20040619.pdfW
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
V NAMENAME OF BUSINESS
MAILING ADDRESS
CITY ZIP
91�
NAME
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ADDRESS
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111EXATINI
ADDRESS
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CITY
STATE LICENSE NUMBER
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ADDRESS
PI AT NAMEISUBDIVISION NO
PERMIT EXPIRES
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PERMIT 'Imz/
NIJIMBER.,;-�/
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ez151
SUITE/APT#
LOT NO LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Fjw pofmil nequirod
SIree, Use pelmit Hoq'd
TELEPHONE EXISTING -ff� PROPOSED inspectian noquirod 10
Sidowalk Required
000,o� F, underground
416' �70 1,-Yt6- REQUIRED DEDICATION wiring required
METER SIZE LINE PRV REQUIRED
11__� I YES 0 NO 1:1
ZIP I TELEPHONE
CBL #
ZIP TELEPHONE
EXPIRATION DATE I CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
S 7 5
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
CYDS
DEMOLISH
TANK
GARAGE
RETAININGWALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY.) EX.P6AIN
uj NUMBER NUMBER OF
OF DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
OP4
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/d, at
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SOURCE GLAZING %
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COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
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OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL 92r
AR
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OYS, 7&
LOT SLOPE %
7� 0/17
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.
cc PERMIT APPLICATION: 180 DAYS
LU
IL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
U)
W IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMIESS THE CITY OF
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2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
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4 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF I HIS PERMIT SHALL NOT BE
0 DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
_j JY -TO ENFORCE ANY ORDINANCE PROVISION.-
01 NOR LIMIT IN ANY WAY THE CITY's ABILI
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 UWS REGULATING CONSTRUC-
1ION; AND IN)PING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLAT19YOF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKME46/1V4%1LtENSATION AURANCE AND RCW IB 27.
E JIGNED I
REMARKS
OWNER/CONTRACIOR RESPONSIBLE FOR EROSION CONTROkJDRAINAGE
ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE
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VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
REqP4 POSTED
----------- OYES 9ko S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (FT3 PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRqN SIDE 96*! FRONT UR SIDE REAR 0
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PARKI LOT AMEA I PLkNNING REVIEW�D BY DATE
REO'D PROVIDED I --%
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REMARKS r� I , f1k7- 3t,�rLCtt_ k 0 ro 1% 2j �vje,
CHECKED BY ITYPE
SPECIAL INSPECTION ln,4�L
REQUIRED [] YES I
OCCUPANT
GROUP
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REQ-D
VALUATION
$
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE Description FEE
State Surcharge
City Surcharge /,, Z D
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt N
APPLICATION APPROVAL
I his application is not a permit until signed by the
Building Olficial or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
-.FICL&&�SIGNMURE DATE
ATTENTION I I
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09!03 PRESS HARD -YOU ARE MAKING 4 COPIES
D BY
ORIGINAL - FILE - YELLOW - INSPEC`rO
PINK -OWNER - GOLD ASSESSOR
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Height Calculation/Grading Verification Worksheet
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Address: Permit #:
Date:
A. Datum Point:
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B. Datum Point Elevation:
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C. Average Grade:
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3. Maximurn Elevation Allowed: (average grade) + 25' -n
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4. Reference Point Elevation Shot to House:
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to house)
(datum elevation) + 9 CO
!L� (grade to transit level line shot
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6. Measurements from line shot onto house to roof ridge:
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Total
7. ActUal E-Leyation. (reference point elevation) _(measurements from
#6)
Conclusion:
[��-.(O----(actual) is greater lesst Aj2W,1 (allowed); therefore the house is/
is not over the height require=CDC 16.20.30 requirements
LATEMNBUILDINCAMISCUieight CaICUlationGrading Verification Worksheet.doc
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/ zz y Setbacks
A14th ?Iaco'bouthwost Front
Al"ProUVED AS NOTED edge of pav Sides
Qv i: Ki ral Pi: RING.
Reguired
Actual
Vieight CalIcs.
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101-5
-7 ' /4"1
R-W
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L 7'� R-Jq'1
t-3, to 1.0
7'11(
7L�-L/,
?i C 101.0
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I T- A IF 7'11)1) io nfl% a-,44-, sc, baq< 0 K - -ey--�57 I ko,te Pt D 101.5
HeiWit
N qo* o' o" s 13 I.=
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Point B 101'
Point A 101 .5'
6vtrithing t*Acepl for the
propo6fd garage iS VAWin9 r
------------------- imperviouG surface. ThIS
infjudDs the. elMsfinq hOU60,
driveval and Walyval.
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16-
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2'-0'
lot. (S.
qoo sl
7'-6-l' footprint qoo scl. Q
bottom foolin/ Z,
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24" Eaves TYP- - 32'-0'
Point C 10V
Point D 10J.5' 7'-6-
N qo!....o,.' 2--000'
PI of proposed cotajo: jin ?-oft. oin. NORTH
Ciara 0 MditiOn
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Mp, 6irado 100-5
t,4ay. lieight IV-0-2-5
Finished floor 1013-5
MaY. kieight M5.2-5
(see caheet Itl for height
on section vieM.)
Topographl
-fhe site has less than 2: of elevation
change across the, entire, site.
LOSS than 50 (,.1. Of soil will be
enavated for the proposed
foundation.
3:
C erosion C-ontrol
a
IIZ pI stocj�pijed soil will be, covered to
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protect from erosion in storm events.
j3,ecause the site is relative-11 fl3t and
anj erosion will stal on the propertj
we request an oszmption from anj
filter fencing requirements.
Catch ?,asin OPY
Datum = 100 RC
RECEIVED
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PERMIT (.'OUNTER
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FINAL PROJECT A PPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM.: -FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE
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PLEASr SIGN
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PROJECT
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C:
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SITE ADDRESS
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DATEINSPECTED
C:
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PERMIT# 11)r)4 ADB#
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DESCRIPTION OF WORK TO BE INSPECTED n n
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A field inspection was conducted to determine compliance with - approved plans. Final approval
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denotes that there are no objections from the above signed Department to the release of
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PERFORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
M Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
[I Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANTFINAL PROJECT APPROVAL
Date Signature
1:teni1):b1dg:forn1s:ocaprv1 3/25/04
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
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Wall..........................
Pier/Porch .................
Retaining Wall ...........
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Stab Insulation ..........
0
PLUMBING:
M
Underground .............
Rough -In ................... Cl) —11
M
Commercial Final ...... C:
0
M
0
HEATING: 0
4- —4 K
Gas Test .................... 0 M M
ct M Z
Gas Piping ................. jo
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Equipment .................
Commercial Final ....... Cz
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0
EXTERIOR SHEATHING
NAILING ..........................
____ M_
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FRAMING ........................ 0 —
4 4") Cz Cn
0
0 0
FIRST FLOOR FRAMING ... M
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0 9 Cn
INSULATION ................... po Q 0
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Floor Insulation .........
Wall Insulation ........... __4
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Ceiling Insulation ....... z
SHEETROCK NAILING
Cn
SPECIAL INSPECTION ... z
0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
Side Sewer # q2S vlwv� POO
Amout Paid $ Receipt f
DateLwuerl xplm
WaterMeterSize M, I
Amount Paid._.,,...,.,.Receipt
DatePurChaSed
ROW#
Aflount Paid $.--..Receipt
Date xpires