20040845.pdfFDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF B ESSt
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STATE LICENS NUMBER EXPIRATION DATE CHEWED B
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-,j PROPERTY TAX ACCOUNT PAHGEL NO.
NEW
XRESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
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TANK
GARAGE
RETAINING WALL
El CARPORT
ROCKERY
(TYPE OF USE, BU�INESS OR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
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STORIES
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UNITS
DESCRIBE WORK TO BE DONE
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HEAT SETURCE GLAZING %
PLAN CHECK NO;,
1:1 PLUMBING / MECH
COMPLIANCE OR
13 CHANGE OF USE
11 SIGN
EFENCE
( X FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL /7
AREAS
NUMBER
LOT SLOPE %
VESTED DATE
on
PERMIT
EXPIRES'
USE
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PERMIT
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ADDRESS
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PLAT NAME/SuBDIVISION NO,
LOT NO,
LID No.
LID FEE $
IESCP Approved E3
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RA, Permit Roque
Street use Permit Req'cl
inspection Requilod
EXISTING PROPOSED Sidewalk 110fleirml
Underground
REQUIRED DEDICATION� Fi wiring required -
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES [3 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
FD P, tt P, L J) E P-S Q
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
CC PERMIT APPLICATION: ISODAYS
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CL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) *APPLICAN1. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS -
V)
UJI IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS 111F CITY Or
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2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
CC S FOR DAMAGES OF WHA1 EVER NXTURE, ARISING DIRECTLY OR INDIRECHY
4 ALL CLAIM IT SHALI. NOT HE
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF IHIS PERM
C3 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMEN1 OF ANY CITY ORDINANCE
-1 Y WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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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 CTTY 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 COMPENSATION INSURANCE AND RCW 18.27,
DATE SIGNED
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REVIEWED BY
DATE
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VARIANCE OR CU SHORELINE OR AD1111 INSREO..TION POSTED
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SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP �&_
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (IT)
FRONT UR SIDE REAR L)
ALLOWED PROPOSED FRONT SIDE REAR
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FLOT AREA PIlKN?ING RIK, Y Df
PARKING
REQ DED
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REMARKS
CHECKED BY
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SPECIAL IN
REQUIRED
REMARKS
=/jr04613 CLEAN
AREA
1 SEWER MUST BE
VALUATION OL414-
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$ FOR I
pDescription
Plan Check
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Building Permit
Plumbing
Mechanical
Gradding
Engr. Review
Engr. Inspection
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OCCUPANT
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FWq0 19lWW~4%W(WN IREQ'D
BIB WITS] AVb INS'EALLED M
AT APPROVED DUMP SITE ONLY
E-EI-NIOLITION INSPECTION
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PECT
i iUN i�LQUIRENIENTS
cr_r: Descrintion FEE
State Surcharge
City Surcharge
Base Fee
Fire Review PlanChk.Deposit
Fire Inspection Receipt # -
LandscapeInsp. Total Amt. Due
Recording Fee Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building Oflicial or hisitier Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
=% OF CIA. SIGNATUR DA7E
(425) /M- /-0//" /(�
771-0220 R -ASED BY fdATEI
[=YT 1113
A17ENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 0131GINAL - FILE YCLLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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C014CRETE WALL
LOT 3
�4LW� HEIGHT CALCS
A= 382
D B= 382
C= 382
EXISTING HOUSE rllIvIvo)
ca D- 382
6) TO REMO AVG GRADE- 382
ACTUAL- 402
MAXIMUM- 407
RES
LAN 1788
IMPERVIOUS SURFACE AREA
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LOT AREA
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RECEIVED
JUN 2 2 2004
211 MAO N
FINAL PROJECT APPROVAL FORM.
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLrAS8 SIGN
ENGINEERING DIVISION DATE
PWAKE9IGN
—PLANNING DIVISION DATE
PLEASE SIGN
P ROJECT___AN
SITE ADDRESS— 61 It
PERMIT# 'kA-()?'_AS_'ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED'oema..
A field inspection was conducted to determine compliance with -approved plans. Final approval
the release of
denotes that there are no objections from the above signed Department to
PERFORMANCE BONDS and the granting of:
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 inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tenip:b1dg:f6rms:ocaprv1 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:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final
EXTERIOR SHEATH.ING
NAILING ...........................
-FRAMING
...........
FIRST FLOOR -FRAMING...
INSULATION ....................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
The Initials MT are Milton
Thompson, a temporary contract
inspector ror the City.
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