20040649.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
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CITY ZIP TELEPHONE
NAME
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ADDRESS
CITY ZIP TELEPHONE
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NAME ic
ADDRESS
CITY ZIP
V 09 V I �N N. 11-11 'M�
STATE LICENSE NUMBER
TAX ACCOUNT PARCEL NO.
W,
NEW
RESIDENTIAL
ADDITION COMMERCIAL
TELEPHONE
REMODEL
F-1 MULTIFAMILY
REPAIR
A CYDS
DEMOLISH
F1 TANK
EiGARAGE
RETAINING WALL
E]
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS
OR ACTIVITY) EXPLAIN:
NUMBER
NUMBb OF
OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
7
HEAT SOURCE GLAZING %
'V=CY7 i F14�3t,
PLAN CHECK
LERMIT EXPIRES
P
U U
SE PERMIT
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NUMBER
JOB SUIT /APT#
ADDRESS
PLAT NAME/SUBDIVISION NO, LOT NO. LID NO.
LID FEE $
t d 7Q
"S"
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW pe,,,ul Required CI
Street use Permit Roq'd [3
jr,spection Required
EXISTING PROPOSED Sidewalk Required
Underground
REQUIRED DEDICATION FT Winng required
NO. OF FIXTURES PRV REQUIRED
NO
METER SIZE LINE SIZE
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REMARKS
OWNER/CONTRAGroR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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:NGINEERING PIVVIEWED BY
FIRE REVIEWED BY DATE uj
VARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND
)IRATION DATE CKE Y REQ'D POSTED
EIYES
c6l 0 SEPA REVIEW SIGN AREA N HEIGHT
COMPLETE EX ALLOWED PROPOSED ALLOWED PROP9ZED4
EXP I X -X9 I io
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
PLUMBING MECH ALLOWED PROPOSE F Rp, NJ SIDE BEAR- FROPT URSIDE REAR.-
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COMPLIANCE OR '> 2
CHANGE OF USE _35%4 71� -7 z
PARKING LOT AREA P NING REVIEWEV By ATE :1
SIGN R TED D CIL
FENCE T r WkloiY'
( x FT) REMARKS
0
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6 26A
FIRE SPRINKLER
FIRE ALARM
CHECKED BY ITYPE.0 IftT TION 1CO)E OCCUPAN�2
_�A 151, GROUP A
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CRITICAk_ 6.11" t
LAR E A3S SPECIAL INSPECTIOW ARE A OCCUPANT
NUM13ER REQUIRED C] YES LOAD
I TCr,- VA% --A IC�7 FP
C)NA REMARKS
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REO'D 9
1 0
< AI)a LAAlMr<� /"I il.-), 1/1 k�r IL I.A A M
LOT SLOPE %
VESTED 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.
PERMIT APPLICATION: ISO DAYS
ul
CL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICAN1. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
M
It ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECILY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT 13E
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DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CHYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
'_/56r/
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
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Grading
Engr. Review
Engr. Inspectio
Fire Review
PlanChk.Deposit
Fire Inspection
Receipt #
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Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
211,
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 AGFN1 OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS HEGULATING 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 WASIIING10N RELATING TO FOR INSPECTION receipt is acknowledged in space Provided
WORKMEN'S COliON INSURANCE AND RCW 18.27.
OffIC4
SIGNATURE WNE 1`1 OR AGEN-0 DATE SIONF-D (425) 91)
4�i ; 6V 771-0220 _R F L �_A
ATTENTION Off 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UN'rILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/iRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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ORIGINAL -FILE YELL P FCTC
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MERIDIAN
PREMIER I 101NIES WESTGATE VILLAGE
VOLUME 20. PAGE 2.9
ME-11101) OFSVIVVEN?
FIELD TRAVEKSE. 01; E'XISTING
AMONUMENTATION AND COPUNERS
EOUMMENT USED
SOMA SET 500-1 SECOND ELECTRONIC
TOTAL STATION
FIELD SURVEYPROCEDURE
FIELD SURVEY WITI I I'l IYSICAL CLOSURl-,
EXCEEDING REQU11(rNIENT sc--r FRTll 1\1
WAC-332-130-090
LEGEND
(11) - Plat DiinensiL)n
0,0- Measured Dimension
(C)- Calculated Dimension
0 re -bar %v,'vello%v plastic cap
N-Shore I-S. No 8 - 394 24" lom,
-Existing re -bar with yellow plaitic cap
):i,- Tack in lead with survey tag No 8 19-1
E)NIS`TING ZOPAINGI (RS-8)
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EXISTING LOTI)ESCRI191ONS
Lot I of Citv of Ednionds short subdivision File No. S-99-19.1 recorded
under Snohornish Countv, Washineton Auditor's File No. 200107075211.1.
I -
Lot 2 of City of Ethnonds short subdivision File No. S-99-194 recorded
under Snohomish County, Washington Auditor's File No. 200:107075214,
ADJUSITID Lot I.
That portion of Lot I and 2, of the City of Edmonds short subdivision File
No. S-99-194 recorded under Snoliornish County, Washington Auditor's
File No. 200407075214, described as follows;
Beginning at the Southwest comer of said Lot I
Thence North 0^0'00" East 65.00 feet'.
Thence South 88'54'23" East 15.00 fiect..
Thence North 0*00100" East 13,00 feet-,
T'hencc: North 90"00'00" East 9.48 feet-,
Thence North 1'19'27** East 30.00 feet-,
Thence North 90'00'00" East 47.83 feet;
Thence North 0"00'00" East 834 feet-,
'rhence North 90'00'00" East 17.00 lect to the Northeast comer of said
Lot I-,
Thence South 0'00'00- West 11736 feet to the Southeast comer of said
Lot 1.
Thence North 88*5,I'2j West 90.02 feet to the Point of Beginning;
AD.Jus,mi) Lot 2
That portion of Lot I and 2, of'City ofEdinonds short subdivision File No,
S-99-194 recorded under Snolionush Counly, Washington Auditor's File
No. 200407075214 ; Describedas folloxvs,
Beginnim, at the Southwest cot ner ofsaid Lot 2,
Thence South 88'54'23" East 15.00 feet,
Thence North 0'00'00" East 13.00 feet;
'nence North 90'00*00" East 948 feet;
Thence North 1'19'27" East 30.00 feet,
Thence North 90'00'00" East 47.83 Ilea,
1*hence North 0'00'00** East 8.34 ("cer,
Thence North 90'00'00" East 17.00 feel to [lie Northeast comer of said
Lot 1,
Thence North 0'00'00" E-ast 41.77 feet
Thence North 90'00'00" West 60.00 fiect-,
I'lience North 0'00'00" East 95.98 feet;
Thence North 90'00'00" West 30.00 feet;
Thence South 0000'00" West 188.79 feet to the Point of Beginning.
MAPHIC SCALE 1 30'
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D. NOWFUSHORE LAND SURVEYING LOT LINE ADJUSTNIENT
K PO BOX 785 'MASSOUD KIIAMI TON 98020
-)')01".S-I-- S.W., EDNIONDS,WASIIING
7. 41OTTIELT., WASHINGTON 98041 9307
�jt: 425483-1020 Joe NO.
OWN BY DATE NOV 0 . 2004-
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5X,_?T 27i =200-1�
RUSSEL D. COFFELT
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
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SETBACKS .....................
FOUNDATION:
Footing...................... dr
Wall.......................... -J66
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ................... V\�
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment.................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ........... J)
Ceiling Insulation ....... '7-
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR >
OCCUPANCY ..................
The Illitilis Miltoll
Thollipsoll, a tellipor'll'y Contract
inspector 1,01. tile City.
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