20040037.pdfDATE RECEIVED I I
C1W OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
Paul/Ruth Ghenov
MAILING ADDRESS
535 Hemlock Way
CITY ZIP TELEPHONE
Edmonds 9 1425-775-1745
NAME
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ADDRESS
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CITY ZIP ITELEPHONE
NAME
CBLb ��
ADDRESS
12601 132 Ave NE
CITY ZIP TELEPHONE
Kirkland 98034 1425-814-3124
STATE LICENSE NUMBER EXPIRATION DATE I CHECKED BY
FASTWHCO52DF 2-16-Of 'VMZi
PROPERTY TAX ACCOUNT PARCEL NO
USE
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V
I PERMIT EXPIRES
PERMIT
NUMBER/9/7)Z/
JOB
ADDRESS 535 Hemlock Way
PLAT NAME/SUBDIVISION NO. I LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
I
SUITE/APT#
LID NO.
LID FEE $
TESCP Approved
13
RW Pannit Required
[3
street Use Pairrit Roq'd
13
inspection required
[3
Siciewalk Required
[3
Underground
Wiring required
0
PRV REQUIRED
YES 1:1 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
V^Mliti-ari nn nil h t water tanks per
ENGINEE A�rw_vl TNE
CiV E od By (C) DATE
I C e. ECDC 19,30.020
FIRE REVIEWED BY DATE
Type B �r L vent con�"b,oj,
A�OWED
1.
POSED
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NEW RESIDENTIAL )Q PLUMBING / MECH LdT_Mrn=7__ 4TIMU=4 KS (�T.) 7'ROPOS-Iff-SETBACKS (FF.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
%/ADDITION COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
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PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY
SIGN
REQ'D PROVIDED
GRADING
REPAIR CYDS
o FENCE
( x F-0
REMARKS
DEMOLISH TANK
OTHER
El
oGARAGE RETAINING WALL
E:] FIRE SPRINKLER
ALARM
CARPORT ROCKERY
FIRE
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPIAN:
CHECKED BY jTYPE.QF CONSTRU9TIO
OCCUPANT/)
M 0 AAA
GROUP
NUMBER NUMBER OF
OF DWELLING
'FRITICAL
AREAS
SPECIAL INSPECTION AREA
STORIES UNITS
NUMBER
REQUIRED
LOAD
DESCRIBE WORK TO BE DONE
Remove/replace gas
water heater
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL
INSPECTION RECI'D
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in qaraqe 35,500
hitus
15
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VALUATION
Description
FEE
Description
FEE
Plan Check
.
State Surcharge
-7
H __T
EAT SOURC� GLAZING % LOT SLOPE % Building Permit
City Surcharge
57—
�R 0
Base Fee
PLAN CHECK NO: VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
4APPLICAN'T ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Fire Review
IN INTERES�T, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Plan Chk. Deposit
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OFTHLs PERMIT SHALL NOI BE LandscapeInsp.
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Total Amt. Due
......
NOR LIMIT IN ANY wAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVIS;ON.' . Recording Fee
Receipt it
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
APPLICATION
K
APPROVAL
#;I i nod b the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- its app cation s not a point un s g y
TION; AND IN DOING IIIE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED CALL Build'i'ng Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LAE30R CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27.
0 11CIA SIGNAT R
OFIGGE DATE S GNED
SIGNATURE (OWNEF (425)
R EI-E SED BY
771-0220
ATTENTION EXT 1333
IT is UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- &IA"E YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 %1--IX �A'Nv'A\ V JI G PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARELAKING 4 COPII
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ........................
FOUNDATIO�:
P6otihg . ...... : ...............
Wall ..........................
Pier/Porch .................
Retaini g Wall ............
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ISLUMONG:
Underground .............
Rough -in ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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