20040166.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWN NAME/NAME OF BUSINESS
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MAILING ADIJRESS
CITY
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ADDRESS
CITY
NAME
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ZIP ITELEPH
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[PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB SUITEIAPT#
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STATE LICENSE NUMBER EXP
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PROPERTY TAX ACCOUNT PARCtL NO.
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00 4 312.
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RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
E] REPAIR
XAPING
15 0 CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
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CARPORT
ROCKERY
[TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER
NUMBER OF
OF
DWELLING
or
STORIES
UNITS
DESCRIBE WORK TO BE DONE (e�
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HEAT SOURCE
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,�rplUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X Fr)
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
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PLAN CHECK NO:
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GLAZING %
LOT SLOPE %
7- - 3 �3
VESTED DATE
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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: 180 DAYS
PERMIT LIMIM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
4APPLICANI ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTERE�T, 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 P(5kFNSATION INSURANCE AND RCW 18,27.
SIGNAT OR AG DATE SIGNED
PLAT NAME/SUBDIVISION NO.
LOT NO
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 0
RW Permit Required 0
Street use Permit Pori'd 0
EXISTING — PROPOSED
Inspection Required Q
Sidewalk Herpmed E3
REQUIRED DEDICATION— FT
Undargmund
wiring required E3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV QEQUIRED
YE NO
0
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REMARKS
OWNER/CONTRACIOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
0
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ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE Lu
VARIANCE OR CU
HORELINE OR ADB#
INSPECTION
BOND
REQ*D
I
POSTED
11YES
MrO
S
I
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP I
I C-'7
;P5 .
1 /7'
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT
UR SIDE REAR
0
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PARKING
LOT AREA
PLANNING REVIEWED BY
DATE
REO'D PROVIDED
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REMARKS
CHECKED BY I TYPE
SPECIAL INSPECTION
REQUIRED [—
YES
REMARKS
PROGRESS INSP
LICTION I Go OCCUPANT
GROUP
OCCUPANT
r7a4=
ECTIONS PER WYO-8/FF5'[NAL I N14SPUECT11
VALUATION
Description_
Plan Check L
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE Description
State Surcharge
City Surcharge
ON RECI'D
le-� -I M
FEE
Plan Chk. Deposit I /�
Receipt #
Total Amt. Due
Receipt #
APPLICATION AP�PROVAL
I his application is not a permit until signed by Ilia
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided. V
zF t. SIGNZAJU DATE ,
CO/
777
IF�SELJ UT DATP
A17ENTION 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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
ORIGINAL -FILE YELLOVV/INSPEeTO
PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
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171
OPY
PLOTPLAN RECEIVEL-)
Joe and Andirea 0-sborne
sestle: I" = 20, JAN 2 7 20M
20302 81st Ave. W. +961
+941 +921 100, +91'
000431200003loo
p FR-MIT (2UNTER -
Existing Shed
120 sq. ft. F0n
7-1,
,RVIOS
SURFACE CALCS
DD IOUTTERS/DOWNSPOUTS
Existing Bundling Roof
AND SPLASHBLOCKS
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Outline: 1568sq. rt.
+92.)
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Constructed in 1964
Existing Drivemy
364
sq. IL
Constructed in 1964
APPROIED
AS NOTED
Existing Deck
576
bY I
NGINEEkINC,
sq. %
Constructed in 1964
0 M
C
M 0
0
Existing Shed
0 0
in sq.
Constructed in 2002,
)ate:
MM
I�M!103ed Addition
165
Existing Deck
q
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sq. (L
S76 sq. ft
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MoPosed Deck
L 28 s% rt.
0
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PrOPOsed Deck
c' +9196" 29
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H-EXG13TICALCS
A=+94,11"
B — +91')6"
C=+9475112
D = +§4'091"
AVE GRADE
+93110"
ACTUAL
+110,11"
+118,10"
C +94'5-
Existing R rn M
Csidence
1296 sq. & 0
0
0 M
C Cn
F. Cn
.32,
ProPOSed
/151
A'0+944111
Addifion
165.q. 4.
D +9419"
Vovie.
Lowest
tooting
elev. +93,3"
T
Existing
Drisvemy
6
C4
364 sq. M
8% ar npr
LOT COVERAGE Q.-M____,!� " . �\ i
TS 8-1—S i-_ i _7 ARZ—) +102' 1 1 1009
LOT AREA +100, +98, +96' +95'
15—,206 �s_ A I A f`,; i
DATUM PT. +100, N
A?tel Top of manhole cover
LOTSLOPE
i K. ZONE —Slo`AVE—.W Center orRight-of-Way
-BACK'
REAR,_.- LOT L I N'7 1',,11LJST
BE IN PLA(",F,
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
I'LLASE SIGH
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ENGINEERING DIVISION DATE i
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PLANNING DIVISION DATE'
KXASF SIGN
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PROJECT C) Af E M
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0
SITE ADDRESS A --1 0
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PERMIT #200 q - _ADB# DATE INSPECTED_!Y 0,�e M Z
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DESCRIPTION OF WORK TO BE INSPECTED
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A field inspection was conducted to determine final compliance with approved plans. Final approval 0 -n
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denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of: M M
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GRANT FINAL PROJECT APPROVAL M C)
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
o Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_
ocaprv1.doc.1:temp:b1dg:fbnns 10/0 1
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ..................... -
FOUNDATION:
Footing ...... ........... - '5k2:2 zx/c Iti
Wall ..........................
Pier/Porch ................. z
0
Retaining Wall ...........
0
Slab Insulation ..........
PLUMBING: -n
—1
Underground ............. M
M0
-In 0
Rough ................... __110
0
C:
Commercial Final ...... K
3: M
HEATING: M Z
Gas Test .................... C _Z
r—
Gas Piping ................. 3:
cn
0 -n
Equipment ................. -n r
Commercial Final ....... x
M M
EXTERIOR SHEATHING 0 U5
NAILING .......................... 01-
0 M
C: Cl)
FRAMING ........................ 9 Cn
M 0
Z
FIRST FLOOR FRAMING ... i
INSULATION ................... ;U
Floor Insulation ......... >
z
Wall Insulation ........... --I
3:
Ceiling Insulation ....... z
SHEETROCK NAILING ...
4
0
SPECIAL INSPECTION ... M
MISCELLANEOUS ..........
FINAL APPROVAL FOR C)
OCCUPANCY ..................
SideSewer#
Amout Paid $ R e C eip t
Date lssued ExphTS
WaterMeterSize
Amount Paid—.. Receipt #
Date Purchased
ROW
t,rn.cunt Pa!d $—.Receipt
_—Expires