20040864.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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CITY
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ZIP
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TELEPHONE
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NAME
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ADDRESS
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CITY
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ZIP
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TELEPHONE
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NAME
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ADDRESS
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CITY ZIP
15-WvAi+ C707 57
EPHONE
STATE LICENSE NUMBER EXPIRATION DATE
CH"Ir"
6601 6—A 0 Lo m 'i 1 0 3
0 510
PROPERTY TAX ACCOUNT PARCEL NO.
5� 660
07 1
NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR CYDS
FENCE X
DEMOLISH TAK
OTHER
GARAGE RETAINING WALL
CARPORT ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINE§S OR ACTIVITY) EXPLAIN:
NUMBER NUMBER OF
OF DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
f6o
CRITICAL
AREAS
NUMBER
M
FT)
HEAT SOURCE . I GLAZING % LOT PLOPE.% _
2= " 4 A4H r I Z_�/ZV,�L r',
PLAN CHECKNO: I VESTED DATE
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.
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
OAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESOHS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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 BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
GIVEN 15 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-
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.
SIQNATWR.E,(O DATE
�/IGNED
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PERMIT EXPIRES
USE PERMIT
ZONE
N U M B E
JOB SUITEIAPT�
ADDRESS q112 41 _7::�--?Xb /,!J
PLAT NAME/SUBDIVISION NO,
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
IESCP Approved
RW Permit Requited 13
Street Use Permit Rnq'd CI
EXISTING — PROPOSED
I
inspection Required 14k
Sidewalk Required C3
REQUIRED DEDICATION— FT
underground
Wiring coquirod
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
YESV NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
bI-271 1 /*7') 1 11� /Pn AOI� 1. 'A J
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
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VARIANCE OR CU SHORELINE OR ADS# I INSPECTION BOND
REq'D, POSTED
10YES KNO I s &� —
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT WED LO ED
ALLO___+PROPOSED AL WED PROPOS
EXP :>� 1 111 L 14
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE I- REAR FR9�1`r U11 SID . F REAR
to to Z"�g q7 �q;),,,6-q Z2
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PARKING LOT AREA P Y 5
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REO'D PRT)ED 4t -
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REMARK
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27 0 /%e
TYPE
11 SPECIAL IN$P5CTION
JAREA
REQUIRED YES I -oq7,g
OCCUPANT
GROUP
OCCUPANT
LOAD
REMARKS a
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D F3
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VALUATION
Description
Plan Check C
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
ATTENTION E)ff 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
FEE
�P -
'170 & I
Description FEE
State Surcharge
City Surcharge
11 7
Plan Chk. Deposit
Receipt # L&)1,?
Total Amt. Clue
Receipt #
APPLICATION APPROVAL'
This application is not a permit until signed by the
Building Official or his/tier Deputy: and Fees are paid, and
receipt is acknowledged in space provided,
OFFICIALS SIGNATURE DATE
2z,
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
ORIGINAL -FILE YELLOW-INSP OR
PINK -OWNER COLD -ASSESSOR
GREEN - ACCOUNTING
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3. Average Grade: 0
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.4.. Maximum Elevation Aflowed: Q��(aver-a& giade)��
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5. Reference Point Elevation Shot to House:
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bad�� (datum elevation) 44� (grade to transit level line'shot to house)
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6. Measurements from line shot onto house to roof ridge:'
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Total
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7. Actual Elevation:1 C (reference point elevation) (measurements
from #6) 1 �7, 6-7
Conclusion:
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lr'?,b,-7 (actual) is greater lessstha (allowed); therefore the house W
is not over the height requiremZV4""a CDC 16.20.30 requirements
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
-NT DATE
FROM: FIRE DEPARTME
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NGINEERING DIVISION DATEA2Z�E_�6,
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PLANNING DIVISION DATE
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PLEASESIGN
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PROJECT�_ 7 J",
SITE, ADDRESS
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PERMIT' DATE INSPECTED Z
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DESCRIPTION OF WORK TO BE INSPECTED
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ield inspection was co.nducted to determine compliance with -app roved plans. Final Appioval,
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denotes that . there are no objections from the above signed Department to tile' release of
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'ORMANCE BONDS and the granting of
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GRANT FINAL PROM CT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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Copyof CONDITtONS given toowner/contractor,byinspcctor
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
El. Copy of CORRE CTION NOTICE , given to owner/contractor by inpector
2.
3.
R&INSPECTED OUTSTANDING, ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:teunp:b1dg:f0rms:ocaprv1 3/25/04
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
3 0
Wall..........................
Pier/Porch ................. z
—5 Qy 0
Retaining Wall ........... i
0
Slab Insulation ..........
PLUMBING:
Underground ............. x
M
0
Rough -In ................... M 0
-4 C),
0 C
Commercial Final ......
M
HEATING: MZ
Gas Test .................... C
> z
Gas Piping .................
CD
Equipment ................. 0 -n
-n
Commercial Final ....... 3:9
M M
EXTERIOR SHEATHING 0 _Cn
NAILING .......................... _CL_ 6S 6 3 -4S 0
0 M
C Cn
FRAMING ........................
9 Cn
M 0
Z
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation ......... >
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Wall Insulation ...........
Ceiling Insulation ....... Cn
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SHEETROCK NAILING ... 0
0
SPECIAL INSPECTION ... M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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