20040128.pdfD
ATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/N E OF BUSINESS
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MAILING ADDRESS
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C11 ZIP TELEPHONE
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NAME
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CITY ZIP TELEPHONE
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NAME CBL
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'ADDRESS
CITY ZIP TELEPHONE
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STATE LICENSE NUMBER 'EJX P
PROPERTY TAX ACCOUNT
PARCEL NO.
72o 1
000 640 7e:)o
NEW
1101
5? RESIDENTIAL
2'-<ODITION
COMMERCIAL
E] REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
El
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
Re:51oEwc.6-
NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( x FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
614M / Ly"900 M ALP) 7740 A/ it� /L4 I AJOP,
M62>1rJeA-W0A1S PY
HEAT SOURCE, GLAZING %
A � I LOT SLOPE %
PLAN CHECKt4Q: VESTED DATE
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
SEPARATE PERMISSION.
PERMIT APPLICATION: 100 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANL ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTERES], 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 wl iATEVER NAI UBE, ARISING DIREC ri-Y OR INDIRECT LY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOI BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR I IMIT IN ANY WAY THE CITYS ABILITY 10 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 AGENI 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 VI'6LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27.
SIGNATURE (OWNER 0 GtNTl DATE SIG ED
17
I
LPERMITEXPIRES
-I
USE PERMI T
7ONEe,
NUMBER
JOB
ADDRE SUITE/APT#
'0 IiJIN NU LUT NO LID NO. (j
LID FEE S
[[SCP Appiroired E3
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP HW Permit Required E3
Sifflat Usti Permit Hort'd 0
EXISTING — PROPOSED— Inspection liaquito(I 13
Sidewalk Required 13
REQUIRE[) DEDICArION Fr Underaro(inij
Wiringirriquifud 0
METER SIZE LINE SIZE NO. OF FIXTURES PRv REQUIRED
I - .— I . _ YES 1:1 NO 13
REMARKS
OWNER/CONTRACrOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
NG REVIEWED BY
REVIEWED BY
DATE
DATE
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VARIANCE OR CU HORELINE OR ADB#VINSIPECTION I BOND
REO'D . POSTED
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SERA REVIEW SIGN AREA HEIGHT
COMPLETE I EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
EXP x Q-5 i
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE BEAR FRQNT UZIDE I REAR 1 (5
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LOT AREA I PLANNI
PARKING NG REVIEAE BY DATE/
REO'D I PROVI QED I 1� IL
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REMARKS
CHECKED BY ITYPE F\T
/17UCTION IGO OCCUPANT
Y/ GROUP �
SPECIAL INSPECTION JAR�A OCCUR(NT
REQUIRED [] YES I -:�Pwlv LOAD
REMARKS a
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PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REQ'D I Ei
VALUATION
$ '441 / -4
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771 _nqqn
Rr.1 FAB D�nY I / DAI
ATTENTION EXT 1333 �z
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING Oil STRUCTURE UNTIL 44//
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
091;03 PRESS HARD -YOU ARE MAKING 4 COPIES
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit .11�_14 -
Receipt #
Total Amt. Due
Receipt #
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APPLICATION APPROVAL
I hisapplication is not a permil until signed by the
Building Official or his/her Deputy, and Fees ate paid, and
receipt is acknowledged in space provideo.
OFFICIALS SIGNATURE DAIE
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OflIGINAL FILE YELLOW - INSPtCTC
PINK - OWNEF1 GOLD ASSESSOR
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ALL EXPOSED SURFACES TO
OA
IMPERVIOUS SURFACE CALC BE COVERED WITHIN 2 DAY_S_�
ITEM SQ FT
NEW ADDITION
480
EX HOUSE & FIP
794
EX GARAGE
440
EX & NEW EAVES
282
It 6- 4-,
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TOTAL 1996
EXISTING ON -SITE INFILTRATION
SYSTEM APPROVED FOR 2000 SQ FT
EXISTING DRIVEWAY DRAINS TO —toll
STREET STORM DRAIN, DRIVEWAY
IS BELOW INFILTRATION TRENCH
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2-o + ka 7640 N
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APPROVED AS NOTED
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Date:
104
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OTHER
HEIGHT �L'
ill = 20'
60ruL'vA'u'e-rwo&y
A'PPROVED BY
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JAN 1 5 200h.
'PERMIT CC)LINTF13
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AL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUMDING DIVISION
FIRE DEPARTMENT ATE_
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ENGINEERING DIVE ION DATE —I-.:
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PLANNING
PROM ,
SITE
PERMIT _ADB#_.DATE.INSPE,
OF WORK TO -BE INSPECTED_�e�-�l
DESCRIPTION .
A field inspection was conducted to determine flnal compliance with.approved plans. Final approval -
denotes that there an no objections from the above signed 1[lepartment to the release of
PERFOR—MANCE BONDS and the granting of:
GRANT FINAL PROJECT APPRO�Ala
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
Copy of CONDMONS given to. owner/contmctor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
(3 Copy of-CORR,ECMON NOTICE given to owner/contractor by
2.
3.
RE_INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT
Sign,
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing
......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final ......
HEATING:
GasTest ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING........................
FIRST FLOOR FRAMING...
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INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
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SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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