20040270.pdfDATE RECEIVED [13ERMITEXPIRES
USE PERMIT
CITY OF EDMONDS NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRES' -2,5 -zt_ L, (,J,
OWNER NAMEINAME OF 13USINESS
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO,
92 /C-/ LID FEE $
UM MAILING ADDRESS
1ESGP Approved 0
PUBLIC RIGHr OFWAY PER OFFICIAL STREET MAP RW Permit Required
ze I', A e C Street Use Permit Req'd
CITY EXISTING — (�x PROPOSED inspection Required 13
ZIP TELEPHONE Sidewalk Required 0
underground
REQUIRED DEDICATION FT Wiring required 13
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YEA NO 13
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E ADDRESS REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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CITY Zffi TELEPHONE
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NAME CBL#
ENGINEERING REVIEWED BY OATE
ADDRESS
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VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE BY L R IS POSTED .
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kc/ 1. ,011CHECKED SEPA REVIEW SIGN AREA HEIGHT
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PROPERTY TAX ACCOUNT PARCEL NO. C P ETE EXEMPT ALLOWED PROPOSED ALLOWED
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COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr)
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FROVT SIDE REAR FRON REAR
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COMPLIANCE OR V!�C, / i i b I o,
El ADDITION ED COMMERCIAL 13 CHANGE OF USE `-A C:Jln L�0, Z)A % ro C) 1 31 z
PARKING 6LOT AREA FLAAING REVIEWED BY DhT�, 5
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El REMODEL MULTIFAMILY 1:1 SIGN REO'D PROVIDED
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY ITYPE 0 CONSTRUCTION C27 OCCUPANT
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LU NUMBER NUABER OF CRITICAL OCCUPANT
C' OF DWELLING AREAS SPECIAL INSPECTION IAR
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0 STORIES UNITS NUMBER REQUIRED YES A
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DESCRIBE WORK TO BE DONE C9
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D B
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1 15 �j f -'1, -7- 4 Si" I Description FEE Description FEE
Plan Check State Surcharge
S7
HEAT SOURCEAT GLAZING % LOT SLOPE % Building Permit
city Surcharge
4.e- S _-1,712? k?.
?K57
PLAN CHEC:1 VESTED DATE Plumbing L
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 100 DAYS
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) CESORS Fire Review Plan Chk. Deposit _50
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUC
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 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 OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION., Recording Fee Receipt
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
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- CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENS�Tio RANCE AND RCW 111.27. YRE DATE
�,INSU OFF111CQW_SS T
SIGNATUR R AGE:NLT) DATE )GNED (425)
10
4 ICLI 771-0220 RELEAf$ D BY 4*DATE
ATTENTION EXT 1333
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPE40R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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Height Calculation Worksheet
Address:
Date:
hispector(s):-
1. Datum Point:
2. Datum Point Elevation: -7 5, 9 -7
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3. Average Grade: 3 -7 -7 -d 5
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.4.. Max.imum, Elevation Allowed:
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5. Reference Point Elevation Shot to House:
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6. Measurements from line shot onto house to r6of ridge:'
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7. Actual Elevation:3 ?6 (reference point elevation) + (measurements
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Conclusion:
(actual) is greater ess t (allowed); therefore the house is!
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is not over the height requiremen CjDC 16.20.30 requirements
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN z
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ENGINEERING DIVISION DATE
PIXASCSIGN
PLANNING DIVISION DATE
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I PERMIT kDB# DA E INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED oval
A field inspection was conducted to determine compliance with -approved plans. Final appr
the release of
denotes that there are no objections frorn the above signed Department to
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
El Copy of CORRECTION NOTICE given to ow ner/co n tractor by hipcctor
I .
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:f6rms:oca1)rv1 3/25/04
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RNAL PROJECT APPROVAL FORM
TO:
DATE:
MEMOTO: P ERMrr cooRDINATOIZ, BUILD ING DIV IS ION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN z
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PERMITit 2 (0 fl)j- 0Z Z&ADBY DATE INSPECTED —
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine compliance with -approved plans. Final approval
denotes that there are no objections from the above signed Dcparti I nent to the release of
PERF ORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of.C.ONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
El Copy of CORRECTION NOTICE given to owncr/contractor by inpector
1.
2.
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RE -INSPECTED OUTSTNNDING ISSUES - GRANTFINAL PROJECT APPROVAL
Date Signature
I:teiiiii:bldg:fonii.s:ocal)i-vI 3/25/04
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(titp of (1b
DEPARTMENT OF BUILDINGS
lot (PC till L?
PER UNIFORM BUILDING CODE SECTION 109
At: 23128 76 th Avenue W, Edmonds, WA BL iflding Permit #: 2004-0270
Occupancy established by this certificate: Dwelling Units: 12** No. Stories: 2
R3/1.11 Type� Construction: VN Basement: No
Maximum Occupant Load (Per U.B.C. 1002)
Room capacity signs, wh. en.,req , uirdid; �"must remain posted at all times.
Owner of Building: Donald Sweazey -Addrt ' )ss: 17921:'Lind"e::'n:'�-Av':e'n'ue N� Shoreline, WA 98133
THE Sweazey Duplex HAS BEEN INSPECTED AND APPROVED AS COMPLYING WITH THE REQUIREMENTS OF THE 1997 Edition of
the UNIFORM BUILDING CODE AS ADOPTED BY . T I HE CITY POR� THE GR OUP AND DIVIS16N OF OCCUPANCY AND THE USE FOR WHICH THE
PROPOSED OCCUPANCY IS CLASSIFIED.
Issued this. 13 th dtliy,of December 2005
CHIEF BUILDING OFFICIAL
BY:
This certificate shall be posted In a conspicuous public area and shall not be removed, mutilated or obscured and shall be maintained in legible condition at all times. Any change of occupancy or use requires a building permit and a new
Certificate of Occupancy issued by the City of Edmonds Building Official.
NMI assess..
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ...................... \NIN3 ? 11
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
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 ...
—(-7
MISCELLANEOUS ..........
FINAL APPROVAL FOR jwe
OCCUPANCY ..................
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The initials MTare Milton
Thompson, a temporary contract DatePUrChaSed—m—"--
inspector for tile City.
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