20040886.pdfPERMIT EX RES
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I / I USE PERMIT
CITY OF EDMONDS ZONE /
NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS ;� )p
SINESS -7 77
OWNER AMEINAME OF B 08,/ 71,d.,, N , �_ W�
PLAT NAM�ISUDDIVISION No. LOT NO LID NO
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METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED 0
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ADDRESS REMARKS
OWNER/CONTRACTOR RESPONSIBI E FOR EROSION CONTROL/DRAINAGE
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REMODEL MULTIFAMILY SIGN RE, 'D d I
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FENCE
REPAIR GRADING CYDS X FT) REMARKS CAA
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
Fr CHECKED BY ITYPEoF qQnTRUCTION TCbO E OCCUPAN-L
GROUP L�l 0'--2
Lu NUMBER NUMBER OF CRITICALWW/A7q1172:z
OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
STORI UNITS NUMBER 4//� 7e) REQUIRED [] y S LOAD
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DESCRIBE WORK TO BE DONE
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
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Description FEE Description FEE
A6 Plan Check State Surcharge
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HEAT SOURCE 7 GLAZING % LOT SLOPE %
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0/— Building Permit City Surcharge
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PLAN CHECWNO-. VESTED DATE Plumbing Base Fee
6LMechanical
THIS PERMIT �UTHOFIIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: ISO DAYS ----
IL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
I SEE BACK OF PINK PERMIT FOR MORE INFORMATION
cn Fire Review Plan Chk
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
_j
2 EDMONDS, WASHINGTON. IIS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIREC I LY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHAI L NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due 19
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0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- &L.
me Recording Fee Receipt # /Z
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
GIVEN IS CORRECT AND THAT I AM THE OWNER, OR THE DUTY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGRiE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. 1 his application is not a perinit until Signed by The
TION; AND IN DOING THE WORK - T 'a HEREBY, NO PERSON WILL BE EMPLOYED CALL Building Olficial of his/tier Deputy: and Foes are paid, and
IN VIOLATION OF THE LAPOR COD OF IE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S COMPENSAYON INSURA A D RCW 111,27.
OF IeIA IGNAT DATE
sicrAa-G-F-it (owNE:11 (GENT�)�' DA� E S (425)
,�ZGNE D
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771-0220 RELEASED BY
Lm 1. - DATE
ATTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL Oil A CERTIFI- ORIGINAL - FIL YELLOW - IN9PEC R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK_O.V R GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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200411030051 1 PG
CITY CLERK 11-03-2004 09:20am $19.00
CITY OF EDMONDS SNOHOMISH COUNTY. WASHINGTON
121 STH AVENUE NO.
EDMONDS. WA 98020
STATEMENT ON ACCESSORY DWELLING UNITS
Property Address: -7 r10 0 n 5�rnf-+ �s CA-)
Edmonds, Washington
Legal Description: Lo A- Q Sg-a �-a-wy� Tlecface�
't-Nn"t -ILA O-t4
Assessor's Parcel Number: C)05L,(Db— OOC> —Co 1-00
I have read the requirements for accessory dwelling units contained in Chapter 20.21 of the
Edmonds Community Development Code (ECDC) and understand that an accessory dwelling
unit as defined in ECDC Section 21.05.015 is prohibited until an Accessory Dwelling Unit
Permit is approved.
I also understand that an Accessory Dwelling Unit Permit cannot be approved unless all the
criteria in Chapter 20.21 are met, and all the necessary items are submitted, including an
affidavit of occupancy and a covenant to be filed with the Snohomish County. regarding the
regulations imposed on Accessory Dwelling Units.
Property Owner Signature:
Property Owner Name (2ril
Date: C)C.kelLnex +,2oOc�
STATE OF WASHINGTON
COUNTY OF SNOHOMISH)
I certify that I know or have satisfactory evidence that
signed this instrument and acknowledge it to be his/her free and voluntary act for the uses and
purposes mentioned in this instrument.
Notary::sl j�s , re" gi��Njnust be smudged. Dated: /0
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Signature of
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Notary Pa'
blic: r
(P PUB00' Z t� Residing at:
My Appointment
fill .'It"N6, 41 Expires: Z9 7
THIS DOCUMENT MUST BE P\ECORDED WITH THE SNOHOMISH COUNTY AUDrrOR.
RECEIVED
JAN 1 8 2005
ADUstatement EDMONDS CITY CLERK
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Height Calculation Worksheet
Address: -7 Li �s Lai"'
Date: 3-ii,-ofi
hispector(s): )M k
1. Datum Point: Q
2. Datum Point Elevation: too.o
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3. Average Grade: Lp cl
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.4. Maximum Elevation Allowed: i0cf.n (�veriag6giade):+25"-'--L'9'�,C),
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5. Reference Point Elevation Shot to House:
CM
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ID610 (datum elevation)+ jo,6]; (grade to transit level line shot to house) =1
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6. Measurements from line shot onto house to roof ridge:*
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7. Actual Elevation: 110, 6�L (reference point elevation) + 21,2'.'q (measurements
from #6) tsz 6
Conclusion:
19 014, (actual) is greater @�than 13 0- (allowed); therefore the house is/
is not over the height requirement per ECDC 16.20.30 requirements
ATTN:
CASCADE TESTING LABORATORY, INC.
TESTING & INSPECTION / ENGINEERS
12919 N.E. 126TH PLACE
KIRKLAND. WASHINGTON 98034 1425) 823-9800
EVERETT 1:425) 259-0817
FIELD REPW IVEII
DEC 2 1 '2004
(2)
INSPECTION PERFORMED
— RESTEEUCONCRETE — RESTEEL ONLY
RESTEEUMASONRY STR.ST[WELDING
OTHER STR.ST/BOLTING
(4) 14�e
LOCATION (AREAS)
PREVIOUS
REPORT No.
DATE z
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PROJECT
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No. 116490
CERT. NO
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NO
BLDG. PERMIT OWNER
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WEATHER TEMP. AT AM
—!�is I t E AT PM
ENGINEER
141""
gAVI�
(3)
ITEMS INSPECTED
FOUNDATIONS
FOOTINGS
SLAB
AUGER CAST PILES
COLUMNS
DRILLED PIERS
WALLS
BEAMS
(5)
CONCRETE/MASONRY MIX NO. I DESIGN STRENGTH (f'c)
SUPPLIER TOTAL CU. YD. PLACED
SLUMP(INCHES)— SPECIMENS CAST
AIR CONTENT (%) SEE CYLINDER REPORT NO.
YYES — NO — ITEMS INSPECTED WERE IN CONFORMANCEWITH BLDG. DEPT. APPROVED PLANS
-14 ` aeel ent)"Al l4wegalrzf Xe-66o�mlj 6
_7,
REMARKS:
TEST RESULTS APPLY ONLY TO THE ITEMS
HEREIN TESTED, THIS REPORT SHALL NOT INSPECTOR(S), NAME(S) PRINTED
BE REPRODUCED EXCEPT IN FULL, WITH.
OUT THE WRITTEN APPROVAL OF CASCADE
TESTING LABORATORY. INC. I INSPECTOR SIGNATURE
REVISED 8100 1 SIGNED BY
COPIES TO: c-
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CASCADE TESTING LABORATORY, INC.
TESTING & INSPECTION / ENGINEERS
12919 N.E. 126TH PLACE
KIRKLAND, WASHINGTON 98034 (425) 823-9800
(425) 259-0817
EVERETT
FIELD REPORT
TO: I V Er D
DEC 13 1004
DEVELOPMENT SERVICES CTR.
el I Y Flo r-AMANAR
�ATTN:
(2)
INSPECTION PERFORMED
RESTEELICONCRETE — RESTEEL ONLY
RESTEEUMASONRY — STR.STfWELDING
OTHER — STR.ST/BOLTING
1V61 /) Ilt--1 /.,k, I : n"
(4)
LOCATION (AREAS)
(5) 1
CONCRETE/MASONRY MIX NO. � I
SUPPLIER
SLUMP (INCHES) —
AIR CONTENT I(%)
PREVIOUS 3-16490
REPORT No. No.
DATE CERT. NO. -7
PROJECT
Owl�
r
WEATHER TEMP. AT AM
r AT PM
ENGINEER
'�l
(3)
ITEMS INSPECTED FOUNDATIONS
FOOTINGS SLA B
AUGER CAST PILES COLUMNS
DRILLED PIERS WALLS
BEAMS
DESIGN STRENGT�
TOTAL CU. YD. PLA
SPECIMENS CAST
SEE CYLINDER REPORT NO.
YES _NO — ITEMS INSPECTEDWERE IN CONFORMANCEWITH BLDG. DEPT. APPROVED PLANS
REMARKS:
,
TEST RESULTS APPLY ONLY TO THE ITEMS
HEREIN TESTED. THIS REPORT SHALL NOT INSPECTOR(S), NAME(S) PRINTEE
BE REPRODUCED EXCEPT IN FULL, WITH.
OUT THE WRITTEN APPROVAL OF CASCADE J/
TESTING LABORATORY. INC. INSPECTOR SIGNATURE
REVISED 8/00 SIGNED BY
COPIES TO:
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CITY 01F EDMONDS
SPECIAL INSPECTION AND TESTING AGREEMENT
issued under building permit
-77 0 5 _171 &I',
The project at ------- �k wor testing per IBC Chapter 17. The
number requires special inspection an
c(Implete i t of special inspections is attached to this document
BEFORE A PERMIT CAN BE ISSUED: The owner and contractor and special inspector shall comPicte
this agreement and the attached structural test(s) and inspections schedule including the required
acknowledgements. ach special inspector shall be approved by the Building
APPROVAL OF SPECIAL INSPECTORS: E ctions. Each special inspector sh&H subafit Statement of
official prior to performing any duties or inspe cation when
cial for review. Special inspectors shall display Identifi
Qualifications to the Building OM inimum requirements
performing specia,l inspections on site. Special inspection and testing shall meet the M
of IBC Chapter 17 and the following:
& Duties�and , onsibilities of the SpecisLIRH�elctOr
1. Observe Work he site work, for conformance with the approved (.Stamped) plans
The special inspector shall observe t kwInship, provisions of the IBC. Architect or Engineer
and specifications and applicable wor only as an aid to inspection. Special Inspections are to be
reviewed shop drawings may be used the special inspector is on site at all times observing
performed on a continuous basis —meaning that ;pections, if any, must have prior approval by the
the work requiring special inspection. Periodic in! by the Building official and the
city based on a separate written plan reviewed and approved
engineer or architect of record.
2. Report Non -conforming Items
The special inspector shall bring non -conforming items to the immediate attention of the contractor
and note all such items in the daily field report- Any item not resolved in a timely mallneir shall be
immediate cause of the special inspector to notify the Building Official of the plan deviation, error,
change or omission. It shall also be the duty of the special inspector to promptly notify the engineer
or architect.
3. Complete Daily Reports th the special inspection record -and the daily report
Each speetal inspector shall complete and sign bo
form for each day's inspection. These records shall remain at the jobsite with the contractor for
review by the City Building inspector.
4. Furnish Weekly Reports
The special inspector or inspection agency shall furnish the City with weekly reports of tests and
inspections. The project engkneer or architect, and others as designsued shall also be copied on
reports. Weekly reports must include the following:
• Description of daily Inspections and tests made with applicable locations
• List of all non -conforming items
• Reporton status of non-cooforming items (resolved or unresolved)
• itemized changes authorized by the Architect, Engineer and City if not included in non-
conformance items.
5, Furnish Final Construction Report agency shall submit a final signed reporl to the City stating that
The special inspector or inspection
all items requiring special inspection and testing were fulfilled and reported. And, to the best of
L-.\TEmp\BUILDING\SPecialImPectiOnAgreemcnt'B C.dDc 7104
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PlaffORCED CONCRETE GuNMv GROUT AND MORTAR: STRUCTURALSTEELtwELVING:
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ADDITIONAL INSTRUCTIONS OR OTHER TESTS
AND INSPECTIONS'
FIgEpROOFING:
Pbetmew l"SPwtim
Density -legs
Thitim—Tcas
inspect Botching
INSULATING CONCRETE'
Smilift and Test
rim=C01 InspIcclim
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Form completed by: DPW.
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
f4 V
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
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Commercial Final ......
HEATING:
Wr
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
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EXTERIOR SHEATHING
ID 7--
NAILING ..........................
IN-77
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
M 77-
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Floor Insulation .........
cv-(' e-c-,
Wall Insulation ...........
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Ceiling Insulation .......
SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANt,T ..................
t - r
AM etc i"- 77
kmour",
The Initials MT are Miltoll
Thonipsoll, a temporary contract
inspector ror tile City.
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