20040704.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MATTTIELJ SAL -DO C-4—
MAILING ADDRESS
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CITY ZIP TELEPHONE
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ac 16936 165T21 AVE, SE
CITY ZIP TELEPHONE
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NAME (06A _JLAST V�161rll CBL 1�1
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CITY ZIP TELEPHONE
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S WC*10H I S 14 CIS290 1
STATE LICENSE NUMBER EXPIRATION DATE OHECKEDI BY
71Z8A q-��J _S_ L4 12
JLA
PROPERTY TAX ACCOUNT PARCEL NO.
2 70 33
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NEW
RESIDENTIAL
1:1
PLUMBING MECH
ADDITION
COMMERCIAL
1:1
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
171
SIGN
REPAIR
G
CYDS
M
FENCE
X F_r,
El
DEMOLISH
TANK
11
OTHER
GARAGE
RETAINING WALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSASS OR ACTIVITY) EXPLAIN:
rF CRITICq
Lu NUMBER NOMBER
OF DWELLING AREAS
0 STORIES UNITS e- NUMBER
DESCRIBE WORK TO BE DONE
5 fE-LV_7r C LA)
11
-4 E;
HEAT SOURCE GLAZING % LOT SLOPE %
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PLAN CHECK
VESTED DATE L/�
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVIERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT 1 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 CIT-Y OF
EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENIS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT 13E
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABIL11Y TO ENFORCE ANY ORDINANCE PROVISION. -
PERMIT EXPIRES
USE
ZONE
PERMIT
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NUMBER/
JOB
ADDAESS,,,�
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SUITEIAP
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PLAT NAME/SUBDIVISION NO
LOT NO.
LID NO.
LID FEE $
IF.SCP Approveo
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW permit Required 13
Street U5n permit Raq 'd
inspection Required
EXISTING — PROPOSED Sidewalk Required
Underground
REQUIRED DEDICATION FT Wiring required
METER SIZE LINE SIZE NO OF FIXTURES PIRIV REQUIRED
Q
0 0
I I _Y EE LSS N
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REMARKS 7
OWNER/CONIRACTOR RESPONSIBLE FOR EROSION CONTROIiDRAINAGE E5
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EERING REVIEWED BY DATE
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COMPLETE ENE PT
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SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWE �OSED
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EXP
LOT COVERAGE
BACKS (Fr.)
REQUIRED S ETI
PROPOSED SETBACKS (FT)
ALLOWED PROPOSED
FRON� SIDE REAR,,
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FROF UR SIDE REAR
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REQ'D PROVIDED
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REMARKS
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SPECIAL INSPECTION JAREA OCCUPrNT�
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REQUIRED []
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I PROGRESS INSPECTIONS PER UEIC 108/FINAL INSPECTION REQ'D 6
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 LAWS REGULATING CONSTRUC-
R
TION; AND IN DOING TH E WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
['11N VI-OLATION OF THE ILABOR CODE OF THE STATE OF WASHINGTON RELATING TO
C P
WORKMEN'S 5PAffNSATION INSURANCE AND RCW 18 27.
0 1 DATE SIGNED
'Ir OR AGENT)
IGNAT P) I
VALUATION
$
Description FEE Descr ' iption FEE
Plan Check State Surcharge 77j
-7F
Building Permit City Surcharge 44;
Flumbing Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review Plan Chk. Deposit
Fire Inspection Receipt #
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Landscapeinsp. Total Amt. Due 9Z
Recording Fee Receipt #
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"55
APPLICATION APPROVAL
1 his application is not a permit until signed by the
CALL Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt isacknowledged in space provided.
o I -9tGNATURE DATE
(425)
771-0220 REL Sf"Y DA7E
ATTENTION Ex 1 1333
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
091/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL -FILE YELLOW-INtPECTO
PINK -OWNER GOLD -ASSESSOR
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IMPERVIOUS SURFACE CALCS
EXISTING BUILDING PAD: 1178SF (CONSTRUCTED PRIOR TO 1977)
EXISTING CARPORT. 280SF (CONSTRUCTED PRIOR TO 1977) PROVE LANNING Zone
NNINO
LPROJVIY,�.
7�71
PROPOSE GAMGE: 630SF ��-g Corner A/ Flag /v
DRIVEWAY TO REMOVE: 670SF �etbacks, Reauired Actual
HEIGHT CALCS LOT AREA: Front q5 -
A=+99.5' .24 ACRE = 10,454.44 SF Sides
B=+99.65' 15
C-+99.65' Rear
LOT COVERAGE: !
L,=Tvu.v 2418SF = (23%) Other
AVG GRADE=99.58' 15 - max,
ACTUAL=l 11.75' Height IA' 311
MAXIMUM=111.75'
0ViNElr'l'/CONTfqA"",'! Of:) 13 RESPONSICLE
FOR EROSION C,r"
SETBACK LINE FOR
I ORIGINAL HOME/CARPORT
STRUCTURE TYP.
DEMOLITION OF 51 7.5L—
EXISTING ASPHALT DRIVEWAY
AND CARPORT.
Ex. RESIDEtACE
Cw 0 1178 Sf
SF BEFORE 197�,
EXISTING 20'x2O' f D OR 1 77
4' ASPHALT
DRIVEWAY TO REMAIN 10.0
5% SLOPE
A 8 —w--w
—W--W--
OSED GARAGE
630 SF
99.5
DATU -=5% —SLOPE
Llj 25.0'
C)
VSKAN N
APPROVED AS NOTED
BY ENGINEERING
!�-- I'm n, &—t
Date: '916 kec);5� --.
OPERTY LINE
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NEW SETBACK LINE BY
CITY OF EDMONDS TYP.
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WATER & SEWER GUTTERS/DOWNSPOUITS
INSPECTIONS REQ'D. TO CONNECT TO EXIST. SYST
CALL 425-771-C,220 EXT. 1326 CITY C"'
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLXASE SIGH
VY E�(n ENGINEERING DIVISION DATE -2- zek)
MWE SIGN
PLANNING DIVISION DATE
PLEASESIGN
PROJECT Attelmx
SITE ADDRESS -
PERMIT# �&d.d ADB# DATE INSPECTED 04
DESCRIPTION OF WORK TO BE INSPECTED
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
PERFORMAN!CE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
[3 Copy of CONDITIONS given to owner/contractor by inspector
1
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
C�
Footing ...................... VVIS
Wall ..........................
Pier/Porch .................
Retaining Wall ........... z
0
Slab Insulation ..........
M
PLUMBING:
Underground ............. =i In
Rough -In ................... rn
C
Commercial Final ...... ITI 0
--A 0
0 C:
HEATING:
M
Gas Test .................... M z
Gas Piping .................
Equipment ..� .............. Cn
0 _n
Commercial Final .......
EXTERIOR SHEATHING x
M IT11
NAILING ..........................
FRAMING ........................ 0
0 M
C C/)
FIRST FLOOR FRAMING ... 90)
ITI 0
Z r
INSULATION ................... _4
Floor Insulation .........
Wall Insulation ...........
z
Ceiling Insulation .......
Cn
SHEETROCK NAILING ...
z
0
SPECIAL INSPECTION --I
0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ............. W, .7-
A-4 d, I
P,53
-.4 5
-45
A1111111001,
,rile illiti�lis Ni,r are Milton
T110111PS011,a temporary contract
inspector for tile CitY.