20040676 (2).pdfa
DATE RECEIVED IT EXPIRES
[PERM
USE PERMIT
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CITY OF EDMONDS NUMBER,,9,,�_ 14 L�v
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
ADDRESS
OWNE NAME/NAME OF BUSINESS v),
PLAT NAME/SUBDIVISION NO, LOT NO� LID NO.
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9z MAILING LID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street Use Permit ROCIA [3
inspection Required [3
�Iir TELEPHONE EXISTING — PROPOSED Sidewalk Required E3
REQUIRED DEDICATION- Fr underground E3
36v 1413-2 o:3 fit 1 wiring required
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NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO 11 z
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/D RAIN AGE
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VARIANCE OR SHORELINE OR ADBI INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE LCHECK B Y CU REO'D
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1,:)-h3h7s SEPA REVIEW SIGN AREA HEIGHT
-4 PROPERTY TAX ACCOUNT PARCEL NO. \-I COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
0 -7 Ott 0 -7 0 6 00 K(Y'D k� CA_�k'
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LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
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ADDITION COMMERCIAL C'2 -F
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LOT AREA (L
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GRADING FENCE
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DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
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(TYPE OF USE-11C NESS OR\ACjF, EXPLAI PE OF CONSTRUCTION UPANT
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GROUP
WUMBER NUMBER OF CRITj1C
M OF DWELLING AR SPECIAL INSPE;TION JAREA OCCUPANT
0 STORIES UNITS NU I I:k REQUIRED YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS z
PROGRESS INSPECTIONS P�R UBC 108/ IBC109/ IRC109 FINAL INSPECTION REO'D —9
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L", tk_ 6011NIY6T� 004CS!�� Description FEE Description FEE
Plan Check e / State Surcharge
HEAT SQURCE GLAZINq % LOT SLOPE % Building Permit City Surcharge
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PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
W 91\
CL PERMIT LIMIT! I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
W Fire Review Plan Chk. Deposit
OAPPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTERE�T, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTiY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHAt I. NOT BE
a Landscapelnsp. Total Amt. Due
i DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMEN I OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt # L
iili� L� 76- 0
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT., AND THAT I AM THE OWNER. Oil THE DULY AUTHORIZED AGENT OF
THE 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 Official or his/her Deputy; and Fees ate paid. and
IN VIOLAT THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
E;;N OF
WORKM COMPENSATION INSURANCE AND RCW 18.27.
OFFIC JLS SIG TURE DATE
WNER 0 A E C
IGN DATE GNED (425) C
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771-0220 .4 v I. s Y ATE
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AlrTENTION EXT 1333
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IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILA FINAL J
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCLI- y ORIGINAL -FILE - YELLOW-/NSPECT6R
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK -OWNER - GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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Zipper Zeman Associates, Inc.
Geotechnical Engineers and Environmental Consultants
18905 33rd Ave. W, Suite 117, Lynnwood, WA 98036 (425) 771-3304 / FAX (425) 771-3549
L PAGE OF
DAILY FIELD REPORT #
DATE -7)��L041-
PROJECT: 1-70067a--��
�ef ZZA JOB NO:
CLIENT:
CONTRACTO
ZZA FIELD REP:
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LOCATION:
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REVIE,7WE, D BY:
'rhis report presents opinions forniedws aresult ofour observations of the contractors activities relating to geolechnical engincering.We rely on the contractorto comply with
ficat ions throughout the duration ofthe project irrespective ofthe presence oftheZZA field representative. The presence ofour field representative will
the plans and s peci
be for the purpose of providing observation and field testing services. Our work does not include supervision or direction of the actual work ofthe contractor, its employees,
field nor the observation and testing by ZZA shall excuse the contractor in any way for defects discovered in its
or agents. Neither the presence of the
ZZA representative
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E_FNATIOKAL RESIE)ENTIAL CODE (IRC) 2003 EDITION, IUL 2 6 2-004
PERMIT
E LQA COUNTER
OUND SNOW LOAD (Ce=10, Ct-10) 25 PSF APPROVrW AS NOTILID
)OR 40 PSF BY ENGINILEERING
CERAL LOAQL-.
D: 5ASIC WIND SPEED 85 MPH, EXPOSURE 5 /Date:
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BMIC: SEISMIC DESIGN CATEC-sORY D2
STATEMENT OF PLAN REVIEW SERVICES AGREEMENT
ACKNOWLEDGEMENT OF REQUIRED
DISCRETIONARY APPROVALS
1, U-to k", am the owner/(g::e5n Nor the owner, for a
building permit tb
congnic-tion im' rovtments upon real property located at:
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in Edmonds, Washington. I acknowledge that, pursuant to terms of this agreement, the Building Permit
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Application I have submitted will be accepted for review by the City concurrently with the review of any
necessary discretionary project permits or approvals required by the provisions of the Edmonds
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Community Development Code. I also acknowledge that the City shall not accept an application for
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building permit that is not complete as determined by the minimum submittal requirements published by
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the City which I have read and understand. In signing this form, I acknowledge that I have submitted all
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necessary documentation in order to make a complete application for a building permit. The City
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determined that the discretionary application(s) for this project were deemed complete on (date).
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I acknowledge that any plan review fees paid in connection with this application are solely for the
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expenses and costs associated with review the plans as I have submitted them, and do not entitle me to
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any right or claim to the issuance of a building permit. In consideration for the consolidated review of the
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building permit application concurrently with any required discretionary project permits or approvals, I
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hereby acknowledge and agree to be bound by terms and conditions of this agreement as. set for herein.
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1. The required discretionary project permits or approvals for this project currently include, but are not
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limited to the following:
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M Architectural design review ........................................... Hearing date:
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Subdivision or short subdivision ................................... Hearing date:
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Planned residential development ................................... Hearing date:
F-1 Conditional use permit ................................................... Hearing date:
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F-1 Variance ......................................................................... Hearing date:
2ec ritical areas determination or variance request ............. Hearing date:
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Other (specify) Hearing date:
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I further understand that additional discretionary project permits or approvals may be determined
during the course of discretionary project review which may affect plan review timelines and plan
review fees paid for this building permit application.
2. Any building permit issued and approved for this project will be subject to any conditions or
restrictions imposed pursuant to the review and approval of any required discretionary project permits
or approvals. Such conditions or restrictions may require that the building plans I have submitted be
modified or amended to be consistent with such conditions or restrictions. I understand that additional
plan review fees will be required in the event that modifications or amendments to the plans
submitted are required by conditions or restrictions imposed pursuant to a final decision to issue or
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
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Retaining Wall ........... 0
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Slab Insulation .......... 0
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PLUMBING:
Underground .............
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Rough -In ................... C
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Commercial Final ......
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HEATING: M
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Gas Test ....................
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Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING M
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NAILING .......................... 0 C#)
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FRAMING ........................ 0 M
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FIRST FLOOR FRAMING ... M 0
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INSULATION ...................
Floor Insulation .........
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Wall Insulation ........... z
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Ceiling Insulation .......
SHEETROCK NAILING ... z
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SPECIAL INSPECTION ... 0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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grant any required discretionary project permits or approvals. In the event that modifications or
amendments are required, the owner shall be solely responsible for any and all costs which result
therefrom, including, but not limited to, additional full plan review fees. When additional plan review
fees are required, the fees shall be paid in full prior to the commencement of additional plan review
by the City.
3. No building permit will be approved or issued until such time as a final decision for all required
discretionary project permits or approvals have been issued or granted, including theexpiration of all
appeal periods. A decision to issue or approve any required discretionary project permit or approval z
shall not be considered final until the limitations period for any appeal has expired or until all 0
administrative and Superior Court appeals have been resolved. In the event that an appeal of a --4
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discretionary project permit or approval results in new or additional conditions or restrictions which M
require modifications or amendments to the building plans, such conditions and restrictions shall be
treated as if originally imposed in the issuance or granting of the discretionary permit or approval. Zi
However, new full -plan review fees shall be required. Cn
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4. The building permit application shall expire 180 days after the building permit submittal regardless of 0
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whether a final decision, including' expiration of appeal periods, for all discretionary project permits 0 C
or approvals have been issued or granted. I understand that I may request a building permit --i K
on of the M M
application extension for an additional 180 days, in writing, if filed before the expirati M Z
original application. The City may grant only one extension. In the event that the building permit 0-4
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application expires prior to a final decision on the issuance or approval of all required discretionary >
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permits or approvals; or if not request for an extension is submitted in writing prior the expiration of � M
the original application, then the application shall expire and a new application and new full -plan Cn
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review fees will be required. >
5. in the event that any application for a required discretionary project permit or approval is withdrawn, M M
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1, no portion of any plan Cn
or if such permit or approval is denied either by the City or upon appea 0 r-
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review fee shall be refunded by the City. Cn
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6. In the event that the building pen -nit applicant initiates or requests amendments or modifications to Z
is complete, new full -plan
the building plans after plan review by an applicable City Department M
review fees will be required and shall be required to be paid in full prior to the commencement of
additional plan review by the City.
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1 certify that I have read and understand t
,�e terms and provisions of this agreement for plan review
services and agree to be bound by such. - CII
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'141ey e n VtO w.ne r Date: M
Services Permit Coordinator Date:
statement of plan review sery agree-doc 2
01.17.2001
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
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Slab Insulation ..........
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PLUMBING:
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Underground .............
Rough -In ...................
Commercial Final ......
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HEATING:
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Gas Test ....................
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Gas Piping .................
Equipment
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Commercial Final .......
EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ........................
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FIRST FLOOR FRAMING...
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INSULATION ...................
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Floor Insulation .........
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Wall Insulation ...........
Ceiling Insulation .......
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SHEETROCK NAILING
SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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