20040592.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP ITELEPHONE
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NAME
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NAME
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ADDRESS
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CITY
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TELEPHONE
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STATE LICENSE NUMBER
EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
00 55 50 o6o oo qo
1:1 NEW
RESIDENTIAL
XPLUMBING / MECH
0 ADDITION
COMMERCIAL
COMPLIANCE OR
1:1 CHANGE OF USE
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MULTIFAMILY
SIGN
REPAIR
GZD N&) FENCE
CYDS X FT)
DEMOLISH
TANK
OTHER
EiGARAGE
CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
r (TYPE OF USE. BUSINESS OR ACTIVITY) EXPL�l :/1
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uj NUMBER NUMBER OF CRITICAL
0 OF DWELLING AREAS 0q-
121 1 1 NUMBER
STORIES UNITS
0
DESCRIBE WORK TO BE DONE
HEAT SOURCE GLAZING % __LOT SLOPE %
oil, 7 S-- Pic, 4-
PLAN CHECK 7,10.-, VESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
It= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
W PERMIT APPLICATION: ISO DAYS
CL 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 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
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREcrLY 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
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY ACKNOWLEDGE THAT I 14AVE 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 COM PEN SATIQ4,1NsURANCE AND RCW 18.27.
ORWT4)�L DATE SIGNED
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PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB SUITE/APT#
ADDRESS A <— j,J
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PLAT NAME/SUQPIVt§tON NO. LOT NO. LID NO.
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TESCP Applovild 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 13
Street Use permit Raq'd 13
EXISTING — PROPOSED- Inspection norlilirod -Cc,
Sidewalk Required
Underground
REQUIRED DEDICATION FT Wiringroquitud [3
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES gr^ NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CON1ROLJDRAINAGE
REVIEWED 13Y , C-7`\ DATE
REVIEWED BY DATE
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SHORELINE OR ADB#
INSPECTION
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SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED/ PROPOSED
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EXP
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT S I D),: REAR
PROPOSED SETBACKS (FT)
FROT LJR SIDP REAR/,
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LOT AREA
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REMARKS
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OCCUPANT
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SPECIAL INSPECTION
REQUIRED [] YES
JAREA
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OCCUPANT
LOAD
1 REMARKS
PROGRESS INSPECTIONS PER UBC 108/ IBC109/ IRC109 FINAL INSPECTION REQ'D
ounr QIAMie�� pk55 M
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VALUATION
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Description
Plan Check
Building Permit
Plumbing '
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-022z0---1
ATTENTION EXT 1 a�
ITIS UNLAWFULTO USEOR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
FEE Description FEE
TState Surcharge
61 City Surcharge
Base Fee
Plan Chk. Deposit
Receipt III
Total Amt. Due
Receipt #
I
APPLICATION APPROVAL
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.
OFFICIALS SIGNATURE DATE
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL -FILE
PINK - OWNER
ELLOW - INSPECTOR
GOLD -ASSESSOR
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LOT AREA 13845 50 FT
BUILDING LOT COVERAGE 11%
LOT 5LOFE = 3%
HEIGHT CALCULATION
A = +955
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C= 955
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AVERAGE GRADE =.955
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ACTUAL HEIGHT = +11166
MAXIMUM HEIGW . 12.3 5
IMFERVIOU5E 5URFACE CALCULATION
EX 5TIN ' BU LMNG ROOF OUTLINE. 1476 5Q FT (CON5TRUCIED 1954)
EX:5TINCG DRIVEWAY; 432 E4 FT (CON5TRUCrED 1.954)
EX15TING GRAVEL FARKING 5TRIP 350 5Q FT (PATE UNKNOWN)
PROP05ED ADOTION 182 OQ FT
1IN bli
EXOTING
DRIVE
CENTER OF CUL-PE-5AC 197M
5TREET 6OUTH wE9T
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DATUM POINT
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PAUL MON50N DE51GN INC. 425-478-0340
FAX 425-4-89-&345
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE—
PLEASESIGN
-ENGINEERING DIVISION DATE 44Z LQ
PLANNING DIVISION DATE
PI.EASESIGN
PROJECT -,,uv v all
SITE ADDRESS— lei -7 1L St S �1/
PERMIT# 1A64-0'5'1'Z- ADB# DATE INSPECTED 411 -2,110S_
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 Department to the release . of
PERFORMANCE BONDS and the granting of:
/GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FrNAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:f6mis:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
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SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
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Rough -in ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final ....
EXTERIOR SHEATHING
C)
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING...
Ot -
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................
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The 111iti,,lis MT are Milton
Thompson, a tclilporary contract
ilispector for the CitY.
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