPAIR
GRADING
a6io- CYDS
FENCE
( — X—FT)
REMARKS
DEMOLISH
TANK
OTHER
GARAGE
o RETAINING WALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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CHECKED BY TYPE OF CONSTRUCTION COL)E_ CCUPAa
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9?�_
NUMBER
OF
NUMBER OF
DWELLING
FUNITS
CRITICAL t W_
AREAS
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SPECIA1 L INSPECTION ANT
-STORIES
NUMBER
REQUIRED [] zS
Yr
DESCRIBE WORK TO BE DONE 6---n
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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H I GLAZING % LOT SLOPE-%— i
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PLAN 0HECK NO VPTED DATE
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THIS PERMIT AUTHOREMS ONLY THE WORK NOTED. Till PERAIrrCOVA1SWSRKTO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT UMM I YEAR - PROVIDED WORK 15 STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORM ION
'APPLICANT; ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFX 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,00
,PR�INSATION INSURANCE AND RCW 18.27.
SIGNATURE DATE SIGNED
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$01(,4, 1
Description
FEE
Description
FEE
Plan Chock
SEED
2,1 29 —
St escr"
State Surcharge
to Surl
Building Permit
City Surcharge
City Surct
'57—
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
PlanChk.Deposft
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Fire Inspection
Receipt #
Landscapeinsp.
Total Amt. Due
I
Recording Fee
Receipt #
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CAL
AR INSPECTION
(425)
771-011262COU,
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official of histher Deputy: and Foos are paid, and
receipt Is acknowledged In space provided.
4FFICIALS SIOVATURE DATE
�A LEASED ELY"
D E
A*ff ENTION IEXAT V
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- VORIGINAL - FILE - YELLOW - INSPE TOR,,,)�
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CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 P NK-OWNER - 'GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COP S GREEN - ACCOUNTING
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Height Calculation/Grading Verification Worksheet
Address: Go 9 p 1 -'s, tj Permit #:C2d3,T,-(397z)
Date: 4
A. Datum Point: 014
B. Datum Point Elevation: -3,s4t
C. Average Grade: -3 Le�
6 7�average grade) + 25'
3. Maximum Elevation Allowed: L
4. Reference Point Elevation Shot to House:
(datum elevation) + (grade to transit level line shot to house).f U
6. Measurements from line shot onto house to roof ridge:
Total : 5 Cf-
7. Actual Elevation: 3 eference point elevation) +aq�measurements from
#6) = Z 2 %--, �� L&
Conclusion: US G "allowed); therefore the house is/
-(actual) is greater/ 0"
CDC 16.20.30 requirements
is not over the height requiremen;=11 L
LATEMBUILDINGWISCHeight CalculationGrading Verification Worksheet.doc
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1�4 C. 18913
GARY HAAKENSON
CITY OF EDMONDS MAYOR
121 5TH AVENUE NORTH , EDMONDS, WA 98020 - (425) 771-0220 FAX (425) 771 -=I
Website: wmdedmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning* Building- Engineering
April 20, 2004
Leif Helleren Construction Inc.
PO BOX 1764
Edmonds, WA 98020
Re: Building Permit: 2003-0970
Site Address: 9609 215'h Pl. S.W.
Expiration Date: December 9. 2004
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
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.
. 7c ely,
& A
eMnny Readwin
nnit Coordinator
L\Temp\DST's\Mastcr Lettcrs\SRwaamLtrSFR
Incorporated Au'gust 11, 1890 0
Sister City - Hekinan, Japan
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FINAL PROJECT -APPROVALFORM,
TO:
DATE:
3.
RE-INSPECTBD oLrrSTANDING ISSUES - GRAPT FERAL pRoJECr APPROVAL.
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