20040233.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER PIRATION
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PROPERTY TAX ACCOUNT PARCEL NO
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MULTIFAMILY
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REPAIR
FENCE
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DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BU"ESS OR ACTIVITY) EXPLAIN
NUMBER NUMBER OF 1 CRITICAL
OF DWELLING OV&
[ we UNITS
STORIES I NUMUCM
DESCRIBE WORK TO BE DONE
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I PERMIT EXPIRES
PE11MIT
NUMBER4,�,�,/,/,
PLAT NAME/SUBDIVISION NO.
LOT NO.
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PUBLIC RIGHT OF WAY PER OFFICIAL
STREET MAP
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EXISTING PROPOSED
REQUIRED DEDICATION-
FT
METER SIZE
LINE SIZE
NO. OF FIXTURES
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SUITE/APT 1
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LID NO.
LID FEE $
7ESCP Approved
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RW Permit Required
Street use Pflnnit Heri'd
inspection Required
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SidaAalk Required
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Undergrotind
Wiring required
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PRV REQUIRED
YES 0 NO 13
REMARKS
OWNER/CONTRACIOR RESPONSIBLE FOR EROSION CONTROLYDRAINAGE
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
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VARIANCE OR CU
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INSPECTION
BOND
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POSTED
OYES &NO
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SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP ,
LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
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PARKING
LOT AREA
PLANNING REVIEWED BY DATE
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REMARKS
By I TY CTION DE OCCUPANT
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SPECIAL INSPECTION J�REA L OCCUPANT
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
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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.
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PERMIT APPLICATION: 180DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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'APPLICANI. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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DEEMEDTO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION"
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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 COMPENSATION INSURANCE AND RCW 18.2T
SIGNkTURE PAEd4R AGENT)
DATE SIGNED
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VALUATION
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Descript ion
FEE
Description
FEE
Man Check
State Surcharge
Building Permit
city Surcharge
Plumbing
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Mechanical
Grading
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Engr. Review
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Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt It
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
APPLICATION APPROVAL
CALL
This application is not a perinit until signed by the
Building Official or his/tier Deputy: and Fees are paid, and
FOR INSPECTION
receipt is acknowledged in space provided.
OFFIC &� DATE
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MiJIGNATURE
771-0220
RFIIVASVY
ATTENTION t:y% I I did
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
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ORIGINAL - FILE YELLOW - INSPtCTC
PINK - OWNER GOLD - ASSESSOR
GREEN ACCOUNTING
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AREAS:
HOUSE (LIVING)
2331-51 S.F.
GARAGE
ENTRY
508-33 5.F. 16,
PORCH
49.3,3,5.F. 1
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LOT AREA
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8587.066 S.F.
LOT COVERAGE=
34.920%
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IMPERVIOUS SURFACES:
ROOF
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DRIVEWAY
3462.2,3 S.F.
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UNCOVERED WALK
1794.03 S.F.
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I TOTAL
7.59 5.F.
5265-85 5.F. = rol.30 %
PLOT PLAN
SCALE: I- = 200
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0'*iPPRUVED OY PLANNING
RE-C,EIVED
DEC - 5 2003
PEBMIT COUNTER
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RECEIVED
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APPROVED 13Y EN COE
PERMIT COUNTER
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HOUSE (LIVIN0) 2531.31 S.F.
GARAOE 508.53 S.F.
ENTRY PORCH \,49.,33 S.F.
LOT AREA W87.0ro S.F.
LOT COVERAGE= b4.192%
IMPERVIOUS SURFACES:
ROOF 3462.23 S.F.
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CD z I PRIVEWAY 1794.03 S.F.
<'-:2 tn c, UNCOVERED WALK 7.59 S.F.
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L TOTAL E5263.85 S.F. 61.36 %
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-PLOT PLAN
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APP�ROVVD BiEWGINEERING
Date:
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DEC - 5 20031-
PERMIT COUNTER
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FINAL YROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLFASESIGN
ENGINEERING DIVISION DATE
PLE�SE SRY,
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT
SITEADDRESS '1013
PERMIT ADB#___ DATEINSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
approved plans. Final approval
A field inspection was conducted to determine compliance with
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
V GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tcmp:b1dg:forms:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ...................... Z4 _5
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ................... vy)
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping ................. L 12 L8
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................ d
FIRST FLOOR FRAMING ... 0-- 0
INSULATION ................... a
Floor Insulation .........
Wall Insulation ...........
Ceiling insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
Side Sewer
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Amout Pa d
Date Issue
WaterMetcrS,.'=__�
Amount
DetePurcb- Scd�,
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