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DATE RECEIVE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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MAILING ADDRESS
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NAME
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ADDRESS
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CITY
STATE LICENSE NUMBER
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PERMIT EXPIRES
PERMIT
NUMB
ADDRESS
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PLAT NAME/SUBDIVISION NO.
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- Fr
METER SIZE I LINE SIZE I NO, OF FIXTURES
REMARKS
E/APT #
LID NO.
LID FEE S
TESCP Approved
Rw Permit Roquiaod
street Use Permit Roq'd
inspection Required
Sidewalk Required
Underground
Waing required
PRV REOUIRED
YES 11 NO 1:1
OWNERICONI-RACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ZIP TELEPHONE
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CNeMEERING REYJEWED BY
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EXPIRATI
PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
RESIDENTIAL
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ADDITION
COMMERCIAL
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MULTIFAMILY
REPAIR
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TANK
GARAGE
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RETAINING WALL
ROCKERY
(TYPE OF USE, BUSINESS OJT-AI�TIVIM EXPLAAN:
uj NUMBER NUMBER OF
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DESCRIBE WORK TO BE DONE
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PLAN CHECK NO: j,:!:,i.. I I
CHECKED BY
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SIGN
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INSPECTION
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POSTED
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SEPA REVIEW
COMPLETE E)K
SIGN AREA
ALLOWED PROPOSED
HEIGHT
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EXP
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT)
ALLOWE( PROPOSED,
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LOAD
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION FILE�20'dD
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LOT SLOPE %
VESTED DATE
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 LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 100 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 CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIREC I I.Y
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 CITY'S 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 COMPENSATION INSURANCE AND RCW 18.27.
SIGNATUREI(OWNER 918 AGEN-9 J! I DATE SIGNED
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FEE
Description
FEE
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Surcharge
415-D
city Surcharge
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Base Fee
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Plan Chk. Deposit
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Receipt # Z9 I
Total Amt. Due 737,50
Receipt #
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APPLICATION APPROVAL I
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
FF)CIALS SIGNATURE ATE
V Elf BY DATE
X17ENTION E)ff 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL LL,
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
VALUATION
s 2 3,
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
CALL
FOR INSPECTION
(425)
09!03 PRESS HARD -YOU ARE MAKING 4 COPIES
OR,
PINK - OWNER - GOLD - ASSESSOR
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'PPROVED 4c?'(6U,�
BY P-LANNING
HEIGHT CALCS IMPERVIOUS SURFACE CALC5
PROP05ED AbbITION FOR
A = +99 EXI5T'G ROOF OUTLINE 2533 S.F.
Joe Clements
B= +99 EXI5T'G DRIVEWAY 474 S.F.
C +98.5 EXI5T'G PATIO& POOL 1904 S.F.
20628 78TH PL W
0 +99 PROP05ED ADDITION 253 S.F.
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EDMONDS WA 98026
AVG GRAbE 98.8
PROP. HEIGHT 113
MAX. ALLOWED 124.1
13' 24' EXI5T'G
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Legal Description:
R58000
Jackson Park BLK 000 b-00 LOT 2
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FRONT SETBACK
Tax Parcel I.D. No. Scale
SIDE SETBACK 7.5
ill 20 15
00 4811 000 002 00
REAR SETBACK
Lot Area 8741 S.F.
Lot Coverage Existing 2268 5. F. (2 5.9 %)
Lot Coverage Proposed 2521 S.F. (28.8%)
RECEIVED
Lot 51ope < 2%
MAY 14 2004
PERMIT cOUNTER
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HEIGHT CALC5 IMPERVIOUS SURFACE CALC5
PROPOSED ADDITION FOR
A +99 EXI5T'G
ROOF OUTLINE 25TS —577
Joe Clements
+99 EXIST'G
DRIVEWAY 474 S.F.
C +98.5 EXIST'G
PATIO & POOL 1904 S.F.
20628 78TH PL W
b +99 PROPOSED
ADDITION 253 S.F.
EDMONDS WA 98026
AVG GRADE = 98.8
PROP. HEIGHT 113
MAX. ALLOWED 124.1
Wt-ft,,4 -9-A'VeVA09-
13' 24' EXIST'G
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Leqal Description:
PFRMIT Q
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ZONE
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FRONT
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Tax Parcel I.D. No. Scale
SIDE
SETBACK 7.5'
lit 200
00 4811 000 002 00
REAR
SETBACK 15
Lot Area 8741 S.F.
Lot Coverage Existin 2268 S.F. (25.9%)
Lot Coverage Propose9d 2521 S.F. (28.8%)
Lot Slope < 2%
APPROVED AS NOTED
-NGiNEERING
BY E
Date:
Joe G. Clements
20628 78h Place West
Edmonds WA. 98026
(425) 771-4359
To: City of Edmonds
From: Joe Clements
Re: Percentage of Drainable Land Subject to (ECDC) (Chapter 18.30)
I am applying for a ing permit for the of adding a 247 sq. ft.
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Master bedroom and bat e rear of my existing residence. This
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is less square foota e 2000 squa ld stated in your
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inf6rm0oR-btdlieTkn�#E-21 as needing a drainage plan.
2. Existing drainage is provided by splash blocks for the comers of the house,
U nderground 4" plastic slotted pipe for the front of the house, and a 25' long x
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3' Wde x 3' deep French drain that serves a channel drain in front of the
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garage, and a box drain for the pool deck.
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3. Gutters for the new addition can be tied into existing gutters on the South
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RECEIVED
MAY 14 200�
PERMIT COUNTER
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GARY HAAKENSON
CITY OF EDMONDS MAYOR
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 FAX (425) 771-0221
Website: www.d.edmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
1,8 9 �) rianning - Building - Eng nee, "y
December 3, 2004
Attn: Joe & Cindy Clements
20628 78th P1 W
Edmonds, WA 98026
Building Permit: 2004-0445
Site Address: 20628 78th P1 W
Expiration Date: 6/9/05
Dear Joe & Cindy Clements:
The purpose of this letter is to inform you that the last remaining inspection on your
project is a final inspection(s). The final inspection(s) detennines that there are no
outstanding life -safety issues and approval allows the City to close your permit file.
The City considers the final inspection to be one of the most important inspections
conducted on a project. In order to grant final approval the following must be complete:
smoke detectors, house numbers, guardrails, handrails, self -close doors between garage
and residence, egress from sleeping rooms, safety glazing, weather-stripping, any
Engineering department requirements etc. Of course not all of these things may
specifically apply to your project but it does give you an idea about the kinds of things
that must be complete as well as some items that do not need to be installed such as:
paint, carpet, moldings, wallpaper, etc. Please be advised pen -nits expire one year from
the date of issuance. if you will need more time to complete the work, permits can be
renewed prior to expiration for one half fees. If the pen -nit expires without a final
approval granted by the Building Inspector, ftill fees are required in order to renew the
permit. This can be very costly to you and we strongly encourage you to check your
pennit expiration date and call for tile required final inspection(s). Note: If more than
one department is required to final your project, this is noted on your Job Card.
Please feel free to contact me at 425-771-0220 if you have any questions.
Sincerely,
Pennit Coordinator
incorporated August 11, 1890
Sister Citv - Hekinan, Japan
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
nXAU S"
ENGINEERING DIVISION DATE z
FLEXSE SIGN 0
PLANNING DIVISION DATE
PLEASP SIGN
PROJECT— ZJ9
SITE ADDRESS -711? 1A_(
PERMIT ADB# 'DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine final compliance with approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
Z! GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
20,�—
Rough -In ...................
Commercial Final ......
HEATING:
GasTest ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
<;
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
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Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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SideSewer# 'r4ffl'f 00V
Amout d$ Receipt #
)Expires,., ......... �
Datebsu 4/Z
WaterMeterSize—
Amount Paid.... Receipt
Datepurchused--
ROW#
Amount Paid $._.Receipt
Date 1ssucd---,,�E%Pirf-'S -------
Tile Initials MT are Milton
Thompson, a tcrtiporary contract
inspector For tile City.
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