20040737.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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U&E PERMIT '7
ZONE NUMBER
JOB SUITE/APr*
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
71" " A d
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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RW Permit Required
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13
Street Use Permit Recta
13
EXISTING - PROPOSED
inspection Required
13
Sidirwalk Required
0
REQUIRED DEDICATION FT
underground
wiring required
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METER SIZE
LINE SIZE
NO. OF FIXTURES
PAV REQUIRED
YES NO
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLiDRAINAGE
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CITY ZIP TE EPHONE
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STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
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DEMOLISH
TANK
EGARAGE
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o RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS-f�IkACTIVITYk EXRLAIN
, A 05� �
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PLUMBING / HECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
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OTHER
FIRE SPRINKLER
FIRE ALARM
NUMBER ER OF CRITICAL
UMB
UMB
OF TDWELLING AREAS
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a STORIES U NITS NUMBER
DESCRIBE WORK TO BE DONE
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VARIANCE OR CU HORELINE OR AD1111 I INSPECTION I BOND
0 R E Q�c POSTED
01 ES AN S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED PROPPSED
EXP :K a5 11.5,
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOS�D, FROI$T SIPE REAR ir FROVT LJR SIFE VAR
'35 "lo a1%.r),9 7 61' 10:11 101 361
PARKING LOT AREA I PM RUEVIEZ DATE 5
REO'D PRQ�DED 9_ 0.
(t'�
Fr) I REMARKS
CHECKED BY
TYPE OMCTION
OCCUPANT,-,-31
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SPECIAL INSPECTION
REQUIRED [3 YES
ARE4
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/ IBC109 It IRC109 FINAL INSPEC710N REO'D
1.01"J yo - , It 4
HEAT SOURCE GLAZING % LOT
I QPE %
C-i A- S FC+ (
PLAN CHECK NO: VESTED DATE
2-
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
It= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
uj PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
(n "APPLICANI ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN WTERE�T, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS 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 HE
_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
91 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND T14AT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COM PEN SA9D9jN SURANCE AND RCW 18 27.
Sj71GN'PV (OWNER 0 DATE SIGNED
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12gle-ILl
VALUATION
$ __-� . 6? /";
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
ATTENTION E)ff 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/iRC110.
FEE Description F
State Surcharge
City Surcharge
7/1— Base Fee e;e.;1_
Plan Chk. Deposit
Receipt # L Lb_H5
Total Amt. Due r,;f e�;
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
:FICIA)S SIGNATURE DATE
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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TIECT�
ORIGINAL - FILE YELLOW - IN
PINK - OWNER GOLD - ASSESSOR
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5 18 X 18 11.25 SQ. FT. WINDOW +16 rut
1 72 X 80 40.02 SQ. FT. - FR. DOOR - q 35
TOTAL GLAZING: 51.27 SQ. FT.
GLAZING PERCENTAGE: 51.27 -348 = .147 = 14.7%
CIS,
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1 Legal Description
RICHMOND PARK HOMES BLK 000 D-00 - ALL LOT 24
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zone--- Comer
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Front 31C, - =5- JUL ? 9 2004
Sides -7 Vt - io ", 10
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Raw IDERVI-If COUNTER
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN ea ENGINEERING DIVISION D 'ATE
LO
P p .. #
LCA F IGO'�
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT 14RT2�
W J C., ;� A�w
SITE ADDRESS
PERMIT# _ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED Y
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A field inspection was conducted to determine 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:
G NT FINAL PROJECT APPROVAL
GIANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
1 .
2.
3.
RE-fNSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fom1s:ocapr%,1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
f>4
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
-7
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Ins ulation .........
Wall Insulation ...........
I x -1
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
IV7
OCCUPANCY ..................
0737soow
Tile initials NIT are Milton
1,. 110,11psoll, I temporary contract
inspector for tile City.
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