20040556.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAI�N ADDRESS
CITY
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NAME
ADDRESS
CITY
NAME
ADDRESS
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ZIP
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PERMIT EXPIRES
USE PERMIT
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NUMBER,
rL ".2
JOB SUITE/APT#
ADDRESS 35
PLAT NAME/SUBDIVISION NO LOT NO, LID NO
1, 1 1 1 LID FEE $
PUBLIC RIGIiT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 13
HW Permit Required 13
street Use Permit Rriq-d 13
1 FLEPHONE
e
7 �i
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
inspection Required Q
Sidewalk Required
Underground
Wiring required
PRV REQUIRED
METER SIZE LINE SIZE NO. OF FIXTURES
TELEPHONE
T
STATE LICENSE NUMBER EXF
v7:1 9 C 0 P(A�
PROPERTY TAX ACCOUNT PARCEL NO.
NEW
RESIDENTIAL
ADDITION
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REPAIR
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DEMOLISH
TANK
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CARPORT
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(TYPE OF USE, BFS)NESS
OR 4CTIVITY)
EXPLAIN:
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NUMBER
NUMBER OF
OF
DWELLING
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LINT
DESCRIBE WORK TO BE DONE
YES 1-1 NO 11
REMARKS
OWNER/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
Al" 1 ENGINEERING REVIEWED BY DATE
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OYES ORNO'S
SEPA REVIEW SIGN ARbA HEIGHT
COMPLETE , EXT ALLOWED PROPOSED ALLOWED PROPOSED
EXP
PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FION; SIDE REAR FRO LJR.SIDE AEAR/
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COMPLIANCE OR
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PARKING LOT AREA Pr),NING 8
(A WEWEP By/ DATE
SIGN RM'D I PRC,�T�DED !to oj�
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NU LIT C LOAD
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REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D a
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VALUATION
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Description
HEAT SOURCE I GLAZING %
LOT SLOPE %
PLAN CHECK NO: VESTED DAT E (
1�3 1 ', * ql, # 6;� 7
44. r
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMITICIVERS 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: 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 S130U SE, 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 OFwHATEVER NATURE. ARISING DIRECTLY Oil 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 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 Cr�LY)VITII CITY AND STATE LAWS REGULATING CONSTRUC.
TION; AND IN DOING THE o �UTIIORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THr-UlptIOR OQJF>-�iE STATE OF WASHINGTON RELATING TO
WORKMEN'S C!OMPEI�APN
Itig ANCE A��PCW 18 27.
SIGNATURE (OWNE� OVAQEf�i�
I
DATE SI ED/
-7
FEE Description
TState Surcharge
(7 City Surcharge
Base Fee
FEE
Y-1-I'L
Plan Chk. Deposit ILI 1.1
Receipt # 24
Total Amt. Due 10
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Btlilding official or his/her Deptily: and Fees are paid, and
receipt is acinowladged in space provided
OFFICIALS SIGNATURE DATE
-7111
RF4FA6FD BY
DATE
ATTENTION EXT 1333 V")z
IT ISANLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILE - YELLOW- i'NSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK MVNEFA - GOLD -ASSESSOR
0% 03 PRESS HARD -YOU ARE MAKING 4 COPIES
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
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Footing ......................
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FRAMING ........................ M
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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
L-A[c,l-�, �_
MAILING ADDRESS
CITY
NAME
CITV
f
NAME
ADDRESS
CITY 4!P LTELIEPHONE
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TATE LICENSE NUMBER EXPIR7,10N DATE
V--:, , 1. , _y
ZIP ITELEPHONE
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CBL #
PROPERTY TAX ACCOUNT PARCEL NO.
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11
NEW
0_1RESIDENTIAL
11
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11 COMMERCIAL
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1:1
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1:1
DEMOLISH
1:1
TANK
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GARAGE
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RETAINING WALL
ROCKERY
1
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/ I PERMIT EXPIRES
USE PERMIT
ZONE
NUMBER
JOB SUITE/APT#
ADDRESS
PLAT NAMEISUBDIVISION NO.
L 0.
LID NO.
Z�T
Ir
14 . I
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TFSCP Approved
RW Permit Required
Street Use Permit Herid
EXISTING PROPOSED—
Inspectian Required
Sldo*alk Required
REQUIRED DEDICATION F1
underground
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
—
I YES0 NO 13
REMARKS
OWNERICONIRACTOR RESPONSIBLE FOR EROSION CONTROL /DRAINAGE
L),= f--,, I I � � 11 1 - - — � - .
'ic.12 J^ � � - I
ERING REVIEWED BY DATE
REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
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REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
FRONT SIDE REAR
FRON; LJR, SIDE/ REAR
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PROGRESS INSPECTIONS PER 1i 108/FINAL INSPECTION REO'D F3
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Description FEE Description FEE
State Surcharge Z_%r)
6md4e-7 ZI/ Plan Check
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HEAT SOURCE GLAZING % L LOPE % City Surcharge
Building Permit
PLAN CHECM/_)/,/ VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
i DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
cc PERMIT APPLICATION: 180 DAYS
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IL 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
ul
Lu 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
At-[. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIREC1 LY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF -THIS PERMIT SHALL NOT BE
DEEMED To MODIFY. WAIVE 08 REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
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0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
Recording Fee Receipt #
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
TliE 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 011icial or hisitier Deputy: and Fees are paid, and
IN Viii 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.
OFFICI IGNATURF QATE
[SIGI�ATUFIE (OWNER Of� ATE S "Y
N1 I ED (425)
ID -0220
4- 771 H F i�. IF A D�TE I
ArrENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING Oil STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILE YELLOW - INS rECTOR1
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER - GOLD -ASSESSOR
091,03 PRESS HARD -YOU ARE MAKING 4 COPIES
E]
PLUMBING I MECH
COMPLIANCE OR
CHANGE OF USE
E]
SIGN
FENCE
( X FT
OTHER
FIRE SPRINKLER
FIRE ALARM
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Height Calculation Worksheet
Address:
Date: C-�I 14-
hwector(s):
1.
Datum Point: L=
-- " �-g
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2.
Datum Point Elevation:
I'C4,
3. Average Grade: 16�c�
.4. Maximum Elevation Allowed:
_���,(ivera& gi-ade):
5. Reference Point Elevation Shot to House:
o,).2 (datum elevation) + (f� (grade to transit level Une'shot to house) t 2
6. Measurements from line shot onto house to roof ridge:
Total:
7. Actual Elevation: I (reference point elevation) + (measurements
from#6)= I Ui- .38
Conclusion:
: t ( 4 � 7 1 _ (actual) is greater / less thani 1 (allowed); therefore the house is/
is not over the height requirement per ECDC 16.20.30 requirements
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Date:
bWector(s):
tion Worksheet
1. DatumPoint: Gc�-KI/k
2. Datum Point Elevation: t'CD,
3. Average Grade:
.4, Maximum Elevation Allowed: (a'vezttgib giade)`4�
5. Reference Point Elevation Shot to Ouse:
o,42 (datum elevation) + C-� 'grade to transit level line *shot to house) L -'5P, a
6. Measurements from line shot onto �ouse to idof ridge:"
Total: lr�,(5
7. Actual Elevation: (r + (measurements
(r ference point elevation
from #6) J8
Conclusion:
Q4.7i -(actual) is greater/ less tl�anl Il- (allowed); therefore the house is/
l
is not over the height requirement per ECDC 16.20.30 requirements
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
YROW MAAMSM FIRE DEPARTMENT DATE------------
4"
ENGINEERING DIVISION DATE_V
PLANNING DIVISION DATEL-___�
SITE ADDREbb
ADB DATE.INSPECTED_ 71L
PERMIT
DESCRIPTION OF WORK TO -BE INSPECTED
A rield inspection was conducted to determine flnal compliance with.approved plans. Final approval
denotes that there am no objections from the above signed Department to the release of
PEYWOMWANCE BONDS and the granting of
GRANT MAL PR03ECT APPROVAL
GRANT PRoJEcr APPROVAL wrrH coNDMONS NOTED
Copy of CONDITIONS given to. owner/contractor by inspector
I. -
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
C, Copy ofCORRECTION NOTICE given to owner/contractor by inspector.
1 .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL.
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
GasTest ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ... 0
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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