20040515.pdfc
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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
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CITY ZIP TELEPHONE - -
NAME
ADDRESS
CITY ZIP ITELEPHONE
NAME G/J �'l C`�!n
ADDRESS
CBL`#
t ZIP kTELEPHONE.
STATE LICENSE NUMBER EXPIR TION DATE CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
❑ NEW BO�RESIDENTIAL ❑ PLUMBING / MECH
❑ ADDITION ❑ COMMERCIAL CO PLIANC R
CHANGE OF USE
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN
❑ REPAIR ❑ GRADING CYDS ❑ FENCE X FT)
❑ DEMOLISH ❑ TANK _ OTkn
GARAGE RETAINING WALL RE SPRINKLER
❑ CARPORT ❑ ROCKERY ❑ FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE /%
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: l L _ IED DATE �(
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
F-
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w PERMIT APPLICATION: 180 DAYS
a PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
y 'APPLICANI, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
¢ ALI. 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
o DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
SI NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
USE
ZONE
JOB
ADDRESS
PLAT NAME/SUBDIVISION NO.
PERMIT EXPIRES
PERMNU M BiER..� � L ' f/ f)
NO.
S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
REQUIRED DEDICATION IFT
METER SIZE I LINE SIZE NO. OF FIXTURES
f SUITE/APT
LID NO.
LID FEE $
TESCP Approved [
RW Permit Required [
Street Use Permit Roq'd [
Inspection Required [
Sidewalk Required [
Underground
Wiring required [
PRV REQUIRED
YES ❑ NO ❑
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING R
FIRE REVIEWED BY
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DATE
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VARIANCE OR CU SH6RELI R ADB# INSPECTION I BOND
REQD POSTED
&:;cewtP YES '40 S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP .�
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSEq FRON� SIDE REAR/ FRONT L/R SPE REAR, �
3.5`, 1 ,8% s to aS J1\5 to aS -
PARKING LOT AREA NING R VIEW D Y go'..
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RFp'D I P VIDED lq/' I!(� sld} ! / O I a
REMARKSOeCk `( j S.Trt- 0co U w6eJ
W I/N Srd� �cl v`I.CKJ •, wr k1^ 15,/p V✓7l r^
CHECKED BY TYPE OF U�TIgN C OCCUPANTq
/� J GROUP C
SPECIAL INSPECTION JAREA r OCCUPANT
REQUIRED YES •-� (�- • LOAD
I /Y��% t l� � ,Si
REMARKS c7
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REO'D J
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
FEE Description FEE
State Surcharge tJ C 7
City Surcharge
Base Fee ?S
Plan Chk. Deposi j(&1/, `J 1'
Receipt k-
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Total Amt. Due
Receipt k /
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 CO NSATION INSURANCE AND RCW 18.27.
OFF S SIG T RE DATE
SI NATUR owNEFi R AGENT) DATE SIGNED (425) _7
L1 _?. - . C/ 771 0220 I! L
Fire Review
Fire Inspection
Landscape Insp.
Recording Fee
RF�LtASED BY
ATTENTION EXT 1333 i
IT IS UNLAWFULTO USE OR OCCURYABUILDING OR STRUCTURE UNTILAFINAL i 1 " ; I �7
INSPECTION HAS BEEN MADE AND APPROVAL OR ACERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW -
PANCY HAS BEEN GRANTED. UBC 109 / IBC110 / IRC110. PINK -OWNER GOLD - A
09/03 PRESS HARD =YOU ARE MAKING 4 COPIES
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S- ( Corner/Vs Flamm. /
Lone I A
Actual
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Front - t �' �' JccK ' 7 ; 1 `� E 0
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Sides aS----� 7�5� ec�C t srM:,y
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Rear v K ��I l 5 6.IlJ;.� sZrbw� �\ e ,. sloe ZoPi
I Other ..000 -- — I N _ _
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BUILDING HEIGHT
CALCULATION:
A = 181.6
B = 181.2
C = 188.3
D = 189.3
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AVERAGE HEIGHT = 185.1
MAX. ALLOWABLE HIGHT = 210.1
ACTUAL DESIGN HEIGHT = 209.75
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM:
FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
PLANNING DIVISION DATE 3 O.S
PROJECTS
SITE ADDRESS
PERMIT # ADB# DATE INSPECTED
1
DESCRIPTION OF WORK TO BE INSPECTED % J
A field inspection was conducted to determine 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
/,� GRANT FIla1AL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
❑ Copy of CONDITIONS given to owner/contractor by inspector
1
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
❑ Copy of CORRECTION NOTICE given to owner/contractor by inpector
I_
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:forms:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR
SETBACKS .....................
DATE APPROVED
FOUNDATION:
Footing ......................
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 ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
n
'l he Initials NIT are Milton
Thompson, a temporary contract
inspector for the CitY.
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