20040656.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNE NAME/NAME OF BUSINESS
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MAILING ADDF -SS
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CITY zliIi TELEPHONE
NAME
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NAME
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ADDRESS
CITY 11
STATE LICENSE NUMBER
E
ZIP I TELEPHONE
EXPIRATION DATE
PROPERTY T ACCOUNT PARCEL NO.
00143 bd r?
coo 84
El NEW x RESIDENTIAL
❑ ADDITION El COMMERCIAL
❑ REMODEL ❑ MULTIFAMILY
❑ REPAIR ❑ GRADING CYDS
❑ DEMOLISH ❑ TANK
GARAGE RETAINING WALL
CARPORT ❑ ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVII�r) EXPLAIN:,,
NUMBER I NUM9ER OF
OF DWELLING
STORIES UNITS
DESCRIBE WORK TO pE DONE
5
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7-aTl 60
CBL a
CHECKED BY
❑ PLUMBING I MECH
COMPLIANCE OR
❑ CHANGE OF USE
❑ SIGN
❑FENCE
( X FT
❑ OTHER
❑FIRE SPRINKLER
FIRE ALARM
PERMIT EXPIRES
USE PERMIT
ZONE 1�� I NUMBER
JOB
ADDRESS 1 Cr 0 C/r�
PLAT NAME/SUBDIVISION NO. LOT V40.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP t
H
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EXIS1l14G PROPOSED
REQUIRED DEDICATION Ff U
METER SIZE I LINE SIZE NO. OF FIXTURES
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SUITE/APT#
(� �^
LID NO.
LID FEE b _
ESCP Approved
W Permit Required
treat Use Permit Roq'd
nspection Required
..idowalk Required
Underground
Wiring roq uhad
PRV REQUIRED
YES ❑ NO ❑
FIEM.ARKS
OWWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE �
/ /') I /&I C� PrC Cr/ ON (%) : F0 /�zo S / 0�1
ING REVIEWED BY DATE
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REVIEWED BY DATE
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VARIANCE OR CU SHORELINE OR ADB# INSPECTION I BOND
REQ'D POSTED
❑YES NO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXE�T ALLOWED PROPOSED ALLOWED PROPOSED
EXP �A Cj% 9
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT] SIDE, REAR FROtj UP SIDE? REAR t7
35 "lo 7"Yc cZS !C v:)u5 ulv7 iv 7 Z
PARKING LOT AREA P REVIEWED BY DATE
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RFQ'D PRO DED 13v1 07
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REMARKS
14 ) �� 1Cj( 7T� K ( f?1tl STI it �✓t
(Sc c7 — r
c CHECKED BY TYPE OF C TRUCTION CODE]) OCCUPANT
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CRITICAL V 1
AREAS SPECIAL INSPECTION AREA OCCUPANT
NUMBER REQUIRED ❑ YES S`.14REMARKS ] LOAD
rr PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RE ID 9
HEAT SOURCE GLAZING % LOT SLOPE %
I CvL E ,VL _
PLAN CHECK NO: vesTEO OnrE
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
'j SEPARATE PERMISSION.
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¢ PERMIT APPLICATION: 180 DAYS
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n PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
N 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
rn
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS 'THE CITY OF
i EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
¢ ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRFCIIY
¢
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIRFMENI OF ANY CITY ORDINANCE
01 x
NOR LIMIT IN ANY WAY THE CITY'S ABII.IlY TO ENFORCE ANY ORDINANCE PROVISION '
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMA110N
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITII CITY AND STATE LAWS REGULAUING CONSTRUC
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIZ7�ION OF�tE LABOO CODE OF THE STATE OF WASHINGTON RELATING TO
wonENS COdPEQfOL' NbARCM INSORANCF_AND RCW 18.27.
DISIGNED7 // i if(/ I`L 7 1
VALUATION
$1y, L13
Description FEE Description FEE
Plan Check f State Surcharge
Building Permit City Surcharge
Plumbing Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection A ICJ
Fire Review Plan Chk. Deposit ;io 7
Fire Inspection Receipt N
Landscape Insp. Total Amt. Due
Recording Fee Receipt #
APPLICATION APPROVAL
GALL I his application is not a permit Until signed by the
Building Official or tits/tier Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
OFFICI.$IGNAl)1R DATE
(425) //
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771 -022U RFI EASED BY I DATE
ATT%NTION ' EXT 1333 % /
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL ��` l I�
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 013IG N L - F LE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - 'NER GOLD - ASSESSOR
09;03 PRESS HARD -YOU ARE MAKING 4 COPIES
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1;PPHOVED AS NoTEb
BY ENGINEERING
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,. al NttYY:>: EXISTING
GARAt GARAGE
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NEW"PLANTER:..I F6A DESCRIPTION
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EL. 8 117' STRIP
NEW--
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' (� DRIVE
EXISTING
EXISTING PARKING
- _ - .N :_..�. — - -----.PRIVEWAY----.
39� I i 9 0 (pj� PARCEL NUMBER _
_bag3.4�a aSo3— —
BE COVERED WITHIN 2 DAYS
RETAIN EXISTING
GRADE AS REQ'D 20' EXISTING EASEMENT I
- ASSUMED EL. 100,00
100.0' PL. �:5(Z vE DATE SITE PLAN _ _ -• _ SHEET
ACCEPTABLE TI�GUIL14EI 11IZW A NEW GARAGE ADDITION
------------ — SITE . PLAN - — -- _ _ . _ ^- NRATERIAt. - - _ . - _ LLAG
OEYMPIC VIEWE - - ---- - - -- - - --- -- - - - _ _ . S p . ..... _.
_-
_ - SCALE: 10- 20'_.. EDMONDS. WA _
SDR 35 L.
_ -
SCH 40 OWN �1.
BY;
GEIGL.E DESIGNS - °No
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_.. --- - :; s _ . �. .: 1410E T1 } AVE M1. OFFICE"f42°3} 767-23f6
'� RR& EDMO .% WX 9602G`_ ._ —.. _ FAX:" 1425I TST-25(G, . 041N
GL:tT1`ERSt�- 0Wi 8P0LITS-
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1N;3 Sty► ASHBI ECT TO EXIBT. ��SP� J _ ..��r �5 0 v
TO CONNECT
S,e (eves} , �eY�;; ewer
MEMO TO:
FROM:
tOVAL FORM
PERMIT COORDINATOR, BUILDING DIVISION
P1 EA E SIGN
PROJECT
SITE ADDRESS
TO:
DATE:
DEPARTMENT DATE
I]EERING DIVISION DATE✓�
PLANNING DIVISION DATE
PERMIT #2 CD 4,- ,: 6 ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED�Q
A field inspection was conducted to determine final 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 e.
'_ GRANT 'FINAL 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 inspector
I.
Q
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date
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INSPECTOR DATE APPROVED
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Footing
Wall
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` Pier/Porch _
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Retaining Wall ........... M
Slab Insulation .......... --1 'il
PLUMBING:
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HEATING: C
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INSULATION - 2
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Ceiling Insulation ....... O
SHEETROCK NAILING ... n
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SPECIAL INSPECTION ...
MISCELLANEOUS Q
FINAL APPROVAL FOR
OCCUPANCY
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