20040271.pdfDATE RECEIV ED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAII. ING ADDRESS
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PERMIT EXPIRES
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USF PERMIT
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JOB SUITEiAPT#
ADDRES'
PIAT NAME/SUBDIVISION NO
LOT NO
LID NO
LID FEE S
PUBLIC RIqHT OF WAY PER OFFICIAL STREET MAP
EXISTING$& 1�0
PROPOJED-
REQUIRED DEDICAI`ION_6 FT
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I L5GP Appfovf(l 0
HAr Permit Horl"Ifed 11
street use Permit Req'd 13
Inspection Rortiniod 13
S00Aalk Required 0
Unnotground
wouto reqnirod 13
METER SIZE
06,0 6
4 'Llr
LINE SIZE
NO, OF FIXTURES
FIRM REQUIRED
YESK NO 0
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REMARKS
OWNERICONTRAClOR RESPONSIBLE FOR EROSION CONIROL/DRAINAGE
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M� VA'hlAftE OR Cu SHORELINE OR ADB# I�SF3ECTION BO�D
STATE LICENSE NUMBER EXPIRATION DATE ED BY REO'D P TED
....... tEPES ONO S
SEPA REVIEW SIGN AREA HEIGHT
< PROYERTY TAX ACCOUNT PARCEL NO. CRPETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSET
7 ill 7 /)111K' 4 P ) BCA_,:,x)
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EX
X,N'EW RESIDENTIAL PLUMBING MECH LOT dOVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (IT)
ALLOWED PROPOSED FRONT SIDE REAR FROVT L/P S DE REAR
ADDITION COMPLIANCE OR I I I � * . I I z
COMMERCIAL H D , rj I C) I(:j / 10 z!* E
CHANGE OF USE 5 �') z
PARKING LOT AREA I PLANNING REVIEW ED BY bATE a.
REMODEL MULTIFAMILY SIGN REQ'D P . ROVID 1) I-Q14. X0 k Cc�;�,ft Ljl:d. z 1(
REPAIR GAIING FENCE Q
YDS X FT)
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OTHER I OC�_k
DEMOLISH TANK
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GARAGE RETAININGWALL FIRE SPRINKLER
CARPORT ROCKERY E] FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY TYPE OF CONSTRUCTION E OCCUPANT
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C"-7,4� Ill 1-nalak f� Cal GROUP
En - I �/ 9:3101
Lu NUMBER NUMBEFrOF CRITICAL CTION JAC��' OCCUPANT
SPECIAL INSPE
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OF DWELLING tAREAS LOAD
ci STORIES UNITS N UMB ER REQUIRED YES
DESCRIBE WORK TO BE DONE
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REOID F3
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VALUATION
7 71
Description FEE Description F7E
Plan Check State Surcharge
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HEAT SOURCE GLAZING % LOT SL E %
;3 -2, e, Building Permit City Surcharge
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PLAN CHECK_NO-� VESTED DATE Plumbing
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ta_7)�E / - Mechanical
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 Grading
M SEPARATE PERMISSION.
Engr. Review
LU PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF 2
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
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
xi Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT T14E INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a perinit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Foes 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 COMPENSATION INSURANCE AND RCW 18.27.
OF�l I SIG ATqRE DATE
-49
'UR DATE SIGNED
SIGN NE P
(425)
A t-,) rl!�
771-0220 RELEASED BY DATE
ATTENTION 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- ORIGINAL - FILE YELLO�V - INSKECTOR"
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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Height Calculation Worksheet
Address:
Date: 0 (-7-GS
Inspector(s):
1. Datum Point:
2. Datum PO intElevation: -7
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3
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3. Average Grade: 7 (o dSO
30
owed: (avera
.4. Maximum Elevation All ge grade)"+
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5. Reference Point Elevation Shot to House:
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Rlatum elevation) + 'shot to house) =-3
(grade to transit level line
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6. Measurements from line shot onto house to roof ridge:'
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Total --2�i
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7. Actual Elevation. (reference point elevation) +DG A (measurements
from #6)
Conclusion:
44*1.0S (actual) is greater 4Q(P,5- (allowed); therefore the house is/
is not over the height requirement per ECDC 16.20.30 requirements
I , 0:
DATE:
mr-mo,ro: PERMrr COORDINATOR, BUILDf.NG DIVISION
FROM: FIR�E DEPARTmENT DATE
PLEASE SIGN
"-7 0 NGINEER_ING DIVISION DATE
_42)C4 /1Z E
PLANNING DIVISION DATE
PLEASE SIGN
PRO.FECT A_,� g')_-Q,
SITE ADDRESS Izz 1162)
PERN41T H ADBY DATE INSPE CTED
.......... i(
DESCRIPTION OF WORK TO BE INSPECTED_C/--�ar—
A field inspection was conducted to determine compliance with approved plans. Final app rioval
denotes that there are no objections from the -above signed Department to tile release of
PERIF ORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WIT14 CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of ICORRE'CTION NOTICE givcn to owncr/contractor by inpector
2.
3.
RE -INSPECTED ouTSTANDING fSS U'ES - GRANTFINAL PROJECT APPROVAL,
Date Signature
1Aemp:b1dg:ronns:oca1)rv1 3/25/04
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDIN`G DIVISION
DEPARTMENT DATE
FROM: —FIRE
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ENGINEERING DIVISION DATE
PLEASE SIGN
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PLANNING DIVISION DATE
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PLEME SIGN
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SITE ADDRESS
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PERMIT ADB# AI'la/6ATE INSPECTED
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DESCREPTION OF WORK TO BE INSPECTED A,1,4
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A field inspection was conducted to determine compliance witl -approved plans. Final approval
e of
denotes that there are no ohjections from the ahove signed Department to the releas
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
I .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
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3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
I:teiiii):bidg:foriiis:ocal)i-N,I 3/25/04
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DEPARTMENT OF BUILDINGS
F fin
PER UNIFORM BUILDING CODE SECTION 109
At: 23130 71�h Avenue W. Edmo Bu"liding Permit #: 2004-0271
occupancy established by this ceftificate: Dwelling Units: '2**.
No. Stories: 2
R3/U1 TOP Construction: VN
5�- (Per U.B.C. 1002)
Maximum Occupant Load
Room'.capacity signs, whidri�,Mqdired; must remain posted at all times.
Owner of Building:. Donald SIAMM70V doress: 1791-1;Lin'd6n�-Allilrlinue N, S line, WA..98133
THE SweazgLqqg!ex HAS BEEN INSPECTED AND APPROVED AS- COMPLYING WITH THE REQUIREMENTS OF THE 1997 _Edition of
the IJ�NIFORM BUILDING CODE AS ADOPTED BY THk CITY FOR THE GROUP AND DIVISION OF OCCUPANCY AND THE USE FOR WHICH THE
PROPOSED OCCUPANCY IS CLASSIFIED.
issued this 113 th day of Decem_ber, 2005
CHIEF BUILDING OFFICIAL
BY: /-2;
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.
:..... A. Ai M.
AU U.: ass
(T)i (T*), (T), (T�
\V \V T T T T
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
IL 4 Commercial Final .......
EXTERIOR SHEATHING
NAILING ........................ -boa
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ................... (-IDS
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
e
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
Side Sewer 0 f bOC)
Amout Paid$ Rec-c-Ept plo /I
Date Issued W11ma)-m
WaterMeterSize
AmountPaid- 5�00 Rccelpt0cDOID
10
Date Pumhased - - 4 yllo4wl7ls
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