20040246.pdfDATE RECEIVE D _f�l
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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NAME
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PROPERTY TAX ACCOUNT PARCEL NO.
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MULTIFAMILY
REPAIR
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TANK
GARAGE
CARPORT
RETAINING WALL
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(TYPE OF USE. BUSINESS
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NUMBER
NUMBER OF
OF
DWELLING
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STORIES
UNITS
DESCRIBE WORK TO BE DONE
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GLAZING %
PLAN CHECK
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PLUMBING/MECH
COMPLIANCE OR
CHANGE OF USE
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FENCE
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FPERMIT EXPIRES
PERMIT EXPIF
USE PERMIT
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NUMBER
JOB SUITE/APT#
ADDRESS 7� 0), 1
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PLAT NAMEtSUBDIVISION N LOT NO, LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL. STREET MAP
IESCP Approved
RW Potme Hequitod
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Streel Use Pumil Roq*d
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EXISTING — PROPOSED
Inspectinn ne(iijued
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Stdowalk Required
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REQUIRED DEDICATION— F1
Undeiground
Winng requifed
13
METER SIZE NO. OF FIXTURES
PRV REQUIRED
YES 13 NO
REMARKS
OWNER/CONTRACIOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
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VARIANCE OR CU HORELINE OR ADO# I INSPECTION I BOND
REO'D POSTED
YES ONO s
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED I PROPOSED
EXP I
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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PARKING I LOT AREA I PLANNING REVIEWED BY DATE 5
REO'D I PROVIDED (L
FT) I REMARKS
FIRE SPRINKLER
FIRE ALARM
CHECKED BY I TYPE OF CONSTRUCTION OCCUPANT
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AREAS SPECIAL INSPECTION JAREA OCCUPANT
NUMBER REQUIREDE] YE LOAD
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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LOT SLOPE %
VESTED DATE
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THIS PERMIT AUTH6RIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK70
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES To INDEMNIFY, DEFEND AND HOLD HARMLESS THE CIT-Y OF
EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREc rLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT 13E
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT 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 OULY 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 13E EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27,
DATE SIGNED
VALUATION
$ t7
Description
FEE
Description
FEE
Plan Check
State Surcharge
:�6.e2
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chtk. Deposit
.........
Fire Inspection
Receipt #
2
2
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
�`PPLICATION APPROVAL
CALL
This application is not a permit until signed by the
FOR INSPECTION
Buildingofficial orhis/her Deputy: and Fees are paid. and
receipt is acknowledged in space provided.
(425)
OFFI NATURE DATE
4111)(
771-022 0
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RELEASEIW ATE
ATTENTION E)ff 1333 1)
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL _(Auh,llc �e
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLA4
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 OW - INSPECTOR
09,'03 PRESS HARD -YOU ARE MAKING 4 COPIES PINK - OWNER GOLD - ASSESSOR
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PR(IIECT ADDRESS / OWNER:
EDIT14 HAGELIN
1014 12"' AVE NORTH
EDMONDS 98020
TAX No. 0060 771K) 000 300
LEGAL;
WAG IN ER A DDITON TO EDMON DS BLK 000 D-flO ALL TI IAT PORTIONOF LOT 3
AND 4 LY WLY OF FOLG DESC: BEG AAP ON S LN SD LOT 3 THAT IS 2 FT NNILY FR MEAS
RIA TO BASE OF PRESENTLY EXST. CONCRETE RFTAINING WALL TN NLY ON LN THAT
IS 2 FT WLY FR MEAS. RJA TO BASE OF SD WALL TO NLYTERM OF SD WALL N-100-10- CITY COPY
53W TO N LN SD LOT 4,
ZONE: RS —12
LOT -SIZE: .45 ACRE / 19,602 SQ. FT.
SCOPE OF PROJECT: ADD NEW 3o DOOR TO LOWER FLOOR RECEIVED
FOR FOOT ACCESS TO FLOOR LEVEL. NO NEW LOT
COVERAGE. NO GRADING. MAR 2 3 2004
LOT COVERAGE: 1480 SQ. Fr. RESIDENCE PERMIT COUNTER
288 SO Fr DECK
1768 SO Fr 9.0 %
CONTACT DURING PERMIT PIIASF:
KRISTIN HANSON
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
0
M
PLUMBING:
Underground .............
0
M
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Rough -In ...................
M
0
Commercial Final ......
0
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HEATING:
X M
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Gas Test ....................
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Gas Piping .................
3:
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Equipment .................
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Commercial Final .......
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EXTERIOR SHEATHING
M M
NAILING ..........................
0-0)
0
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FRAMING ........................
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FIRST FLOOR FRAMING ...
Q 0
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INSULATION ...................
Floor Insulation .........
3:
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Wall Insulation ...........
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Ceiling Insulation .......
SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR /y)
OCCUPANCY ..................
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